Recent discoveries in inclusive food-based approaches and dietary patterns for reduction in risk for cardiovascular disease

PURPOSE OF REVIEW: To discuss new evidence-based dietary recommendations founded on an inclusive food strategy and to address the challenges that are posed by integrating a growing list of heart healthy foods into the diet without increasing energy intake beyond that required to achieve a healthy body weight. RECENT FINDINGS: New food-based dietary recommendations issued by the American Heart Association with the objective of reducing risk for cardiovascular disease (CVD) promote an inclusionary approach. The American Heart Association recommends a variety of foods to target four major goals: achieve a healthy overall diet, achieve a healthy weight, promote desirable lipid levels, and promote desirable blood pressure. Specific foods recommended include fruits and vegetables, grain products (including whole grains), fish, lean meat and poultry, fat-free or low-fat dairy products, and legumes. In addition, the new National Cholesterol Education Program Adult Treatment Panel III recommends reductions in saturated fat and cholesterol and therapeutic dietary options for enhancing LDL-cholesterol lowering, with inclusion of plant stanols/sterols (2 g/day) and increased viscous (soluble) fiber (10-25 g/day). In parallel with the evolution of new dietary recommendations is the expanding list of specific foods that have cardioprotective effects. Additional foods on this list are nuts, soy, legumes, alcohol, tea, and garlic. SUMMARY: It will be challenging to include all foods that reduce CVD risk in the diet and still maintain energy control. Strategies are needed that facilitate developing heart healthy dietary patterns that maximally reduce CVD risk.     

National cholesterol education program keeps a priority on lifestyle modification to decrease cardiovascular disease risk.

The National Cholesterol Education Program's updated third Adult Treatment Panel report on clinical guidelines for cholesterol testing and management adds to the base of knowledge provided by two previous Adult Treatment Panel reports. Similar to the other reports, it has distinctive features and goals that are in accord with the most currently available clinical trial evidence. The major new feature of the third report is a focus on primary prevention of coronary heart disease in persons with multiple coronary heart disease risk factors. The guidelines provide the rationale for intensive cholesterol-lowering therapy in clinical management, and they provide detailed information to help inform clinical judgment for implementation of both medical nutrition management (therapeutic lifestyle changes) and drug therapy for treatment of high blood cholesterol.     

Dietary recommendations for the community towards the postponement of coronary heart disease.

The public has recently been confronted with many, often conflicting, recommendations about diet and reducing the risk of coronary heart disease (CHD). Dietary recommendations to the community designed to lower the risk of CHD should be specific, clear, and brief. People should be advised to reduce their intake of foods that are high in saturated fats and replace these partially with foods that are relatively high in polyunsaturated fats. This will lower both total fat and dietary cholesterol intakes and will also change the ratio of polyunsaturated to saturated fats.     

Does plasma cholesterol concentration predict mortality from coronary heart disease in elderly people? 18 year follow up in Whitehall study.

OBJECTIVE--To explore the extent to which the relation between plasma cholesterol concentration and risk of death from coronary heart disease in men persists into old age. DESIGN--18 year follow up of male Whitehall civil servants. Plasma cholesterol concentrations and other risk factors were determined at first examination in 1967-9 when they were aged 40-69. Death of men up to 31 January 1987 was recorded. SUBJECTS--18,296 male civil servants, 4155 of whom died during follow up. MAIN OUTCOME MEASURES--Cause and age of death. Cholesterol concentration in 1967-9 and number of years elapsed between testing and death. RESULTS--1676 men died of coronary heart disease. The mean cholesterol concentration in these men was 0.32 mmol/l higher than that in all other men (95% confidence interval 0.26 to 0.37 mmol/l). This difference in cholesterol concentrations fell 0.15 mmol/l with every 10 years'' increase in age at screening. The risk of raised cholesterol concentration fell with age at death. Compared with other men cholesterol concentration in those who died of coronary heart disease was 0.44 mmol/l higher in those who died aged less than 60 and 0.26 mmol/l higher in those aged 60-79 (p = 0.03). For a given age at death the longer the gap between cholesterol measurement and death the more predictive the cholesterol concentration, both for coronary heart disease and all cause mortality (trend test p = 0.06 and 0.03 respectively). CONCLUSION--Reducing plasma cholesterol concentrations in middle age may influence the risk of death from coronary heart disease in old age.     

一级预防护理干预对特需病房冠心病高危患者的影响

目的:探讨特需病房冠心病高危患者一级预防的护理干预效果。方法:以2010年7月~2012年7月期间四川大学华西医院金卡医疗中心收住的104例冠心病高危患者为研究对象,随机分为对照组和干预组两组各52例,分别实施常规护理和冠心病一级预防护理干预并随访1年,观察两组效果。结果:干预组干预后血压、血脂、血糖以及体重指数的全部指标值及各项指标达标人数和干预前比较差异均有统计学意义(P0.05或0.001);除TG指标外,其他指标值以及各项指标达标人数和对照组比较差异也均有统计学意义(P0.05或0.001)。对照组患除血压及血压达标人数和入院时比较有明显差异(P0.05或0.001),其余各项指标及达标人数均出入不大(P0.05)。两组随访1年,干预组发生冠心病3例,其他心血管事6例,发生率均明显低于对照组(P0.05)。结论:对特需病房冠心病高危人群通过认知、行为、饮食、用药、心理等方面的护理干预进行冠心病的一级预防,患者血压、血脂、血糖及体重指数均得到了较好的控制。患者若能长期坚持执行预防措施,将大大降低冠心病的发病危险。     

The pathogenesis of atherosclerosis. An interpretive history of the cholesterol controversy, part IV: the 1984 coronary primary prevention trial ends it--almost

As of the early 1980s, despite the wealth of evidence from experimental animal models, the extensive epidemiologic evidence, the powerful genetic evidence, and the strongly suggestive clinical intervention trial results, most clinicians still remained unpersuaded regarding the relevance of the lipid hypothesis. What was needed was a well-designed, large-scale, long-term, double-blind study demonstrating a statistically significant impact of treatment on coronary heart disease events. The National Institutes of Health (NIH) had laid the groundwork for such a study as early as 1970, but the study was not completed and the results published until 1984. This study, the Coronary Primary Prevention Trial, showed that treatment with a bile acid binding resin reduced major coronary events in hypercholesterolemic men by 19%, with a P value of 0.05. The NIH followed this up with a national Consensus Development Conference on Lowering Blood Cholesterol to Prevent Heart Disease. For the first time, the NIH now went on record advocating screening for hypercholesterolemia and urging aggressive treatment for those at high risk. The Institute initiated a national cooperative program to that end, the National Cholesterol Education Program. For the first time, preventing coronary heart disease became a national public health goal.     

Capillary GC quantification of cholesterol oxidation products in plasma lipoproteins of fasted humans

Cholesterol oxidation products have been hypothesized to be important factors in atherosclerosis, a process which can culminate in myocardial infarction. The relative importance of exogenous or in vivo sources of cholesterol oxidation products has not been determined. However, methodology used for cholesterol oxidation products analysis of foods is applicable to the determination of cholesterol oxidation products in human plasma lipoproteins. Such methodology, outlined in this report, permits numerous critical experiments to be conducted on the possible role of cholesterol oxidation products in coronary heart disease.     

The role of high-density lipoprotein cholesterol in the prevention and possible treatment of cardiovascular diseases

Despite significant progress in the management of atherosclerosis and its resultant complications, cardiovascular disease remains the principal cause of death in the world. The National Cholesterol Education Project Adult Treatment Panel III (NCEP ATP III) recognizes low levels of high-density lipoprotein cholesterol (HDL) as a risk factor for coronary heart disease (CHD) and high levels of HDL as a risk-reducing factor; however, the elevation of HDL as a specific therapeutic target for the prevention and treatment of CHD has yet to be accepted on the same level as low-density lipoprotein (LDL)-reducing therapies. Current HDL elevators including nicotinic acid, fibric acid derivatives, peroxisome proliferator activated receptor (PPAR) agonists and statins also affect other lipid constituents which make interpretation of the clinical trials of these drugs difficult in teasing out the independent effect of HDL elevation. Ample laboratory investigation suggests that HDL elevation would reduce atherosclerotic burden through multiple independent mechanisms. In this review, we explore HDL biology, its potential mechanisms in the treatment of atherosclerotic disease, and promising new drugs with HDL-raising activity.     

阿尔茨海默病和血管性痴呆与血糖代谢水平的关系及危险因素分析

目的:研究阿尔茨海默病和血管性痴呆与血糖代谢水平的关系及危险因素。方法:选取2013年12月到2014年12月我院收治的阿尔茨海默病80例(A组)和血管性痴呆70例(B组),另选取同时期无痴呆者70例(对照组),测量三组入选者血糖各指标水平,并分析阿尔茨海默病和血管性痴呆的危险因素。结果:A组和B组空腹血糖(FPG)均显著高于对照组,胰岛素降解酶(IDE)显著低于对照组,比较差异具有统计学意义(P0.05);B组糖尿病、冠心病和高血压疾病的发病率显著高于A组和对照组,比较差异具有统计学意义(P0.05),A组和B组高血脂发病率均显著高于对照组,比较差异具有统计学意义(P0.05)。结论:阿尔茨海默病和血管性痴呆均与FPD、IDE以及高血脂有较大关系,高血压、冠心病和糖尿病与血管性痴呆有较大关系。     

Plasma Biomarker of Dietary Phytosterol Intake

BackgroundDietary phytosterols, plant sterols structurally similar to cholesterol, reduce intestinal cholesterol absorption and have many other potentially beneficial biological effects in humans. Due to limited information on phytosterol levels in foods, however, it is difficult to quantify habitual dietary phytosterol intake (DPI). Therefore, we sought to identify a plasma biomarker of DPI.ConclusionThe ratio of plasma campesterol to the coordinately regulated endogenous cholesterol metabolite 5-α-cholestanol is a biomarker of dietary phytosterol intake. Conversely, plasma phytosterol levels alone are not ideal biomarkers of DPI because they are confounded by large inter-individual variation in absorption and turnover of non-cholesterol sterols. Further work is needed to assess the relation between non-cholesterol sterol metabolism and associated cholesterol transport in the genesis of coronary heart disease.     

Do clinical and experimental investigations support an antiatherogenic role for dietary phytosterols/stanols?

The plasma cholesterol-reducing effect of phytosterols (PS) has been recognized in several studies, but the usefulness of PS in preventing coronary heart disease remains controversial, as some investigations claim that the high PS concentrations found in plasma and specific tissues are related to an increased risk of cardiovascular events. It has also been demonstrated that PS may induce inflammation and reduce cholesterol efflux from macrophages, conditions that are directly implicated in the development of atherosclerosis. As to arterial dysfunction and atherosclerosis, some studies have concluded that plasma PS concentrations are unrelated or only weakly related or that PS intake or plasma PS concentrations are harmful. Thus, in light of the National Cholesterol Education Program-ATPIII report, it is necessary to evaluate the relevance of their findings. To this end, we have evaluated the studies conducted on cells, animal models, and humans regarding the influence of PS on the development of atherosclerosis.     

Cholesteryl ester transfer protein inhibition, high-density lipoprotein metabolism and heart disease risk reduction

PURPOSE OF REVIEW: Cholesteryl ester transfer protein (CETP) inhibitors (JTT-705 and torcetrapib) are currently in clinical testing, and significantly raise high-density lipoprotein (HDL) cholesterol levels. Low HDL cholesterol is a significant independent predictor of coronary heart disease (CHD) and HDL raising has been associated with coronary heart disease risk reduction, but there is debate about whether CETP inhibition will reduce coronary heart disease risk. RECENT FINDINGS: It has been documented in transgenic mouse models that apolipoprotein (apo) C-I inhibits CETP, and that high mono-unsaturated fat diets prevent the normal stimulation of CETP activity by dietary cholesterol. In rabbits, torcetrapib markedly decreases clearance of HDL cholesteryl ester via an indirect pathway, but has no effect on total plasma cholesteryl ester clearance. In humans, torcetrapib raises HDL apoA-I by modestly decreasing its fractional catabolic rate, while having a very profound effect on raising HDL cholesterol and large alpha-1 migrating HDL particles by more than 50%, with no effect on fecal cholesterol excretion. When JTT-705 at 600 mg/day was given to hypercholesterolemic patients already on pravastatin 40 mg/day, the combination was well tolerated and increases in HDL cholesterol of 28% were noted. SUMMARY: In our view, CETP inhibitors in combination with statins will be profoundly beneficial in reducing human atherosclerosis, primarily because they normalize HDL particles and prevent the transfer of cholesteryl ester from HDL to atherogenic lipoproteins.     

Intracellular cholesterol accumulation is accompanied by enhanced proliferative activity of human aortic intimal cells

Cholesterol accumulation in smooth muscle cells of unaffected human aortic intimal tissue occurred in the following conditions: (1) incubation of cells with atherogenic blood serum from patients with coronary heart disease (CHD), (2) cultivation of cells in the presence of insoluble associates containing low density lipoprotein (LDL). Preincubation of cells with blood serum from CHD patients resulted in a 2-5-fold increase in intracellular cholesterol and in 1.5-3-fold increase in cellular [3H]thymidine uptake. Blood serum collected from healthy donors had no significant effect on cultivated smooth muscle cells. When intimal cells were preincubated with insoluble associates containing LDL and components of fibrous extracellular matrix, the level of intracellular cholesterol increased from 2-4 times and uptake of [3H]thymidine increased 1.5-2.5-fold. Thus, a strong correlation was found between [3H]thymidine incorporation and intracellular cholesterol accumulation. The current study suggests that intracellular lipid accumulation may stimulate the proliferative activity of human aortic intimal cells from uninvolved tissue.     

Dietary Sugar and Ischaemic Heart Disease

Comparison of the sugar intake of 1,158 men believed to be free of ischaemic heart disease failed to establish any real difference in intake when compared with 170 men with confirmed or possible ischaemic heart disease. In neither group was mere any significant correlation between sugar intake and serum cholesterol, white blood cell count, haemoglobin, E.S.R., β-lipoprotein, or uric add; nor was there any correlation between total sugar intake and weight gain after the age of 25 years.These results suggest that considerably more confirmation is required before acceptance of Yudkm''s hypothesis that high sugar intake is the chief dietary factor causing ischaemic heart disease.     

Effect of seaweed mixture intake on plasma lipid and antioxidant profile of hyperholesterolaemic rats

Cardiovascular disease (CVD) is the leading cause of death in many countries. Hypercholesterolaemia is a recurring risk factor in CVD leading to coronary atherosclerosis, stroke and ischemic heart disease. Previous research has proven that seaweeds are highly nutritious, providing a good source of dietary fibre, minerals, proteins and vitamins as well as being high in antioxidants. Antioxidants have been known to retard low-density lipoprotein (LDL) oxidation to reduce CVD risk in hypercholesterolaemia. However, there is yet to be a study on the effect of a mixture of different seaweed species on cholesterol lowering properties. Therefore, this study was designed to investigate the effects of a mixture of extracts from two seaweed species, red seaweed Kappaphycus alvarezii and brown seaweed Sargassum polycystum on plasma lipid and antioxidant profiles of rats fed high-cholesterol diet. S. polycystum extract significantly decreased plasma cholesterol by 37.52 % over an 8-week treatment period compared to K. alvarezii and mixture groups. However, S. polycystum showed an increase in plasma triglyceride (TG) levels by 16.66 %. K. alvarezii extract most effectively decreased TG levels by 40.11 % and the mixture extract most effectively increased high-density lipoprotein cholesterol by 56.71 %. All treatment groups were able to reduce LDL cholesterol levels compared to the high-cholesterol group, with no significant differences between them. K. alvarezii and S. polycystum mixture extract had the best atherogenic index, which is an indicator of lipid disorder in coronary diseases, among treatment and high-cholesterol-fed groups. All treatment groups were able to restore enzyme antioxidant levels (superoxide dismutase and catalase) to normal.     

心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛的临床研究

摘要 目的：探讨心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛的临床疗效。方法：按照随机数字表法将湖北民族大学附属民大医院和武汉市江夏区第一人民医院2019年4月-2021年9月间收治的98例老年冠心病心绞痛患者分为对照组（盐酸地尔硫卓片治疗,n=49）和观察组（心可舒片联合盐酸地尔硫卓片治疗,n=49）。观察两组疗效、心绞痛缓解情况、血脂指标、血管内皮功能指标、心功能指标、血液流变学指标和不良反应发生情况。结果：观察组的临床总有效率高于对照组（P<0.05）。治疗4周后,与对照组相比,观察组的心绞痛发作频率减少,全血黏度、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、内皮素-1（ET-1）、血浆比黏度、左室收缩末期内径（LVESD）、红细胞压积更低,一氧化氮（NO）、高密度脂蛋白胆固醇（HDL-C）、左心室射血分数（LVEF）、心排血量（CO）更高,心绞痛发作持续时间缩短（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：心可舒片联合盐酸地尔硫卓片治疗老年冠心病心绞痛,可缓解心绞痛症状,改善血液流变学、心功能、血脂和血管内皮功能。     

Effect of a therapeutic lifestyle change diet on immune functions of moderately hypercholesterolemic humans

Hypercholesterolemia is a risk factor for coronary heart disease (CHD) and also could contribute to impaired immune response. The National Cholesterol Education Program Expert Panel recommends a therapeutic lifestyle change (TLC) diet to reduce the risk for CHD. We investigated the effects of changing from a high-fat Western diet to a low-fat diet in accordance with a TLC diet on immune functions of older adults with hypercholesterolemia to determine whether improving the lipid profile via dietary intervention would have beneficial effects on immune functions. In a double-blind study, 18 subjects consumed both a Western diet (38% fat) and a TLC diet (28% fat) for 32 days in a randomized order. Measures of cellular immune responses, including delayed-type hypersensitivity (DTH) response, in vitro lymphocyte proliferation, and interleukin (IL)-2 production, and production of proinflammatory mediators, including tumor necrosis factor-alpha, IL-6, IL-1beta, and prostaglandin E2, were determined. DTH response and lymphocyte proliferative response increased significantly (29% and 27%, respectively) after consumption of a TLC diet. Our results indicate that consumption of a TLC diet enhances T cell-mediated immune functions in older adults with elevated cholesterol level. This might be a clinically important benefit, considering the decline of T cell-mediated immune functions with aging and evidence of impaired immune function associated with hypercholesterolemia.     

Cholesterol oxidation: health hazard and the role of antioxidants in prevention

Cholesterol is a molecule with a double bond in its structure and is therefore susceptible to oxidation leading to the formation of oxysterols. These oxidation products are found in many commonly-consumed foods and are formed during their manufacture and/or processing. Concern about oxysterols consumption arises from the potential cytotoxic, mutagenic, atherogenic, and possibly carcinogenic effects of some oxysterols. Eggs and egg-derived products are the main dietary sources of oxysterols. Thermally-processed milk and milk-derived products are another source of oxysterols in our diet. Foods fried in vegetable/animal oil, such as meats and French-fried potatoes, are major sources of oxysterols in the Western diet. Efforts to prevent or to reduce cholesterol oxidation are directed to the use of antioxidants of either synthetic or natural origin. Antioxidants are not only able to inhibit triglyceride oxidation, some of them can also inhibit cholesterol oxidation. Among synthetic antioxidants 2,6-ditertiarybutyl-4-methylphenol (BHT), and tertiary butylhydroquinone (TBHQ) can efficiently inhibit the thermal-induced oxidation of cholesterol. Some natural antioxidants, such as alpha- and gamma-tocopherol, rosemary oleoresin extract, and the flavonoid quercetin, show strong inhibitory action against cholesterol oxidation.     

Relationship of dietary intake of fish and non-fish selenium to serum lipids in Japanese rural coastal community.

Several studies have suggested that dietary selenium deficiency may be associated with an increased risk of coronary heart disease (CHD). In the present study, 55 men and 71 women were selected from participants in a health examination in a rural coastal community in Japan. The mean dietary selenium intake calculated from the simple food frequency questionnaire (SFFQ) was 127.5 micrograms/day. Fish was the major source of dietary selenium and it contributed to 68.7% of the daily total. HDL cholesterol was higher in the middle selenium intake group and in the high selenium intake group than in the low selenium intake group in all subjects and for males, and a significant difference was found between the middle selenium intake group and the low selenium intake group. The atherogenic index was significantly higher in the low selenium intake group than in the middle selenium intake group and in the high selenium intake group in males. GPx activity, total cholesterol and triacylglycerols did not show any significant differences among the three different selenium intake groups. Dietary intake of non-fish Se had a positive correlation with HDL cholesterol, and an inverse correlation with the atherogenic index in all subjects and for females. On the other hand, dietary intake of fish-Se had no relationship with any serum lipids. Non-fish Se is an important factor in selenium status for the prevention of CHD.     

Evaluating metabolic syndrome in a medical physiology laboratory

The metabolic syndrome, a cluster of factors linked to obesity that contribute to risk for atherosclerosis and Type 2 diabetes, may affect 20-25% of the adults in the United States. We designed a medical physiology laboratory to evaluate and discuss the physiological and nutritional principles involved in the metabolic syndrome. The five criteria used to diagnose this syndrome (fasting blood triglycerides, high-density lipoprotein cholesterol, and glucose, blood pressure, central obesity) were measured by students on each other either previously or during this exercise. In addition, to illustrate nutritional factors involved in causation and treatment of the metabolic syndrome, a meal was provided during the laboratory. Class members were randomized to groups allowed ad libitum meal composition, or constrained to the National Cholesterol Education Program Step I or Step II diets. The composition of the diet (including saturated fat, cholesterol, dietary fiber, and carbohydrate content) was discussed in the context of blood cholesterol, triglyceride, and glucose levels. This laboratory allows a comprehensive analysis of the physiological and nutritional factors involved in the development of the metabolic syndrome.