To elucidate the direction and magnitude of effects of "nutrition" on "coronary artery disease" (CAD), the relation between "nutrient" intake and angiographic changes were examined in the course of a controlled dietary trial.
No 'protective' effect of linoleic, linolenic or "eicosapentaenoic acid" was demonstrable. Intake of trans "fatty acids" was directly related to progression.
Together with the favorable treatment effects on angiographic appearance and clinical end-points, these findings provide further support for a causal role of saturated "fats" in CAD; restriction of foods containing such fats should be emphasized as part of regimens aimed to reduce progression of coronary "atherosclerosis".
Watts-GF et al: Relationships between nutrient intake and progression/regression of coronary atherosclerosis as assessed by serial quantitative angiography. Can-J-Cardiol. 1995 Oct; 11 Suppl G: 110G-114G.
The "oxidative" modification of low density lipoprotein (LDL) may be an early step in atherogenesis. Furthermore, evidence of "oxidized" LDL has been found in vivo. The most persuasive evidence shows that supplementation of some animal models with "antioxidants" slows atherosclerosis.
Reviews the roles that "vitamin E", "vitamin C" and "beta-carotene" may play in reducing LDL "oxidation".
Vitamin E has shown the most consistent effects with regard to LDL oxidation. Beta-carotene appears to have only a mild or no effect on oxidizability. "Ascorbate", although it is not lipophilic, can also reduce LDL oxidative susceptibility.
Jialal-I; Fuller-CJ: Effect of vitamin E, vitamin C and beta-carotene on LDL oxidation and atherosclerosis. Can-J-Cardiol. 1995 Oct; 11 Suppl G: 97G-103G.
The history and today's knowledge on the pathogenesis of arteriosclerosis emphasizing the importance of cholesterol concentration in plasma for the development of atherosclerosis is summarized.
For proving the lipid hypothesis careful patient observation and new findings of molecular biology have added important information. More and more details on the complex interaction between risk factors, endothelial cells, smooth muscle cells, growth factors and the coagulation system are clarified.
The increasing knowledge on the arteriosclerotic process has led to the fascinating situation, that for the first time in arteriosclerosis research causal approaches for therapy are under investigation.
Schettlerballot G: Arteriosclerosis. Eur J Med Res, 1997 Jun 16, 2:6, 233-5.
Fatty Acids ( Arteriosclerosis)
Both the levels of "fat" and "cholesterol" in the diet and its "fatty acid" composition influence the CAD risk. In recent years, it has been recognized, however, that a high percentage of "polyunsaturated fatty acids" can have a negative effect, for example on the "immune system". It is therefore recommended that 7-10% of dietary energy be consumed in the form of polyunsaturated and "saturated fatty acids", but 10-15% as "mono"-"unsaturated fatty acids".
An increase in consumption of sea fish is recommended.
The positive effect of a "fiber"-rich diet is largely due to the associated decrease in consumption of saturated fatty acids. An additional cholesterol-lowering effect has been demonstrated only for particular substances, for example "oat bran". Numerous other dietary constituents, such as "alcohol", "salt" or antioxidants, may also have effects on atherogenesis.
Richter-WO: [Nutrition and atherosclerosis] Fortschr-Med. 1995 Jun 10; 113(16): 243-6
Mediterranean Diet (Arteriosclerosis)
It has been suggested that "antioxidant" vitamins or other antioxidants might inhibit the oxidation of low density lipoproteins into a particularly atherogenic form and preserve endothelial function.
Comparisons were made between Naples (Southern Italy) and Bristol (UK). The Naples group consumed more tomatoes and "tomato juice", a higher proportion of "monounsaturated fatty acids" (from "olive oil") and had a higher level of "lipid" antioxidant vitamin E (P = 0.005) and of "beta carotene" (P < 0.001) than the Bristol group. The intake of vitamin C, fresh fruit and vegetables, plasma "vitamin A", "serum" "selenium" and "copper" levels did not differ.
Dietary habits leading to relatively low levels of oxidized lipoproteins might contribute to the lower risk of coronary artery disease in Southern Italy.
Mancini-M et al: Antioxidants in the Mediterranean diet. Can-J-Cardiol. 1995 Oct; 11 Suppl G: 105G-109G.
The epidemic of coronary artery disease (CAD), the main cause of deaths in 'western' countries, could have been avoided through appropriate lifestyles of eating and activities.
Critical are the sources of fats (often key economic commodities), the amount of salt, preventing "obesity" especially of the central type, and provision of plant foods with a better understood mix of fatty acids, antioxidants and specific "starches" and nonstarch polysaccharides.
Nestel-PJ: Controlling coronary risk through nutrition. Can-J-Cardiol. 1995 Oct; 11 Suppl G: 9G-14G
Optimal intake (25/25 diet)
"Optimal" Intake (25/25 diet)
Much of the current chronic disease incidence, notably coronary artery disease and certain types of "cancer", relates to nutritionally induced "metabolic" overload.
This communication makes recommendations as for an "optimal" diet, especially for fats and fibers, as a goal for effective disease prevention that is within our reach with the appropriate support of an informed public and a cooperative food industry. To facilitate effective public health action, the "optimal" diet is called the 25/25 diet, that is, 25% of "calories" as fat and 25 g per day of fiber.
Wynder-EL: Nutrition: the need to define "optimal" intake as a basis for public policy decisions American-Journal-of-Public-Health. 1992 Mar; 82(3): 346-50 (42 ref).
A critical step in atherogenesis is oxidation of low-density lipoprotein (LDL) within the arterial wall. Direct data supporting this theory are limited, but indirect evidence suggests that oxidized LDL plays a role in atherogenesis.
Grundy-SM: Oxidized LDL and atherogenesis: relation to risk factors for "coronary heart disease". Clin-Cardiol. 1993 Apr; 16(4 Suppl 1): I3-5.
Trans Fatty Acids
Trans Fatty Acids
In British and U.S. reports from 1984-1989, the trans fatty acids were basically acquitted of unhealthy effects. However, a series of new studies has been published regarding both the connection between the consumption of trans fatty acids and the occurrence of coronary heart disease and the impact on the lipoprotein level in plasma.
Studies suggest that the consumption of trans fatty acids from "margarine" is equally, or perhaps more, responsible for the development of arteriosclerosis than saturated fatty acids. In addition, it is now clear that both the "fetus" and the breast-fed baby are exposed to trans fatty acids in relation to the mother's consumption. A couple of recent studies suggest a possible restrictive influence of the trans fatty acids on the weight of the fetus.
The trans fatty acids make margarines more solid at room temperature and therefore provide an economical storage advantage.
The Danish Nutrition Council recommend that the consumption of trans fatty acids is reduced as much as possible. This can be done by reducing the fat content in food and by reducing the trans fatty acid content in all Danish margarine products to 5% or less. Also, encourage the producers of margarines to make products that can be marketed as 'free of trans fatty acids'.
This would bring consumption down to the levels in the lowest risk groups c 2 g of vegetable trans fatty acids/day.
Stender-S: The influence of trans fatty acids on health: a report from the Danish Nutrition Council [see comments]. Clin-Sci-Colch. 1995 Apr; 88(4): 375-92.
Vitamin C In People Aged 65
Vitamin C in people aged 65
To determine whether vitamin C status, as measured by dietary intake and plasma "ascorbic acid" concentration, is related to mortality from "stroke" and coronary heart disease in people aged 65 and over.
Mortality from stroke was highest in those with the lowest vitamin C status. No association was found between vitamin C status and risk of death from coronary heart disease.
In "elderly" people vitamin C concentration, whether measured by dietary intake or plasma concentration of ascorbic acid, is strongly related to subsequent risk of death from stroke but not from coronary heart disease.
Gale-CR et al: Vitamin C and risk of death from stroke and coronary heart disease in cohort of elderly people [see comments]. BMJ. 1995 Jun 17; 310(6994): 1563-6.
Arterial calcification is a common feature of atherosclerosis, occurring in >90% of angiographically significant lesions. Recent evidence suggests that development of atherosclerotic calcification is similar to osteogenesis; thus, we undertook the current investigation on the potential role of osteoregulatory factors in arterial calcification.
Results revealed that 1,25-vitamin D levels are inversely correlated with the extent of vascular calcification in both groups. No correlations were found between extent of calcification and levels of osteocalcin or parathyroid hormone.
Data suggest a possible role for vitamin D in the development of vascular calcification. Vitamin D is also known to be important in bone mineralization; thus, 1,25-vitamin D may be one factor to explain the long observed association between osteoporosis and vascular calcification.
Watson KE et al., Active serum vitamin D levels are inversely correlated with coronary calcification. Circulation, 1997 Sep 16, 96:6, 1755-60.
Nutrition & Coronary Heart Disease
Nutrition & Coronary Heart Disease
It is well established that nutrition plays an important role in the prevention and treatment of the classical atherogenic risk factors such as obesity, "diabetes mellitus" and "hyperlipidemia".
Also, some "nutrients" such as the polyunsaturated n-3-fatty-acids or antioxidative vitamins can intervene directly by influencing one or more steps of the atherogenetic and/or thrombogenetic process.
Given the complexity with which nutrients intervene in the atherosclerotic process and their interactions with each other, "nutritional" prevention strategies should be based on well-grounded dietary modifications rather than supplementation with individual nutrients.
Hrboticky-N; Sellmayer-A: [Nutrition in prevention of coronary "heart disease"]. Z-Arztl-Fortbild-Jena. 1996 Feb; 90(1): 11-8.