Diet (to tackle atherosclerotic disease)

• 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)
• in a cohort study of 407,531 participants with 24 years of follow-up and nearly 190,000 deaths, greater plant fat intake was associated with lower overall and cardiovascular disease mortality, particularly fat from grains and vegetable oils, independent of other important mortality risk factors (6)

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
• (6) Zhao B, Gan L, Graubard BI, et al. Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality. JAMA Intern Med. Published online August 12, 2024.