Coronary Heart Disease: Nutritional Interventions for Prevention and Therapy

Coronary heart disease (CHD) is a major cause of morbidity and mortality in the Western world. Factors that are strongly associated with elevated risk of CHD are increasing age, male sex, smoking, lack of exercise, hypertension, obesity, and type 2 diabetes. In addition, blood lipid levels are strong predictors of CHD risk. A pattern of blood lipids that accelerates atherosclerosis is one where total cholesterol (TC)total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are elevated and high-density lipoprotein (HDL-C) is relatively low (Cochrane Database Syst Rev 4:CD0021281, 2007). A 1% reduction in circulating LDL-C is associated with a reduction in CHD risk of about 1% (J Am Coll Cardiol 44:720–732, 2004). Research in recent years has added C-reactive protein (CRP), a biomarker of inflammation, to the list of risk factors. A large body of evidence, collected over several decades from observational epidemiological studies and randomized controlled clinical trials (RCTsRCTs), strongly supports a major role for diet in the prevention and treatment of CHD. (Epidemiological studies refer mainly to prospective cohort studies and case–control studies). Dietary factors that have been proposed to affect the risk of CHD include saturated fatty acids (SFA), trans fatty acids (TFA)trans fatty acids (TFA), polyunsaturated fatty acids (both n−6 and n−3 PUFAn−3 PUFA), non-milk extrinsic sugars, dietary fiber, antioxidant vitamins, and vitamin D. This chapter examines how each of these food components, as well as whole dietary patterns, affects CHD risk. Obesity and exercise are also considered. Early studies focused on the effect of diet on blood lipids, but it is now accepted that diet affects CHD etiology through multiple mechanisms, including insulin resistance, blood pressure, endothelial function, inflammation, and thrombosis.