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HOW TO PREVENT CORONARY HEART DISEASE WITH DIETARY
Sharapova Nozima Erkinjonovna
Teacher of the Department Fundamental Medicine Disciplines Asia International University.
E-mail:
sharapovanozimaerkinjonovna@oxu.uz
https://doi.org/10.5281/zenodo.14909859
Abstract
.
Coronary heart disease (CHD) remains the leading cause of mortality in
industrialized countries and is rapidly becoming a primary cause of death worldwide. Thus,
identification of the dietary changes that most effectively prevent CHD is critical.
Key words:
unsaturated, saturated,
trans
-fats, lipoprotein, low-density lipoprotein,
carbohydrates,
fatty acids.
КАК ПРЕДОТВРАТИТЬ ИШЕМИЧЕСКУЮ БОЛЕЗНЬ СЕРДЦА С ПОМОЩЬЮ
ДИЕТЫ
Аннотация.
Ишемическая болезнь сердца (ИБС) остается основной причиной
смертности в промышленно развитых странах и быстро становится основной причиной
смерти во всем мире. Таким образом, определение изменений в питании, которые
наиболее эффективно предотвращают ИБС, имеет решающее значение.
Ключевые слова:
ненасыщенные, насыщенные, трансжиры, липопротеины,
липопротеины низкой плотности, углеводы, жирные кислоты.
Compelling evidence from metabolic studies, prospective cohort studies, and clinical
trials in the past several decades indicates that at least 3 dietary strategies are effective in
preventing CHD: substitute non hydrogenated unsaturated fats for saturated and
trans
-fats;
increase consumption of omega-3 fatty acids from fish, fish oil supplements, or plant sources;
and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain
products.
However, simply lowering the percentage of energy from total fat in the diet is unlikely
to improve lipid profile or reduce CHD incidence. Substantial evidence indicates that diets using
non hydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the
main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty
acids can offer significant protection against CHD. Such diets, together with regular physical
activity, avoidance of smoking, and maintenance of a healthy div weight, may prevent the
majority of cardiovascular disease in Western populations. Until recently, most epidemiologic
and clinical investigations of diet and CHD have been dominated by the diet-heart hypothesis.
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However, the original hypothesis was overly simplistic because the effects of diet on
CHD can be mediated through multiple biological pathways other than serum total cholesterol or
low-density lipoprotein cholesterol.
Numerous controlled feeding studies of the effects of different dietary fatty acids on
serum cholesterol levels have been summarized in several meta-analyses from which predictive
equations have been developed. All such analyses confirm early reports by Keys and Hegsted
that saturated fatty acids increase and polyunsaturated fatty acids decrease total and LDL
cholesterol. All 3 classes of fatty acids (saturated, monounsaturated, and polyunsaturated)
elevate high-density lipoprotein cholesterol (HDL-C) when they replace carbohydrates in the
diet, and this effect is slightly greater with saturated fatty acids. Also, triglyceride levels increase
when dietary fatty acids are replaced by carbohydrates. Because replacement of saturated fat
with carbohydrates proportionally reduces both LDL-C and HDL-C, and, thus, has little effect on
the LDL-HDL ratio and increases triglycerides, this change in diet would be expected to have
minimal benefit on CHD risk.
However, when monounsaturated or polyunsaturated fats replace saturated fat, LDL-C
decreases and HDL-C changes only slightly. Moreover, substituting polyunsaturated fat for
saturated fat may have beneficial effects on insulin sensitivity and type 2 diabetes. In numerous
controlled metabolic studies,
trans
-fatty acids (found in stick margarine, vegetable shortenings,
and commercial bakery and deep-fried foods) have been shown to raise LDL-C levels and lower
HDL-C relative to
cis
-unsaturated fatty acids, and the increase in the ratio of total to HDL
cholesterol for
trans
-fat is approximately twice that for saturated fat .
Trans
-fat increases plasma
levels of lipoprotein and triglycerides and may reduce endothelial function by impairing flow-
mediated dilation. In addition,
trans
-fatty acids adversely affect essential fatty acid metabolism
and prostaglandin balance by inhibiting the enzyme delta-6 desaturase. Finally, high intake
of
trans
-fat may promote insulin resistance and increase risk of type 2 diabetes. Only a handful
of dietary trials with CHD end points have been conducted and most were among patients with
CHD.
Two dietary approaches were tested in earlier trials; one replaced saturated fat with
polyunsaturated fat, leaving total fat unchanged; the other lowered total fat. In all the high-
polyunsaturated-fat trials, serum cholesterol was significantly reduced. In the Finnish Mental
Hospital Study, soft margarine replaced stick margarine, so the reduction in CHD was
probably in part due to reduction in
trans
-fat intake. In the Minnesota Coronary
Survey, cardiovascular events were not significantly reduced by a high-polyunsaturated-fat diet
despite a decrease in serum cholesterol, but the mean duration of dietary intervention was only
about 1 year.
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Two secondary prevention trials testing the approach of total fat reduction did not find a
significant reduction in serum cholesterol or CHD events. Omega-3 fatty acids may reduce risk
of CHD by preventing cardiac arrhythmia, lowering serum triglyceride levels, decreasing
thrombotic tendency, and improving endothelial dysfunction. An inverse association between
fish intake and coronary mortality was first reported in a Dutch population, and more than 15
prospective studies have followed. A systematic review of the 11 studies published before 2000
concluded that the inverse association was stronger for fatal CHD than for nonfatal myocardial
infarction (MI), and the benefit was most evident in populations with higher-than-average risk of
CHD. Since that review, 4 additional prospective cohort studies and 1 case-control study have
provided further support for the protective effects of marine omega-3 fatty acids against CHD in
diverse populations. Notably, 2 recent studies have shown that consuming 2 or more servings of
fish per week was associated with 30% lower risk of CHD in women and that blood levels of
eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were strongly associated with
decreased risk of sudden cardiac death in men. Revailing dietary recommendations have
emphasized high intake of complex carbohydrates, mainly starch, and avoidance of simple
sugars.
However, many starchy foods, such as baked potatoes and white bread, are rapidly
digested to glucose and produce even higher glycemic and insulinemic responses than sucrose
(half glucose and half fructose). The glycemic index (GI) ranks foods based on rise in blood
glucose (the incremental area under the curve for blood glucose levels) after ingestion compared
with glucose or white bread, standardizing the carbohydrate content to 50 g. Foods with a low
degree of starch gelatinization (more compact granules), such as spaghetti and oatmeal, and a
high level of viscose soluble fiber, such as barley, oats, and rye, tend to have a slower rate of
digestion and, thus, lower GI values. In several controlled clinical studies, feeding low-GI meals
to diabetic patients led to significant improvement in glycemic control and lipid profile, but
larger studies are needed. Much evidence suggests that adequate folate consumption is important
for the prevention of CHD. Epidemiologic studies have found an inverse association between
folate intake measured by dietary questionnaire or serum folate level and risk of CHD, which is
likely to be mediated through homocysteine-lowering effects of folic acid.
Two randomized placebo-controlled trials evaluated effects of folic acid supplementation
on the development and progression of atherosclerosis. Vermeulen et al found that
supplementation with folic acid and vitamin B
6
for 2 years significantly decreased subclinical
atherosclerosis indicated by abnormal exercise electrocardiography tests among siblings of
patients with existing cardiovascular disease.
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In the Swiss Heart Study, treatment with a combination of folic acid and vitamins B
6
and
B
12
significantly decreased restenosis and revascularization after coronary angioplasty at 6
months and a combined cardiovascular end point at 11 months. Ongoing clinical trials should
provide more definitive data on the role of folic acid supplementation in CHD prevention, but
the interpretation of the findings from trials conducted in the United States could be complicated
by the fortification of flour with folic acid. The relationship between consumption of specific
foods or overall dietary patterns and risk of CHD has been examined in recent studies.
Such analyses are valuable in evaluating additional diet-heart hypotheses and in making
practical dietary recommendations. For example, replacement of red meat with chicken and fish
has been associated with reduced risk of CHD. An inverse association between nut consumption
and risk of CHD has been seen consistently in prospective studies. Which further underscores
the importance of distinguishing different types of fat. Although nuts are high in fat and, thus,
routinely proscribed in dietary recommendations, the predominant types of fat in nuts are
monounsaturated and polyunsaturated, which lower LDL-C level. Recently, several studies have
reported the role of overall dietary patterns in predicting long-term risk of CHD. In these
analyses, a "prudent" pattern characterized by higher intakes of fruits, vegetables, legumes,
whole grains, poultry, and fish was associated with lower risk of CHD, whereas a "Western"
pattern characterized by higher intakes of red and processed meats, sweets and desserts, potatoes,
french fries, and refined grains was associated with a higher risk, independent of lifestyle factors.
Compelling evidence from metabolic studies, epidemiologic investigations, and clinical
trials in the past several decades converges to indicate that at least 3 dietary strategies are
effective in preventing CHD: substitute unsaturated fats (especially polyunsaturated fat) for
saturated and
trans
-fats; increase consumption of omega-3 fatty acids from fish oil or plant
sources; and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined
grains. A combination of these approaches can confer greater benefits than a single approach.
However, simply lowering the percentage of energy from total fat in the diet is unlikely
to improve lipid profile or reduce CHD incidence. Obesity is an important avenue by which diet
can influence risk of CHD. However, the relationship between diet, especially dietary fat, and
obesity remains controversial. Although reduction in percentage of calories from dietary fat
intake is commonly recommended for weight loss, long-term clinical trials have provided no
good evidence that reducing dietary fat per se can lead to weight loss. There is a growing
consensus that excess calories, whether from carbohydrates or fat, will induce weight gain. A
mildly hypocaloric moderate-fat diet, which allows for a great variety in choosing foods, can
have better long-term compliance than a typical low-fat diet.
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Small short-term studies have suggested roles of several diets in weight control, including
a low-GI diet, a high-protein diet, and a diet high in dairy products, but larger and long-term
studies are needed.
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