Nutrition Studies, Optimum Cardiovascular Health, and Coronary Atherosclerosis-Ensuring A Solid Foundation for Public Policy

Abstract

EditorialCoronary heart disease (CHD), the leading cause of death worldwide, is ideally managed through a combination of lifestyle change, optimum medical care, and interventional therapies, including surgery [1]. These three modalities are partners, rather than competitors, from which cardiologists and patients may chose, according to evidence, patient needs, and preferences. While genetic predisposition is important, diet, lifestyle choices, and other modifiable factors account for about 70% to 90% of CHD pathology [2][3][4][5], and are reviewed elsewhere [6][7][8]. This commentary reflects upon the need for better diet studies, the continuing high burden of cardiovascular risk, particularly obesity and type 2 diabetes (T2D), and the concept that atherosclerosis is a systemic disease.The relationship of diet and lifestyle to heart disease has been appreciated for over 40 years, and yet despite a cohesive basic core of nutrition fundamentals, significant advances, and a tsunami of literature, achieving the potential of cardiovascular prevention remains elusive [9][10][11]. Major barriers do not include lack of knowledge, but involve adoption, implementation, the environment, and social determinants [12][13][14].Counterproductive controversy about some issues has become fashionable, but it is not necessary to cite debated issues when recommending smaller portions, more fresh produce, additional fiber, fewer processed foods (especially meats), controlled salt and sugar intake, and greater physical activity (especially avoidance of prolonged sitting) to the public. Most concerning is the minimal improvement in the U. S. diet, which is still considered poor [12,13]. All told, despite all intermediary and putative explanations, the prevalence of ideal cardiovascular health has not meaningfully changed in the past decade, and remains so even when using self-reported data [15,16]. With respect to the six aforementioned items, individual behavior remains the most important factor, rather than guideline failure [17]. Therefore it is not surprising that background cardiovascular risk and subclinical CHD in asymptomatic individuals remains relatively high, as evidenced by positive calcium artery scores in over half of ostensibly healthy rural U. S. adults younger than 65 years [18]. Since this score is associated with the number, duration, and intensity of risk factors present, including obesity and T2D, behavioral/lifestyle modification as part of prevention programs needs much more attention, as outlined in recent ESC Guidelines [19]. At times, and in combination, these have generally led to a high proportion of both false positive and false negative findings, accompanied by correspondingly poor evaluations [20]. A few of these challenges are discussed, in a number of different forums, by several investigators (Figure 1) [11][12][13][21][22][23][24].In the low-fat vs low-carbohydrate debate, program designs did not succeed in elimination of potential barriers over a period of three decades and considerable investment of...

n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: Principles, Practices, Pitfalls, and Promises - A Contemporary Review

“…In contrast, the total number of all participants in studies examining SCD is now impressive [8][9][10][11][12][13][14][34][35][36][37]. Finally, relying upon dietary recall and study designs that preclude comparison may account for some discrepancies [44,45].…”