CHD (diet to tackle atherosclerotic disease)

Last edited 08/2023 and last reviewed 08/2023

• there is evidence from population data that a diet high in saturated fat, low in fruit and vegetables, and high in salt is associated with a risk of developing atherosclerotic disease (1)
  • of note is the Seven Countries Study
    • this showed that total fat, and specifically saturated fat, are both positively associated in these populations with 25 year coronary mortality (2)
• to reduce the risk of cardiovascular disease, it has been recommended that adults should adopt a balanced diet that includes: less fat, especially saturated fat; five portions or more of fruit and vegetables per day; a third less sodium (from about 150 mmol to about 100 mmol); and two or more portions of fish per week (one oily) (3)

NICE state that (4):

• advise people at high risk of or with CVD to eat a diet in which:
  • total fat intake is 30% or less of total energy intake, saturated fats are 7% or less of total energy intake, intake of dietary cholesterol is less than 300 mg/day and where possible saturated fats are replaced by mono-unsaturated and polyunsaturated fats
    
• advise people at high risk of or with CVD to:
  • reduce their saturated fat intake
  • increase their mono-unsaturated fat intake with olive oil, rapeseed oil or spreads based on these oils and to use them in food preparation
• take account of a person's individual circumstances – for example, drug therapy, comorbidities and other lifestyle changes when giving dietary advice

Vegetarian diet and cardiovascular risk

• a review (20 RCTs; n= 1878) found 6 months of a vegetarian diets was associated with significant improvements in LDL-cholesterol (6.8 mg/dL), HbA1c (0.25%), and body weight (3.4 kg) but no significant change in systolic BP vs all comparison diets (5)

Reference:

• (1) Committee on Medical Aspects of Food Policy (1994). Nutritional aspects of cardiovascular disease. Report of the Cardiovascular Review Group. London: HMSO. Report on Health and Social Subjects, 46.
• (2) Kromhout D et al. Prevention of coronary heart disease. Diet, lifestyle and risk factors in the seven countries study. Kluwer Academic Publishers, 2002.
• (3) Health Development Agency (2000). Coronary heart disease. Guidance for implementing the preventive aspects of the National Framework. London.
• (4) NICE (May 2023).Lipid modification Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• (5) Wang T, Kroeger CM, Cassidy S, et al. Vegetarian Dietary Patterns and Cardiometabolic Risk in People With or at High Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(7):e2325658. doi:10.1001/jamanetworkopen.2023.25658