Analyzing Trends and Recent Controversies in Cardiovascular Nutrition

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Recent evidence clearly indicates that patients should be eating whole foods rather than attempting to get vitamins and antioxidants from dietary supplements.
Recent evidence clearly indicates that patients should be eating whole foods rather than attempting to get vitamins and antioxidants from dietary supplements.

Despite abundant support for the role of a healthy diet in reducing cardiovascular risk, many physicians may be unclear about how to advise patients in this area. This uncertainty may partly stem from the ever-growing number of dietary trends that claim to improve heart health, and the fact that many physicians lack expertise in matters of nutrition.

“One of the major issues we face as medical doctors in general, and cardiologists specifically, is that our patients look to us for nutritional advice all the time, and most of us have very little training” in that area, according to Andrew M. Freeman, MD, FACC, FACP, an associate professor and director of cardiovascular prevention and wellness at National Jewish Health in Denver, Colorado.

“Some of the most potent interventions are related to nutrition, exercise, and other lifestyle variables,” but the well-established data on these topics is “often ignored because it's not the latest medical device or drug,” he told Cardiology Advisor.

In a special issue of the Journal of the American College of Cardiology (JACC) on the topic of cardiovascular (CV) health, Dr Freeman and colleagues published a paper reviewing evidence on dietary patterns and nutrition trends that have been purported to improve CV health.1 

“There is a lot of hype out there, and our goal was to demystify the topic and give the clinician some practical tools” to guide their advice to patients, he said.

The 2015 to 2020 Dietary Guidelines for Americans recommend 3 dietary patterns for disease prevention for people age 2 and older: the Healthy US-style Eating Pattern, the Healthy Mediterranean-style Eating Pattern, and the Healthy Vegetarian Eating Pattern.2 

These approaches encourage frequent consumption of produce, whole grains, nuts, and legumes, with some including small portions of lean animal products and vegetable oils, while minimizing the consumption of saturated and trans fats, refined grains, added sugar, and sodium.

“The vast majority of literature suggests that a predominantly plant-based diet consisting of fruits, vegetables, whole grains, and legumes is best for [preventing] cardiovascular disease and many other health conditions,” noted Dr Freeman.

In a recent international study of 15,482 patients with coronary heart disease (CHD), for example, a Mediterranean-style diet led to a reduction in major CV events, and a prospective study of 44,561 people showed that vegetarians had fewer CV risk factors and a 32% lower risk of CHD compared with non-vegetarians.3,4

In addition, results of clinical trials suggest that a “whole food, plant-based diet may halt progression of coronary atherosclerosis and achieve evidence of angiographic disease regression,” Dr. Freeman and colleagues wrote. They suggest that clinicians become familiar with the 3 recommended dietary patterns and gain further nutritional expertise from available journal articles and continuing education courses.

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