Practical Guidance for Food Consumption to Prevent Cardiovascular Disease

Abstract

This dietary guidance, informed by best contemporary evidence, aims to assist medical practitioners and allied health professionals in advising patients for the primary and secondary prevention of cardiovascular disease (CVD). While differing in some details from other current guidelines, the core messages accord with those published in 2019 by the American College of Cardiology/American Heart Association and the European Society of Cardiology/European Atherosclerosis Society; the National Lipid Association in 2014 and the NH&MRC Australian Dietary Guidelines in 2013. These were assessed through the Appraisal of Guidelines for Research and Evaluation (AGREE II) and the levels of evidence and classes of a recommendation developed using the GRADE system. Recommendations with high levels of evidence include increased consumption of plant based foods comprising mainly complex, fibre enriched carbohydrates (wholegrains, fruits and vegetables) while limiting intake of refined starches; partial replacement of saturated fats with monounsaturated or polyunsaturated fats and oils; reduced salt intake; achievement and maintenance of healthy weight; and low-tomoderate consumption of alcohol. Additional guidance but with moderate levels of evidence includes increased consumption of fish (and fish oils where indicated); reduction in sugar-sweetened beverages and added sugars; avoidance of butter and cream especially in those at increased CVD risk but encouragement of yoghurt; allow moderate consumption of lean meat but limit intake of processed meats; and limit cholesterol-rich foods such as eggs and crustaceans for those at increased CVD risk. Guidance has been formulated qualitatively on food categories of commonly eaten foods while avoiding prescriptive quantitative measures that are less readily translatable. This approach accords with current guidelines such as the American College of Cardiology/American Heart Association 2019 guidelines and is understandable and readily implemented.

Breast Cancer Survivors Undergoing Endocrine Therapy Have a Worrying Risk Factor Profile for Cardiovascular Diseases

“…Although there are quantitative nutritional recommendations for primary and secondary prevention of CVD, the emphasis of the latest guidelines has been, preferably, on qualitative counseling. In clinical practice, qualitative guidance is more easily understood, increasing the adherence [61].…”

Synopsis of an integrated guidance for enhancing the care of familial hypercholesterolaemia: an Australian perspective

“…atorvastatin or rosuvastatin) with or without ezetimibe, and a heart-healthy diet, should initially be employed to achieve the above targets ( Fig. 2 ) [ 1 , 2 , 36 , 39 ]. [CoR Strong; LoE High]

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Essentials of a new clinical practice guidance on familial hypercholesterolaemia for physicians

“… Patients with FH should be counselled on lifestyle modifications and non‐cholesterol risk factors treated 3,5,17,18,20 ( CoR Strong; LoE Moderate ). Therapy should initially aim for at least a 50% reduction in LDL‐cholesterol 1,3,17,18 ( CoR Strong; LoE Moderate ), after which the following therapeutic targets should be considered 3,17,18,21 ( CoR Moderate; LoE Moderate ): LDL‐cholesterol <2.5 mmol/L (absence of ASCVD or other major ASCVD risk factors); LDL‐cholesterol <1.8 mmol/L (imaging evidence of ASCVD alone or other major ASCVD risk factors); or LDL‐cholesterol <1.4 mmol/L (presence of clinical ASCVD). Diet and maximally tolerated high potency statins with or without ezetimibe should initially be employed to achieve the above targets 1,3,21,22 ( CoR Strong; LoE High ). A PCSK9 inhibitor should be used if targets are not achieved with maximally tolerated statins, ezetimibe and diet 1,3,17,21 ( CoR Strong; LoE High ). Patients with FH should continue cholesterol‐lowering therapies during acute illness, such as respiratory infections, unless specifically contra‐indicated 3 ( CoR Strong; LoE Low ). Plasma hepatic aminotransferases, creatine kinase, glucose and creatinine should be measured before starting and dose‐titrating statins; creatine kinase should be measured if myalgia is reported; glucose should be monitored with risk of diabetes (checks also apply to children and adolescents) 1,3,5 ( CoR Strong; LoE Moderate ). All women of child‐bearing age should be offered pre‐pregnancy counselling, with advice on contraception, before starting a statin and this should be reinforced annually (applies also to adolescent girls) 1,3,5 ( CoR Strong; LoE Moderate ). Statins and other systemically absorbed cholesterol‐lowering drugs should be discontinued 3 months before conception, as well as during pregnancy and breastfeeding 1,3,5 ( CoR Strong; LoE Moderate ). In asymptomatic patients with heFH, carotid ultrasonography and computed tomography coronary angiography may be used for monitoring the efficacy of cholesterol‐lowering therapy 1,3,12 ( CoR Weak; LoE Moderate ). …”