The role of diet and nutritional supplements in preventing and treating cardiovascular disease

Purpose of review Healthy lifestyle practices play a key role in preventing and treating cardiovascular disease, and central to such strategy is a recommended dietary pattern. Current Dietary Guidelines from the US Department of Agriculture and the American Heart Association advocate a food-based diet for optimal health and prevention of chronic disease. Considerable research has focused on implementing these guidelines for maximal cardiovascular risk reduction, and this review will discuss the role of specific dietary strategies and select nutrition supplements in achieving this goal. Recent findings Food-based guidelines are reflected in specific dietary approaches to improve cardiovascular risk factors, such as the Dietary Approaches to Stop Hypertension diet and Therapeutic Lifestyle Changes, which have shown to effectively benefit hypertension and hypercholesterolemia, respectively. These diets, therefore, significantly reduce coronary heart disease risk. Although such dietary approaches ensure that nutrient requirements are met through foods, nutrition supplement use in the United States is at an all time high. Summary The Dietary Approaches to Stop Hypertension diet and Therapeutic Lifestyle Changes Diet are effective in decreasing cardiovascular morbidity and mortality risk, and such dietary strategies are endorsed by many organizations, including the American Heart Association and the National Heart, Lung and Blood Institute. In contrast, although some dietary supplements, such as fish oil and niacin, have shown promising cardiovascular effects, justifying their widespread use in clinical practice for some patients, there is insufficient evidence for others. Clinicians should carefully evaluate the claims made for new diet therapies, supplements, or both when counseling at-risk individuals.

[1]  M. Pencina,et al.  Vitamin E supplement use and the incidence of cardiovascular disease and all-cause mortality in the Framingham Heart Study: Does the underlying health status play a role? , 2009, Atherosclerosis.

[2]  L. Appel,et al.  Lifestyle Interventions Reduce Coronary Heart Disease Risk: Results From the PREMIER Trial , 2009, Circulation.

[3]  T. Kotchen Does the DASH diet improve clinical outcomes in hypertensive patients? , 2009, American journal of hypertension.

[4]  S. Lipsitz,et al.  Association between a DASH-like diet and mortality in adults with hypertension: findings from a population-based follow-up study. , 2009, American journal of hypertension.

[5]  R. Detrano,et al.  High-Dose B Vitamin Supplementation and Progression of Subclinical Atherosclerosis: A Randomized Controlled Trial , 2009, Stroke.

[6]  W. Koenig,et al.  The effect of marine n-3 fatty acids in different doses on plasma concentrations of Lp-PLA2 in healthy adults , 2009, European journal of nutrition.

[7]  T. Ueland,et al.  Dysregulated RANK Ligand/RANK Axis in Hyperhomocysteinemic Subjects: Effect of Treatment With B-Vitamins , 2009, Stroke.

[8]  A. Stalenhoef,et al.  Effects of ubiquinone (coenzyme Q10) on myopathy in statin users , 2008, Current opinion in lipidology.

[9]  R. Schnabel,et al.  Selenium supplementation improves antioxidant capacity in vitro and in vivo in patients with coronary artery disease The SElenium Therapy in Coronary Artery disease Patients (SETCAP) Study. , 2008, American heart journal.

[10]  G. Hankey,et al.  The effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis , 2008, BMC cardiovascular disorders.

[11]  F. Violi,et al.  Resveratrol, at concentrations attainable with moderate wine consumption, stimulates human platelet nitric oxide production. , 2008, The Journal of nutrition.

[12]  S. Vollset,et al.  Angiography : A Randomized Controlled Trial CoronaryWith Homocysteine-Lowering B Vitamins After Mortality and Cardiovascular Events in Patients Treated , 2008 .

[13]  M. Boaz,et al.  Effect of homocysteine-lowering therapy on arterial elasticity and metabolic parameters in metformin-treated diabetic patients. , 2008, Atherosclerosis.

[14]  M. Corson,et al.  Review of the evidence for the clinical utility of lipoprotein-associated phospholipase A2 as a cardiovascular risk marker. , 2008, The American journal of cardiology.

[15]  J. Manson,et al.  Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. , 2008, JAMA.

[16]  M. Vitolins,et al.  Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. , 2008, Archives of internal medicine.

[17]  D. Laight,et al.  The effect of oral folic acid upon plasma homocysteine, endothelial function and oxidative stress in patients with type 1 diabetes and microalbuminuria , 2008, International journal of clinical practice.

[18]  D. Giugliano,et al.  Mediterranean diet and metabolic diseases , 2008, Current opinion in lipidology.

[19]  Judith Wylie-Rosett,et al.  Nutrition Recommendations and Interventions for Diabetes , 2008, Diabetes Care.

[20]  E. Trautwein,et al.  Comparison of a dietary portfolio diet of cholesterol-lowering foods and a statin on LDL particle size phenotype in hypercholesterolaemic participants , 2007, British Journal of Nutrition.

[21]  E. Rimm,et al.  Vitamin intake and risk of coronary disease: Observation versus intervention , 2007, Current atherosclerosis reports.

[22]  F. Hu,et al.  Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women. , 2007, Archives of internal medicine.

[23]  A. Gómez de la Cámara,et al.  Effect of folic acid treatment on carotid intima-media thickness of patients with coronary disease. , 2007, International journal of cardiology.

[24]  Lawrence A Leiter,et al.  Effect of Plant Sterols in Combination with Other Cholesterol‐lowering Foods , 2007, Metabolism: clinical and experimental.

[25]  A. Folsom,et al.  Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. , 2007, American journal of hypertension.

[26]  Christian Gluud,et al.  Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. , 2007, JAMA.

[27]  P. Kris-Etherton The Minnesota Heart Survey: nutrition successes pave the way for strategic opportunities for food and nutrition professionals. , 2007, Journal of the American Dietetic Association.

[28]  E. Guallar,et al.  Selenium and coronary heart disease: a meta-analysis. , 2006, The American journal of clinical nutrition.

[29]  P. Kris-Etherton,et al.  Dietary omega-3 fatty acid intake and cardiovascular risk. , 2006, The American journal of cardiology.

[30]  C. White,et al.  The impact of coenzyme Q10 on systolic function in patients with chronic heart failure. , 2006, Journal of cardiac failure.

[31]  Judith Wylie-Rosett,et al.  Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement From the American Heart Association Nutrition Committee , 2006, Circulation.

[32]  A. Jaffe,et al.  Lipoprotein-associated phospholipase A2: review and recommendation of a clinical cut point for adults. , 2006, Preventive cardiology.

[33]  Michael Proschan,et al.  Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial , 2006, Annals of Internal Medicine.

[34]  J. Chin-Dusting,et al.  AMINO ACIDS, ARGINASE AND NITRIC OXIDE IN VASCULAR HEALTH , 2006, Clinical and experimental pharmacology & physiology.

[35]  M. Landray,et al.  Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. , 2005, The American journal of clinical nutrition.

[36]  L. Carlson,et al.  Nicotinic acid: the broad‐spectrum lipid drug. A 50th anniversary review , 2005, Journal of internal medicine.

[37]  J. Manson,et al.  Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer: The Women’s Health Study: A Randomized Controlled Trial , 2005, JAMA.

[38]  Lawrence A Leiter,et al.  Direct comparison of dietary portfolio vs statin on C-reactive protein , 2005, European Journal of Clinical Nutrition.

[39]  R. Schnabel,et al.  Glutathione peroxidase-1 and homocysteine for cardiovascular risk prediction: results from the AtheroGene study. , 2005, Journal of the American College of Cardiology.

[40]  Lawrence A Leiter,et al.  Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. , 2005, The American journal of clinical nutrition.

[41]  M. Kashyap,et al.  Niacin therapy in atherosclerosis , 2004, Current opinion in lipidology.

[42]  V. Kamanna,et al.  Niacin therapy in atherosclerosis. , 2004 .

[43]  B. Howard,et al.  Antioxidant Vitamin Supplements and Cardiovascular Disease , 2004, Circulation.

[44]  K. Dodd,et al.  Use of vitamin, mineral, nonvitamin, and nonmineral supplements in the United States: The 1987, 1992, and 2000 National Health Interview Survey results. , 2004, Journal of the American Dietetic Association.

[45]  E. Ros,et al.  A Walnut Diet Improves Endothelial Function in Hypercholesterolemic Subjects: A Randomized Crossover Trial , 2004, Circulation.

[46]  F. Cambien,et al.  Glutathione peroxidase 1 activity and cardiovascular events in patients with coronary artery disease. , 2003, The New England journal of medicine.

[47]  Lawrence A Leiter,et al.  Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. , 2003, JAMA.

[48]  C. Morris,et al.  Routine Vitamin Supplementation To Prevent Cardiovascular Disease: A Summary of the Evidence for the U.S. Preventive Services Task Force , 2003, Annals of Internal Medicine.

[49]  M. Hardy,et al.  Effect of supplemental antioxidants vitamin C, vitamin E, and coenzyme Q10 for the prevention and treatment of cardiovascular disease. , 2003, Evidence report/technology assessment.

[50]  Victor J Stevens,et al.  Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. , 2003, JAMA.

[51]  J. Mckenney,et al.  National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) , 2002 .

[52]  Lawrence A Leiter,et al.  A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. , 2002, Metabolism: clinical and experimental.

[53]  D. Wald,et al.  Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis , 2002, BMJ : British Medical Journal.

[54]  Lawrence J Appel,et al.  Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[55]  Per Magne Ueland,et al.  Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. , 2002, JAMA.

[56]  G. Moneta,et al.  Homocysteine and arterial disease. Experimental mechanisms. , 2002, Vascular pharmacology.

[57]  E. Bolson,et al.  Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. , 2001, The New England journal of medicine.

[58]  G. Dagenais,et al.  Comparison of Various Electrophoretic Characteristics of LDL Particles and Their Relationship to the Risk of Ischemic Heart Disease , 2001, Circulation.

[59]  G. Bray,et al.  Effects on blood lipids of a blood pressure-lowering diet: the Dietary Approaches to Stop Hypertension (DASH) Trial. , 2001, The American journal of clinical nutrition.

[60]  M. Rayman,et al.  The importance of selenium to human health , 2000, The Lancet.

[61]  P. Ridker,et al.  C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. , 2000, The New England journal of medicine.

[62]  S. Yusuf,et al.  Vitamin E supplementation and cardiovascular events in high-risk patients. , 2000, The New England journal of medicine.

[63]  L. Appel,et al.  Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. , 1999, Archives of internal medicine.

[64]  R. Krauss,et al.  Homocyst(e)ine, diet, and cardiovascular diseases: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. , 1999, Circulation.

[65]  G. Bray,et al.  A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. , 1997, The New England journal of medicine.

[66]  P. Galan,et al.  Effect of 6 month supplementation with different combinations of an association of antioxidant nutrients on biochemical parameters and markers of the antioxidant defence system in the elderly. The Geriatrie/Min.Vit.Aox Network. , 1996, European journal of clinical nutrition.

[67]  W. Willett,et al.  Mediterranean diet pyramid: a cultural model for healthy eating. , 1995, The American journal of clinical nutrition.

[68]  J. Mckenney,et al.  Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) , 1993, JAMA.

[69]  F. Kummerow,et al.  Viewpoint on the Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. , 1993, Journal of the American College of Nutrition.

[70]  J. Salonen,et al.  Effects of antioxidant supplementation on platelet function: a randomized pair-matched, placebo-controlled, double-blind trial in men with low antioxidant status. , 1991, The American journal of clinical nutrition.

[71]  J. Kumpulainen,et al.  Serum selenium, glutathione peroxidase activity and high-density lipoprotein cholesterol--effect of selenium supplementation. , 1984, Research communications in chemical pathology and pharmacology.

[72]  Lin-hua Zhang,et al.  Niacin inhibits vascular oxidative stress, redox-sensitive genes, and monocyte adhesion to human aortic endothelial cells. , 2009, Atherosclerosis.

[73]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[74]  M. Shakibaei,et al.  Resveratrol addiction: to die or not to die. , 2009, Molecular nutrition & food research.

[75]  R. Hui,et al.  Increase in fasting vascular endothelial function after short-term oral L-arginine is effective when baseline flow-mediated dilation is low: a meta-analysis of randomized controlled trials. , 2009, The American journal of clinical nutrition.

[76]  B. Mackey,et al.  Docosahexaenoic acid supplementation decreases remnant-like particle-cholesterol and increases the (n-3) index in hypertriglyceridemic men. , 2008, The Journal of nutrition.

[77]  P. Kris-Etherton,et al.  Position of the American Dietetic Association and Dietitians of Canada: dietary fatty acids. , 2007, Journal of the American Dietetic Association.

[78]  Ose,et al.  Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events* , 2002 .

[79]  S. Grundy,et al.  National Cholesterol Education Program Third Report of the National Cholesterol Education Program ( NCEP ) Expert Panel on Detection , Evaluation , and Treatment of High Blood Cholesterol in Adults ( Adult Treatment Panel III ) Final Report , 2022 .

[80]  P. Wilson,et al.  Remnant-like particle (RLP) cholesterol is an independent cardiovascular disease risk factor in women: results from the Framingham Heart Study. , 2001, Atherosclerosis.

[81]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[82]  A. Hamsten,et al.  Remnant lipoproteins are related to intima-media thickness of the carotid artery independently of LDL cholesterol and plasma triglycerides. , 2001, Journal of lipid research.

[83]  Orton,et al.  EFFECTS ON BLOOD PRESSURE OF REDUCED DIETARY SODIUM AND THE DIETARY APPROACHES TO STOP HYPERTENSION ( DASH ) DIET , 2000 .