Traditional Dietary Recommendations for the Prevention of Cardiovascular Disease: Do They Meet the Needs of Our Patients?

Abstract

The characteristics of patients with CVD have changed: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the “mainstream knowledge” despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.

Effects of Dietary Macronutrients on Plasma Lipid Levels and the Consequence for Cardiovascular Disease

“…Recent research suggests that the average individual affected by or at risk for developing CVD has changed over the years, whereby most patients with coronary problems are also affected by some form of insulin resistance [36]. Therefore, this insulin resistance needs to be taken into consideration when giving dietary recommendations.…”

“…Diets lower in saturated fat have been associated with significantly greater reductions in LDL cholesterol and lower concentrations of large, buoyant LDL particles [34], whereas higher intakes of saturated fat have been associated with significantly greater increases in concentrations of small, dense LDL III particles, and higher contents of ApoC-III in LDL cholesterol particles, specifically LDL IV particles [36]. A 5% increase in saturated fat intake has been associated with a 36% greater risk of coronary heart disease in women in a 16-year follow-up study [37].…”

La asociación de hiperinsulinemia con riesgo cardiovascular y cáncer plantea nuevos retos en el abordaje del paciente con diabetes tipo 2, insulinorresistente

“…Las recientes recomendaciones nutricionales de la American Diabetes Association (ADA) aconsejan 3 tipos de dietas para el control de la DM2: dieta hipocalórica, baja en grasas, dieta mediterránea y dieta hipoglucídica 57 . Existen numerosos estudios que demuestran que, de todas ellas, la que obtiene mejores resultados en cuanto a reducción de hiperinsulinemia posprandial sería, sin duda, la de menor contenido en glúcidos 58,59 . En cuanto al tratamiento farmacológico, se ha pronunciado también la ADA en sus últimas recomendaciones y cito textualmente: «Los estudios aleatorizados controlados han demostrado que los individuos con riesgo elevado para el desarrollo de diabetes pueden recibir intervenciones que reducen significativamente la tasa de inicio de la diabetes.…”

Lifestyle and Dietary Risk Factors for Peripheral Artery Disease

“…100 Thus, a Mediterranean diet could be a good alternative to the traditional low-fat diet because it improves patients' compliance through satiation and the palatability of the diet. 101 Following and expanding the recommendations of the European Society of Cardiology for patients with PAD, 3 a Mediterranean-style diet could be effective not only in the primary and secondary prevention of PAD but also in the reduction of cardiovascular risks factors.…”