Preventive Cardiology: Focus on trans fats

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• Preventive CardiologyFocus on trans fats

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Source CDC/NCHS
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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NHANES C-Reactive Protein and Cholesterol Levels
Highly Predictive of CHD Risk Role for
Inflammation?
Ridker PM. Circulation. 20011031813-1818.
hs-CRP high-sensitivity CRP
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Conventional Risk Factors for Coronary Heart
Disease
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
JAMA 2003290891 JAMA 2003290898
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Approximate Mortality Reduction Potential of Drug
Vs Lifestyle Interventions in Patients with
Coronary Disease
Low dose aspirin 18 Statins 21 ß
Blockers 23 ACE Inhibitors 26
Smoking cessation 35 Physical activity 25 Moder
ate alcohol 20 Combined lifestyle changes 45
Drug
Lifestyle
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
Iestra JA et al. Circ 2005112924
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The effects of lifestyle change and drug therapy
on cardiovascular risk reduction appear to be
independent and additive.

Hunninghake DB et al. NEJM 1993321213 Barnard
RJ et al. AJC 1997791112 Sdringola S et al.
JACC 200341263
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Cardioprotective Dietary Recommendations

• Minimize the intake of beverages foods with
  added sugars
• Choose and prepare foods with little or no salt
• Limit alcohol consumption ( 2 and 1 drink/day
  for men and women, respectively), ideally with
  meals

Lichtenstein A et al. Circ 200611482
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Cardioprotective Dietary Recommendations

• Balance caloric intake physical activity to
  achieve and maintain a healthy body weight
• Consume a diet rich in fruits and vegetables, as
  well as whole-grain, high-fiber foods
• Eat fish, especially oily fish, 2 times/week
• Limit
• saturated fat (lt7 of energy)
• cholesterol to (lt 300 mg/day), and
• trans fat (lt 1 of energy)

Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Trans fatty acids can adversely affect
LDL and HDL cholesterol levels LP(a) and
triglycerides Vascular inflammation IL-6, TNF, CRP
Trans fatty acids increase
Coronary heart disease Diabetes
Mozaffarian D. NEJM 2006
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Trans Fat Increases Risk of Coronary Disease
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI
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Trans Fat Intake Systemic Inflammation(Lopez-Ga
rcia et al. J Nutr 2005)
p trend 0.10
p trend 0.009
Quintiles of Trans Fatty Acid Intake
Among 730 women, adjusted for age, BMI, smoking,
physical activity, postmenopausal hormone
therapy, and intakes of alcohol, saturated fat,
polyunsaturated fat, and monounsaturated fat.
Courtesy of Barry Franklin, PhD, William Beaumont
Hospital, Royal Oak, MI