|SCHAEFER, ERNST - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
Submitted to: Modern Nutrition in Health and Disease
Publication Type: Book / Chapter
Publication Acceptance Date: 8/1/2012
Publication Date: 12/18/2012
Citation: Schaefer, E.J. 2012. Nutrition in the prevention of Coronary Heart Disease and the management of lipoprotein disorders. In: Ross, Catharine A. New York, NY. Lippincott Williams & Wilkins. Modern Nutrition in Health and Disease. 11th edition, p. 862-876.
Interpretive Summary: In this chapter the current dietary recommendations of the United States Department of Agriculture and Department of Health and Human Services, as well those of the National Cholesterol Education Program of the National Institutes of Health are reviewed as are the intervention studies that support these recommendations. The dietary treatment of elevated low density lipoprotein cholesterol, elevated triglycerides, and decreased high density cholesterol levels are discussed and reviewed, along with other lifestyle, nutritional supplements and medications for the prevention of coronary heart disease.
Technical Abstract: Cardiovascular disease (CVD) is comprised of coronary heart disease (CHD), stroke, and peripheral vascular disease (PVD). CVD is caused by progressive narrowing and blockage of arteries supplying the heart, brain, and other tissues and organs. CVD is the leading cause of death and disability in our society. Major causal CVD risk factors as defined by the National Cholesterol Education program (NCEP) include: increased plasma low density lipoprotein (LDL) cholesterol (greater than 160 mg/dl), decreased HDL cholesterol (less than 40 mg/dl), aging (male older than 45 years, female older than 55 years), elevated systolic blood pressure (greater than 140 mmHg), cigarette smoking, and diabetes (fasting glucose greater than 125 mg/dl) have all been defined as independent risk factors for CHD. Additional CVD risk factors include elevated levels of C reactive protein (CRP greater than 2.0 mg/L), lipoprotein associated phospholipase A2 (LpPLA2 greater than 200), lipoprotein(a) (Lp(a) greater than 50 mg/dl), small dense LDL cholesterol (sdLDL-C greater than 40 mg/dl), Dietary guidelines for the general population include balancing caloric intake and physical activity to reduce overweight and obesity, restriction of sodium to less than 2,300 mg/day, saturated fat to less than 10% of calories with replacement by monounsaturated and polyunsaturated fats, cholesterol to less than 300 mg/day, restriction of trans fats, solid fats, sugars, refined grains sugars, and limiting consumption of alcohol (no more than 1 drink/day in women and no more than 2 drinks/day in men). In those with LDL cholesterol greater than 160 mg/dl after ruling out secondary causes, further restriction of saturated fat to less than 7% of calories and cholesterol to less than 200 mg/day is recommended. Dietary intervention studies support the concept of replacing saturated fat with polyunsaturated fat. Statin therapy to lower LDL cholesterol to less than 100 mg/dl, ideally less than 70 mg/dl, has clearly been shown to lower total mortality, CHD morbidity and mortality, and need for revascularization procedures. Markedly elevated triglycerides (greater than 1,000 mg/dl or 11 mmol/L) can be associated with recurrent pancreatitis, and here restriction of total fat, sugar, and control of diabetes are important, and the use of both fibrate and fish oil therapy is effective in lowering triglyceride levels to less than 400 mg/dl. The indications for the use of statins, ezetimibe, anion exchange resins, fibrates, niacin, and fish oil, will also be reviewed, as will the diagnosis and management of disorders of lipoprotein metabolism.