Download Free Medical Best Diet for CHD Prevention PowerPoint Presentation

Best Diet for CHD Prevention PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Congestive Heart Failure, which is titled "Best Diet for CHD Prevention", to know about the best diet for CHD prevention

Tags : Congestive Heart Failure, Diet, CHD, Prevention, Coronary heart disease

Published on : Jul 01, 2021 | Views : 1109 | Downloads : 5

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Best Diet for CHD Prevention Dr. Thomas G. Allison Mayo Clinic Rochester
Slide 2-

Fatty Streaks in Aorta of 19-Year Old Male
Slide 3-

Advanced Lesion with Large Lipid Core
Slide 4-

Plaque Rupture with Torn Cap
Slide 5-

ppt slide no 5 content not found
Slide 6-

Major Statin Trials 50 210 LDL-C (mg/dL) 70 190 170 150 130 110 90 0 5 10 15 20 25 % with CAD event WOSCOPS AFCAPS CARE 4S LIPID HPS PROSPER Secondary Mixed Primary ASCOT-LLA PROVE IT TNT JUPITER
Slide 7-

ppt slide no 7 content not found
Slide 8-

Nissen, S. E. et al. JAMA 2004;291:1071-1080. Intravascular Ultrasound Images at Baseline and Follow-up REVERSAL Trial
Slide 9-

Limitations to Pharmacologic Lipid Management Cost of treatment Not an issue if generic drug will control LDL-C Treatment cost ~ $1000 per year if non-generic agent needed Not all patients tolerant of statins Myalgia most common complaint (5-15%) Alternative drugs (intestinal agents, niacin, fibrates) have limited effect on LDL-C, limited outcome data Benefits of add-on drug therapy not established
Slide 10-

International Comparisons (Men ages 35-74) International rates not due to differences in statin therapy rates! 2002 AHA Heart and Stroke Statistical Update
Slide 11-

Diets and CAD: What’s the Evidence? Dietary therapy can be an alternative to pharmacologic management of lipids in primary prevention Important adjunctive therapy in secondary prevention What is the best diet for CHD prevention?
Slide 12-

East Finland
Slide 13-

Mortality from Coronary Heart Disease Men 35-64 Years (1969-1994) Puska P: Cardiovasc Risk factors 6:203-10, 1996 North Karelia All Finland Per 100,000 800 700 600 500 400 300 200 100 CP999299-39 Now 80%
Slide 14-

Trends in Women’s Lifestyles 1980-82 versus 1992-94 31% decline in CHD incidence across all ages 41% decrease in smoking (27%  16%) Diet changes 31% decrease in trans fatty acid intake 69% increase in P/S ratio 90% increase in cereal fiber 180% increase in -3 fatty acids 12% increase in folate Nurses’ Health Study -- Hu et al: NEJM 2000;343:530-537
Slide 15-

Trends in Women’s Lifestyles 1980-82 versus 1992-94 38% increase in overweight (BMI>25) average BMI 24.5  26.1 kg/m2 22% increase in glycemic load
Slide 16-

Regional Diets with Low CHD Rates Seventh Day Adventist Japanese Rural Chinese Eskimo Mediterranean
Slide 17-

Crete
Slide 18-

Adherence to Mediterranean Diet and Survival in a Greek Population Prospective, population-based investigation of CHD mortality versus diet 22,043 healthy adults in Greece 44-month follow-up Diet assessed by 10-point scale (0-9) vegetables, legumes, fruits and nuts, cereals, fish, alcohol, monounsaturated/saturated fat ratio (+) meat, poultry, dairy products (-) Trichopoulou A et al, NEJM 2003:348:2599-2608
Slide 19-

Results Two single nutrients predicted CHD death Fruits and nuts: +200 g/day = 18% reduction Monounsaturated/saturated fat ratio: +0.5 = 14% reduction 2-point increase in Mediterranean diet score 25% reduction in total mortality 33% reduction in CHD mortality 24% reduction in cancer mortality Adjusted for age, sex, WHR, energy expenditure, smoking, BMI, potato and egg consumption, and total caloric intake
Slide 20-

Epidemiologic Studies Inherently flawed Problems with ascertainment of both independent (diets) and dependent (mortality, heart attacks, etc.) variables Not all non-dietary variables can be measured (and none controlled) Assumes constancy of exposure to dietary factors
Slide 21-

Diet-Heart Studies with Outcomes Location N Year f/u England (Rose) 80 1965 2y Middlesex 264 1965 5y Oslo 412 1966 5y London 393 1968 5y Sydney 458 1978 5y DART 2033 1989 2y Moradabad 505 1992 1y LHT (invite) 48 1998 5y Leon 423 1999 4y Intervention control v corn oil v olive oil control v low fat control v low fat + PUF control v soya-bean oil control v low fat + PUF low fat v fish v fiber low fat v fruit/veg+fish+fiber control v ultra-low fat control v Mediterranean
Slide 22-

ppt slide no 22 content not found
Slide 23-

Lifestyle Heart Trial Randomized invitational design (recruitment in ~1987) 28 experimental patients, 20 usual care Intervention: vegetarian, low fat diet (10% fat, 5 mg cholesterol/day) smoking cessation, moderate exercise, stress management Ornish et al: Lancet1990;336:129-133
Slide 24-

Original Dean Ornish Plan Fats (<10%) Nonfat dairy products – yogurt, cheese, egg whites Nonfat products – cereal, soups, tofu, crackers, egg beaters Whole grain – corn, rice, oats, wheat, etc Beans and legumes Fruits Vegetables Ban All oils All meats Olives Avocados Nuts – seeds High or low fat products Sugar – syrup – honey Alcohol CP1095424-1 Moderate exercise Stress reduction Smoking cessation No calorie restriction
Slide 25-

Lifestyle Heart Trial 1-Year Results Not powered (or randomized) for clinical events
Slide 26-

Lyon Heart Study 423 patients randomized post-MI 1988-92 Mediterranean diet vs “prudent diet” (Step 1) prescribed by patients’ physicians Planned 5-year follow-up Study terminated early (4 years) due to favorable interim analysis -- final report on 423 patients de Lorgeril et al, Circ 1999;99:779-785
Slide 27-

CP1059685-22 The Traditional Healthy Mediterranean Diet Pyramid 2000 Oldways Preservation & Exchange Trust
Slide 28-

Lyon Heart Study - Lipids
Slide 29-

Lyon Heart Study p<.0001 p<.0001 p<.0002 Results consistent with DART and Moradabad trials
Slide 30-

Search for the Perfect CHD Prevention Diet The Lifestyle Heart Trial achieved marked LDL-C lowering, but adversely affected HDL-C The Leon Heart Study lowered CHD risk without affecting lipid levels Can we design a diet that lowers LDL-C without lowering HDL-C while providing the heart protective nutrients?
Slide 31-

Therapeutic Lifestyle Changes in LDL-Lowering Therapy Major Features TLC Diet (Step 2+) Reduced intake of cholesterol-raising nutrients (same as previous Step II Diet) Saturated fats <7% of total calories Dietary cholesterol <200 mg per day LDL-lowering therapeutic options Plant stanols/sterols (2 g per day) Viscous (soluble) fiber (10–25 g per day) Weight reduction Increased physical activity NCEP
Slide 32-

Other Features of TLC Diet Nutrient Recommended Intake Polyunsaturated fat Up to 10% of total calories Monounsaturated fat Up to 20% of total calories Total fat 25–35% of total calories Carbohydrate 50–60% of total calories Fiber 20–30 grams per day Protein Approximately 15% of total calories Total calories (energy) Balance energy intake and expenditure to maintain desirable body weight/ prevent weight gain
Slide 33-

Dietary Portfolio 46 healthy, hyperlipidemic adults randomized Low saturated fat diet Low saturated fat diet + Lovastatin 20 mg/day Diet portfolio (based on Step 2+) Phytosterols 1.0 g/1000 kcal Soy protein 21.4 g/1000 kcal Viscous fiber 9.8 g/1000 kcal Almonds 14 g/1000 kcal 4-week follow-up Jenkins DJA et al, JAMA 2003:290:502-510
Slide 34-

ppt slide no 34 content not found
Slide 35-

Results
Slide 36-

Summary: Best CHD Prevention Diet Low in saturated fat and cholesterol High in monounsaturated fat Fish 2+ servings per week Or omega-3 fatty acids supplement Fresh fruits and vegetables 7+ servings/day Whole grains in place of refined flour and sugar
Slide 37-

Best CHD Prevention Diet Nuts 14+ grams/1000 kcal Added soy protein, soluble fiber, phytosterols Low glycemic index, especially if overweight Calorie control should be automatic Low caloric density CHO’s Satiety from monounsaturated fats, proteins Highly palatable Variety of foods and seasonings
Slide 38-

BMJ 2004;329:1447-1450 (18 December), doi:10.1136/bmj.329.7480.1447 Oscar H Franco, scientific researcher1, Luc Bonneux, senior researcher2, Chris de Laet, senior researcher1, Anna Peeters, senior researcher3, Ewout W Steyerberg, associate professor1, Johan P Mackenbach, professor1 1 Department of Public Health, Erasmus MC University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, 2 Belgian Health Care Knowledge Centre (KCE), Wetstraat 155, B-1040, Brussels, Belgium, 3 Department of Epidemiology and Preventive Medicine, Monash University Central and Eastern Clinical School, Melbourne, Australia The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75% The limits of medicine
Slide 39-

ppt slide no 39 content not found
Slide 40-

Other Aspects of Polymeal Men at age 50 would live an average of 6.6 years longer Women at age 50, 4.8 years longer Cost of polymeal estimated at $28.10/week Addition of other components such as oat bran or olive oil would only enhance effect No obvious contraindications to combining polymeal with polypill (or any subset of components)
Slide 41-

ppt slide no 41 content not found
Slide 42-

Weight Loss Controversy Americans have substituted refined CHO’s for fats over the past 20 years Linked to obesity Low CHO versus low fat for weight loss Atkins versus Ornish Much speculation, many popular books Published data only in past 4-5 years Does losing weight necessarily mean lowering CHD risk?
Slide 43-

Effect of Varying Fat, Protein, and CHO Content on Weight Loss 811 overweight adults randomized to 3 weight loss diets for 2 years Varying content: fat protein CHO Diet 1 20% 15% 65% Diet 2 20% 25% 55% Diet 3 40% 15% 45% Diet 4 40% 25% 35% 750 kcal per day caloric deficit Sacks FM et al. NEJM 2009;360:859-873
Slide 44-

ppt slide no 44 content not found
Slide 45-

ppt slide no 45 content not found
Slide 46-

ppt slide no 46 content not found
Slide 47-

Bon Appetit!
Slide 48-

ppt slide no 48 content not found
Slide 49-

Comments? Questions?