Food and cardiovascular heart disease

1
Food and cardiovascular heart disease

• Pedro Marques-Vidal
• IUMSP
• Lausanne, Switzerland

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Coronary heart disease

• In the next 10 minutes, in Europe
• 40 people will die of myocardial infarction
• 80 will die of cardiovascular disease
• At a cost of 3.2 million
• Each year, one out of 40 Europeans is
  hospitalized for cardiovascular disease
• Cost estimated at 169 billion in 2006,
  increasing to 192 billion in 2008.

European Journal of Cardiovascular Prevention and
Rehabilitation, 14 (2007) Suppl2, E1 Leal et al.
European Heart Journal 27 (2006)1610
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Outline

• Cardiovascular risk factors and diet
• Case stories of dietary prevention
• ESC guidelines on dietary prevention
• Conclusion

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What causes heart disease

• Smoking
• High cholesterol
• High blood pressure
• Diabetes

80 of coronary deaths in France
Thomas et al, Archives des Maladies du Coeur et
des Vaisseaux, 100 (2007) 57
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High cholesterol / fat

• Decreasing saturated and increasing
  polyunsaturated fat can lead to
• 14 in total cholesterol
• 44 in the risk of heart disease 1.
• Increasing trans fatty acids can lead to a 28
  increase in the risk of heart disease 2.

1 Turpeinen et al. International Journal of
Epidemiology 8 (1979)99 2 Oomen et al., Lancet.
357 (2001)746
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High blood pressure

• Effect on systolic blood pressure of
• Less salt 1 5 mm Hg
• More fruit vegs 2 3 mm Hg
• More fruit vegs, less fat 2 5 mm Hg
• All together 3 11 mm Hg
• Stronger effect in subjects with hypertension

• 1 Forte et al, Journal of Human Hypertension, 3
  (1989) 179
• 2 Appel et al. New England Journal of Medicine
  366 (1997) 1117
• 3 Sacks et al. New England Journal of Medicine.
  344(2001)3

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Diabetes

• Less weight
• Less total and saturated fat
• More fiber
• More physical activity
• 58 decrease in the risk of developing type 2
  diabetes

Tuomilehto et al. New England Journal of
Medicine. 344 (2001)1343
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Effect of diet on CV deaths

• Salt (-3 g/day) 1 16
• Fish (4x/week) 2 14
• Fruit (1 portion/day) 3 7
• Vegetables (1 portion/day) 3 4
• Fat (replace SFA by PUFA) 4 12
• Overall 53
• Theoretical 5 75

1 Law et al, British Medical Journal. 302
(1991)819 2 Whelton et al, American Journal of
Cardiology 93 (2004)1119 3 Dauchet et al.
Journal of Nutrition 136 (2006)2588 4 Hu et al,
Journal of the American Medical Association. 288
(2002)2569 5 Franco et al. British Medical
Journal. 329 (2004)1447
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Finland North Karelia Project
Use of vegetable oil for cooking (men age 30-59)


Use of vegetable oil for cooking
Use of butter for cooking
10
Finland North Karelia Project
700
start of the North Karelia Project
600
extension of the Project nationally
500
North Karelia (-82)
400
Mortality per 100 000 population
300
Finland (-75)
200
100
Year
Vartiainen et al, British Medical Journal
311(1995)589
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Poland
Zatonski et al, British Medical Journal 316
(1998) 1047
12
Czech Republic
Bobak et al. Journal of Epidemiology and
Community Health. 51 (1997)272-
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Czech Republic
Bobak et al. Journal of Epidemiology and
Community Health. 51 (1997)272-
14
GISSI Prevenzione trial effect of Omega-3
PUFAs on mortality
40 in all deaths, 30 in cardiovascular
deaths
Marchioli R et al. Circulation 105 (2002)1897
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Mediterranean diet

• Adherence to a Mediterranean-type diet
• 30 the risk of dying from heart disease in
  the general population 1.
• 37 the risk of cardiovascular events after
  myocardial infarction 2.
• 18 the risk of dying among European
  elderly with previous myocardial infarction 3.

1 Trichopoulou et al, New England Journal of
Medicine, 348 (2003)2599 2 De Lorgeril et al,
Journal of the American College of Cardiology. 28
(1996)1103 3 Trichopoulou et al, European
Journal of Epidemiology. 22 (2007)871
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European Journal of Cardiovascular Prevention and
Rehabilitation, 14 (2007) Suppl2, E1
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Salt in breakfast cereals
Current recommendations lt5 g/day
Mancia et al, European Heart Journal 28 (2007)
1462
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Salt in vegetable soups
Current recommendations lt5 g/day
Mancia et al, European Heart Journal 28 (2007)
1462
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Conclusion

• Heart disease represents a health and economical
  issue in Europe
• Dietary prevention works at the population and
  individual level
• but has to be implemented!

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Thank you!