see also:

• cardiology
• ischaemic heart disease (IHD)
• risk factors and molecular genetics of atherosclerosis
• pathophysiology of atherosclerosis

• “prudent” diet is generally regarded as safe & desirable for all adults:
  • < 30% of energy from fat
  • maintenance of ideal weight (BMI 20-25):
    • abdominal obesity is associated with adverse changes in several major risk factors including diabetes, hyperlipidaemia, and hypertension
    • thus obesity is a useful marker for cardiovascular disease risk although nor always an independent risk factor
  • if diabetes then avoidance of simple carbohydrates
  • avoid dietary saturated fat, cholesterol & salt
  • stress importance of variety in diet
  • avoid foods with high energy density but low nutrient density
    • ⇒ use lean meat, low fat dairy products, skinless poultry & fish
    • ⇒ use cereals, fruit & vegetables with plentiful soluble fibre allows a more generous food intake
    • ⇒ use mono- or polyunsaturated fats instead of unsaturated fats
    • ⇒ avoid adding extra butter, sour cream, cheese, gravy to food
    • ⇒ avoid fried dishes, cream sauces, frequent take-aways
  • avoid carnitine (red meat, energy drinks)
  • benefits of Mediterranean diet (olive oil-based, minimal red meat, minimal simple carbohydrates)
  • a large US study published in 2022 suggests eating 1 avocado a week may reduce heart attacks by 16-21% but did not seem to reduce risk of stroke ¹⁾

• avoid alcohol if hyperTG, abdominal adiposity, hypertension or obstructive sleep apnoea is contributing to cardiovascular disease risk

• stop smoking - see also nicotine and nicotine replacement Rx for smokers

• see hyperlipidaemia

• see hypertension

• see diabetes mellitus

• air pollution, in particular iron-rich nanoparticles from traffic, etc may have a significant role

• important because of effects on cardiorespiratory fitness and energy balance
• it may assist development of collateral circulation
• improves caloric balance & may restore the link between appetite & energy requirements, thereby reducing obesity
• see exercise for health

• IHD is uncommon in premenopausal women
• HRT has been shown to decrease risk of atherosclerotic disease - oral effect may be greater than patch
• benefits of HRT in reducing atherosclerosis may be outweighed by its risks

• low dose (75mg/day) may be associated with significant reductions in CVS disease but small increased risk of GIT bleeding and haemorrhagic stroke
• aspirin for primary prevention if benefits outweigh risks:
  • women aged 55 to 79 yrs if benefit of stroke (CVA) reduction outweighs risk of GIT haemorrhage²⁾
  • men aged 45 to 79 yrs if benefit of acute myocardial infarction (AMI/STEMI/NSTEMI) reduction outweighs risk of GIT haemorrhage³⁾
  • do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years ⁴⁾
  • evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older ⁵⁾

• ensure folic acid & B12 deficiency is recognised & treated
• vitamin B6

• In 1993, 2 large studies showed that Vit E could reduce the risk of heart disease in both men & women by around 35%, with best results from those that took at least 100IU per day for 2 years. NEJM 1993; 328:1450-56; NEJM 1993; 328:1444-9.
• In 1995, a study suggested that in pts with Hx of IHD, vitamin E intake of > 100IU/day was able to reduce coronary artery lesion progression when studied with serial angiography. JAMA 1995; 273:1849-54;
• In 1996, a study of > 11,000 elderly persons (>67yrs old), found that combined supplement use of Vit E & C seemed to offer significant protection from both heart disease mortality (down 42%) and all-cause mortality (down 53%) Am.J.Clin.Nutr. 1996:190-6.
• In 1996, Cambridge Heart Antioxidant Study (CHAOS) Lancet 1996; 347:781-86 studied 2000 pts with existing heart problems & found that supplementation with 400IU or 800IU per day for at least 1 year, reduced the risk of non-fatal heart attacks by up to 75%.
• In 2008, it now seems that supplemental antioxidants of vitamin A group or vitamin E actually INCREASES mortality!!
  • antioxidants may cause increased mortality - blog with links to EBM

• low dose aspirin 100-300mg/day unless C/I

• offer prognostic benefit post-AMI

• offer prognostic benefit if significant LV dysfunction

• in 2018, the Cochrane review found that there is little evidence to support these fish oil supplements as benefiting reducing cardiovascular disease

• help stabilise plaque and may induce plaque regression

• interleukin-6 (IL-6) blockers may have a role in those at high risk such as chronic renal failure