cardiovascular diseases andcardiovascular diseases and blood lipidsblood lipids · 2010-10-20 ·...

Master of Advanced Studies in Nutrition and Health HS 2010

Cardiovascular Diseases andCardiovascular Diseases and Blood LipidsBlood Lipids

David Faeh

Universität ZürichInstitut für Sozial- und Präventivmedizin

Aimss

• CVD, CHD, Stroke

• Morbidity Mortality Lethality• Morbidity, Mortality, Lethality

• Prevalence, Incidence

• Blood lipids: What is it? How influenced?

• How are blood lipids related with CVD?

• Risk and protective factorsRisk and protective factors

• Lifestyle recommendationsUniversität ZürichInstitut für Sozial- und PräventivmedizinDavid Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Proportion of causes of death: Age standardized death rates per 100,000, Switzerland

Groups of causes of death 2007, Men1%

30%20%

Groups of causes of death 2007, Men

30%

9%

33%

7%

Infectious disease Cancer Cardiovascular Respiratory Injury Others

Universität ZürichInstitut für Sozial- und PräventivmedizinDavid Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Source: Bundesamt für Statistik, 2007

Proportion of causes of death: Age standardized death rates per 100,000, Switzerland

Groups of causes of death 2007, Women1%

29%26%

Groups of causes of death 2007, Women

6%

33%

5%




Proportion of years of life lost (1-70y) by cause of death: Age standardized rates per 100,000, CH

YLL by group of cause of death 2007, Men2%

28%19%

YLL by group of cause of death 2007, Men

17%

2%

32%

17% = 20,540 YYL or 558 YLL / 100,000 inhabitants


N b f f lif l t (YLL) d t CVD th t l l b th di b f 70



Number of years of life lost (YLL) due to CVD: years that people loose because they die before 70

Proportion of years of life lost (1-70y) by cause of death: Age standardized rates per 100,000, CH

YLL by group of cause of death 2007, Women2%

21%

YLL by group of cause of death 2007, Women

44%

20%

11%

20%

2%


N b f f lif l t (YLL) d t CVD th t l l b th di b f 70

11% = 7,335 YLL or 202 YLL / 100,000 inhabitants



Number of years of life lost (YLL) due to CVD: years that people loose because they die before 70

Cardiovascular disease (CVD): cave definitionem!

standardisierte Sterberaten, Schweiz 2005Subsumed causes of death

Standardized rates, Switzerland, 2005

225Sterbefälle pro 100‘000

Personenjahre

175

200Personenjahre

z.B.: Aneurysma, Thrombose, Phl biti V i

125

150

Hypertonieübrige Herz-Kreislauf-Krankh.

Phlebitis, Varizzen

75

100

andere Herzkrankheiten

zerebrovaskuläre Krankheiten

25

50

KHK

z.B.: Myo-& Pericarditis, Klappen- und Herzinsuff.

0Männer Frauen


mb 2007Datenquelle: Todesursachenstatistik (BFS)

CardiovascularCardiovascular disease (CVD)

Mortality MorbidityDeath:Can be assessed

Disease:Is always higher

only once „Tip of the iceberg“

y gthan mortality. Can occur

tiUniversität ZürichInstitut für Sozial- und PräventivmedizinDavid Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

numerous times in one individual

Mortality Morbidityy y

Incidence“ PrevalenceIncidence„Film“: „Photo“:

„Incidence PrevalenceIncidence

Number of… •…death cases (mortality) or

di ( bidit )

Number of persons that have a•…new diseases (morbidity) per

number of persons under risk (100‘000) and during a certain

have a disease at a specific point


(100 000) and during a certain time span (1 year)

spec c poof time (in %)

Morbidity of CVD: UK, CDN y ,

Myocardial infarction (GB, 60 Mio inhabitants in 2003)

•260´000 new cases per year (incidence)•260 000 new cases per year (incidence)•1.4 Mio live with the consequences (prevalence)

Cerebrovascular disease (C d 32 Mi 2003)Cerebrovascular disease (Canada, 32 Mio, 2003)

•50´000 new cases per year (incidence)•300´000 live with the consequences (prevalence)


Sources: British Heart Foundation & Heart and Stroke Foundation of Canada

Morbidity of CVD SwitzerlandMorbidity of CVD, Switzerland

•60´000 cases of myocardial infarction, stroke and cardiac arrest per yearstroke and cardiac arrest per year

•30-40% without specific warning signs


Source: Switzerlanderische Herzstiftung

Mortality of CVD globallyMortality of CVD, globally

•2005: Globally 17.5 Mio death cases / year30% of all death cases– 30% of all death cases

– 7.6 Mio † coronary heart disease (CHD)– 5.7 Mio † cerebrovascular disease

•2010: CVD = Main cause of death in d l i t ideveloping countries


Source: World Health Organization WHO, 2005, http://www.who.int

Mortality of CVD SwitzerlandMortality of CVD, Switzerland

• 2005: 23´000 death cases per year– About 38% of all registered death cases– 9´400 † coronary heart disease (CHD)

4´100 † cerebrovascular disease– 4 100 † cerebrovascular disease

• German CH > Ticino & French CH Men > Women• German CH > Ticino & French CH, Men > Women

• Social gradient (inequality)

• 86.5% (M) und 97% (W) of death cases occur after age 65 (2005)


age 65 (2005)Source: Bundesamt für Statistik, 2005

KHK: Rohraten vs. standardisierte Raten, Schweiz 1969-200CHD: Crude rates vs. age standardized ratesSterbefälle pro 100‘000 Einwohner und Jahr (WHO-Standard- bevölkerung

180

200Death cases per 100‘000 inhabitantsand year (WHO standard population)

bevölkerung „Europa“)

140

160Männer

RohratenC d tMen

100

120

RohratenCrude rates

60

80

Frauen standardisierte RatenAge standardizedrates

Women

40

60 rates

ICD-10

0

20

1970 1975 1980 1985 1990 1995 2000 2005ISPM Zürich,


JahrISPM Zürich, M. Bopp 2006Year

David Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Geschlechterquotient in der Herz-Kreislauf-Mortalität Schweiz 2001/05

Sex-ratio (men vs. women) in CVD-mortality(Switzerland 2001/05)

4

( )

3

3.5

2.5

1.5

2

1

Alter40-44 50-54 60-64 70-74 80-84 90-9445-49 55-59 65-69 75-79 85-89 95+

Age


mb 2007Datenquelle: Todesursachenstatistik (BFS)


Sterbefälle pro 100‘000 Einwohner, standardisiert auf WHO-Alterstruktur „Europa“

Herz-Kreislauf-Mortalität international um 2002

Koronare Herzkrankheiten (I20-I25)

übrige Kardiopathien (I26-I51)

zerebrovaskuläre Krankheiten (I60-I69)

EstlandUngarn

Tschechien

übrige Herz-Kreislauf-Krankheiten (Rest Kap. I)

TschechienÖsterreichDeutschland

USAFinnland

Schottland

Männer FrauenSchottland

SchwedenNorwegenDänemark

NiederlandeEngland&Wales

K dKanadaAustralienItalien

SchweizSpanien

Frankreich

10002000300040005000600070008000

FrankreichJapan

0 1000 2000 3000 4000

Datenquellen: WHO, World Mortality Database / BFS, Todesfälle und Todesursachen (D S N AUS I E 2001 USA DK NL CDN F JAP 2000 It li h ICD 9) M Bopp 2005


(D,S,N,AUS,I,E:2001; USA,DK,NL,CDN,F,JAP: 2000; Italien nach ICD-9) M.Bopp, 2005

CHD and stroke mortality: German vs French CHCHD and stroke mortality: German vs. French CH

French Switzerland : German Switzerland

1

French Switzerland : German Switzerland

scal

e)

MenRat

io (l

og. s

WomenMenR Women

0.1

D

ke

D

ke

Higher mortality in German-speaking areas

CH

D

Stro

k

CH

D

Stro

k

Data: Swiss National Cohort 2000


Source: Faeh et al, JECH 2009 Aug;63(8):639-45

CHD and stroke mortality: German vs French areasFrench Switzerland : German Switzerland

CHD and stroke mortality: German vs. French areas

1

France : Germany

scal

e)

MenRat

io (l

og. s

WomenMenR Women

0.1

D

ke

D

ke

Higher mortality in German-speaking areas

CH

D

Stro

k

CH

D

Stro

k

Data: Swiss National Cohort, 2000Mortality database WHO, 2000


Source: Faeh et al, JECH 2009 Aug;63(8):639-45

60 German Switzerland

French SwitzerlandMen50

French SwitzerlandMen

30

40

vale

nce

(%)

vale

nce

(%)

20

Pre

vP

rev

0

10

Less-than-good health

Current smoking Daily alcohol consumption

Infrequent f ruit consumption

Physical inactivity Obesity

Data: Swiss Health Survey 1992/93


Quelle: Faeh et al, JECH 2009 Aug;63(8):639-45

60 German Switzerland

French SwitzerlandWomen

40

50

French SwitzerlandWomen

30

40

vale

nce

(%)

vale

nce

(%)

20

Pre

vP

rev

0

10

L h d C ki D il l h l I f f i Ph i l i i i Ob iLess-than-good health

Current smoking Daily alcohol consumption

Inf requent f ruit consumption

Physical inactivity Obesity

Data: Swiss Health Survey 1992/93


Quelle: Faeh et al, JECH 2009 Aug;63(8):639-45

Educational inequality in German Switzerland

400

500

600

low

middleersonyears Educational levelMen

200

300

400 middle

high

ity/ 1

00,000

p

0

100

All CVD CHD Stroke

Mortali

200

250

low

iddl

Educational level

rsonyears Women

100

150middle

high

y/ 1

00,000

pe

0

50

All CVD CHD Stroke

Mortality


Source: Faeh et al, BMC Public Health. 2010 Sep 22;10:567Data: Swiss National Cohort 2000

Lethality

•Death cases per 100 disease cases with the same disease

•Tells us how hazardous a disease is inTells us how hazardous a disease is in terms of risk of dying


Relationship morbidity, mortality, lethality

Morbidity* Mortality** Lethality***Men 356 141 39.6%

Women 109 43 39.4%

*All myocardial infarction events (age standardized rates per 100´000)**Mortal myocardial infarction events***Mortality / Morbidity x 100


Source: MONICA/KORA-Herzinfarktregister, Augsburg 2001-2003

Mortality / Morbidity x 100

Lethality of myocardial infarction (MI) & dd di d th (SCD) 25 74sudden cardiac death (SCD), 25-74 y

• 12% die on the first day after hospitalisation (= 29% of all death cases)

• 5.5% die on day 2 - 28 after hospitalisation 5 5% d e o day 8 a te osp ta sat o(= 12% of all death cases)

• 24% die, before they could be hospitalized (= 59% of all death cases)(= 59% of all death cases)


Source: MONICA/KORA-Herzinfarktregister Augsburg 2001-2003

Sudden cardiac deaths (SCD) vs. surviving (24h) myocardial infarction (MI)-patients (25–74y)

Known disease SCD MI

High blood pressure 65% 65%

High cholesterol levels 40% 60%High cholesterol levels 40% 60%

Diabetes 35% 30%

Coronary heart disease 65% 30%

None 25% 25%


Source: Dtsch Med Wochenschr 127(44): 2311-6

Bl d li idBlood lipids

•Total cholesterol (TC)

•High Density Lipoprotein Cholesterol (HDL-C)

•Low Density Lipoprotein Cholesterol (LDL-C)

•Triglycerides (TG)•Triglycerides (TG)


Factors influencing blood lipidsFactors influencing blood lipids•Age

•SexSex

•Genetic background

•Body weight

•Diabetes

•SmokingSmoking

•Other lifestyles (diet, physical activity)


LDL-Cholesterol According to A d BMIAge and BMI

LDL cholesterol (mg/dl)LDL-cholesterol (mg/dl)

175

125

150

BMI > 30 0 kg/m2

100

125 BMI > 30.0 kg/mBMI 27.6-30.0 kg/m2

BMI 25.1-27.5 kg/m2

BMI 20.1-25.0 kg/m2

BMI 20 0 k / 275

16-25 26-35 36-45 46-55 56-65Age (years) Women (n=7,307)

BMI 20.0 kg/m2


Source: PROCAM (Münster Heart Study)

HDL-Cholesterol According to Age and BMI

HDL h l t l ( /dl)HDL-cholesterol (mg/dl)

70

50

60

BMI 20 0 k / 2

40

50 BMI 20.0 kg/m2

BMI 20.1-25.0 kg/m2

BMI 25.1-27.5 kg/m2

BMI 27.6-30.0 kg/m2

3016-25 26-35 36-45 46-55 56-65

Age (years) Women (n=7,328)

BMI > 30.0 kg/m2


Age (years) Women (n 7,328)


Triglycerides According to A d BMIAge and BMI

Triglycerides (median mg/dl)Triglycerides (median, mg/dl)

175200

125150175

BMI >30.0 kg/m2

5075

100g

BMI 27.6-30.0 kg/m2

BMI 25.1-27.5 kg/m2

BMI 20.1-25.0 kg/m2

BMI 20 0 kg/m25016-25 26-35 36-45 46-55 56-65

Age (years) Men (n=16,288)

BMI 20.0 kg/m



Prevalence of Risk Factors in Men by HDL-C

HDL-C < 35 mg/dl(n=1003)

35 mg/dl(n=5698)

p

Cigarette smoking

(n=1003)

44.7

(n=5698)

29.8 < 0.001g gDiabetes mellitusBMI > 30 kg/m2

11.218.7

6.78.5

< 0.001< 0.001g

Triglycerides > 200 mg/dlHypertension

42.229.5

15.326.5

< 0.001< 0.05yp

Family history of MILDL cholesterol > 160 mg/dl

18.032.5

16.134.0

n.s.n.s.LDL cholesterol 160 mg/dl

MI incidence (in 10 years) 11.9 5.1 < 0.001




Relationship of blood lipidsRelationship of blood lipidswith CVDwith CVD

Depending on…

•Age

S•Sex

•Smoking statusSmoking status

•Body weight

•Blood glucose

R l ti hi f bl d li idUniversität ZürichInstitut für Sozial- und PräventivmedizinDavid Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

•Relationship of blood lipids

Incidence of Coronary Events According toHDL Cholesterol and total CholesterolHDL-Cholesterol and total Cholesterol

382

400Incidence of151

118227300

400Incidence of coronary eventsper 1 000 in 8

250-300> 30074

3812936100

200per 1,000 in 8 years

< 200

200-24936

165321

60

100

TotalCh l t l ( /dl)< 35 35-55 > 55 258 coronary events in 4,639

men, aged 40 to 65 years

Cholesterol (mg/dl)

HDL-Cholesterol (mg/dl)


Source: PROCAM (Münster Heart Study) David Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Distribution of Cholesterol to HDL-Cholesterol Ratio and Incidence of Coronary Events

15 20Prevalence (%) Incidence of coronary events

in 8 years of follow-up (%)

y

15

15

20

10

10

15

55

10

0 0

5

00 1.5 2.5 3.5 4.5 5.5 6.5 7.5 8.5 9.5

0

Total Cholesterol to HDL-Cholesterol Ratio


258 coronary events in 4,639 men (40-65 y)


Incidence of Coronary Events According to HDL- & LDL Cholesterol and Glycemic State

Normal fasting glucose(n=5679, 297 events)

Impaired fasting glucose ordiabetes mellitus (n=1022, 107 events)

Incidence per 1.000in 10 years

Incidence per 1.000in 10 years

144150

200

111

147175

154150

200

1

33

72

26 3783100

1

5059

125100

3

2

126

26 26 60

0

50

3

2

159

23 40

0

50

1 2 3

30Tertiles of

HDL cholesterol Tertiles of LDL h l t l

Tertiles ofHDL cholesterol Tertiles of

LDL h l t l

1 2 3

30


LDL cholesterol LDL cholesterolSource: PROCAM (Münster Heart Study)

CVD mortality risk by cholesterol ratio (total : HDL)y y ( )

Men and women, age, sex and wave adjusted

2 00

2.50

y)

1.50

2.00

D mortalit

0.50

1.00

Ratio

(CVD

0.00

0.50

Chol‐Ratio Chol‐Ratio Chol‐Ratio Chol‐RatioHazard R

Chol Ratiom: 1.56 ‐ 4.36w: 1.83 ‐ 3.36

Chol Ratiom: 4.37 ‐ 5.38w: 3.37 ‐ 4.11

Chol Ratiom: 5.38 ‐ 6.67w: 4.12 ‐ 5.08

Chol Ratiom: 6.67 ‐ 23

w: 5.09 ‐ 15.83


Source: Swiss MONICA population, Faeh et al, unpublished data

Lifestyle and blood lipidsLifestyle and blood lipids

• Risk factors– Carbohydrates (fructose, glucose)y ( , g )– Saturated and trans-fat

Obesity– Obesity• Protective factors

– Unsaturated fat– FibresFibres– Physical activity


Effect of dietary fructose on fasting triglycerides1.6

†

Effect of dietary fructose on fasting triglycerides

1.2

1.4

mol

/l)

†

‡

0.8

1id

es (m

m

* *

‡

0.4

0.6

Trig

lyce

r

hit b t l

0

0.2T

white bar: controlgreen bar: fish oilred bar: high-fructosestriped red and green bar: fish oil & high fructose


striped red and green bar: fish oil & high-fructoseSource: Faeh et al, Diabetes. 2005 Jul;54(7):1907-13.

Increase in triglycerides byg y yfructose-induced DNL

NEFANEFA

1

TGTG

FAFA

23

4

5Adipose Adipose tissuetissue

TGTG

GlucoseGlucose

GlycogenGlycogen

FructoseFructose

G ycogeG ycoge

GlucoseGlucoseVLDLVLDLTGTG

GlucoseGlucose


Source: Faeh et al, Diabetes. 2005 Jul;54(7):1907-13.

DNL: De Novo Lipogenesis

Metaanalysis: Dose-dependentff f fhypotriglyceridemic effect of omega-3 fatty acids.


Source: Proc Nutr Soc 1999;58(2):397–401

Low-carbohydrate vs. high-carbohydrate diets


Source: Nutr Metab (Lond) 2005;2:31

Predicted Changes in Serum Lipids and LipoproteinsUse of dietary fats:


Source: Hu et al, JAMA 2002;288:2569-2578

Changes by Diet Group during the Maximum Weight-Loss Phase (1 to 6 Months) and the Weight-Loss Maintenance Phase (7 to 24 Months) of the 2-Year Intervention


Source: Shai et al, N Engl J Med. 2008 Jul 17;359(3):229-41

Risk of mortality from CVD associated with two point increase in adherence score for Mediterranean dietincrease in adherence score for Mediterranean diet

Squares represent effect size; extended lines show 95% confidence intervals; diamond represents total effect size


Source: Sofi et al. BMJ 2008;337:a1344

CVD mortality risk by adherence to Mediterranean di t (t til f )diet (tertiles of scores)

Menandwomen;age sex andwave adjusted

1.2

Men and women; age, sex and wave adjusted

0.8

1.0

ortality)

0.4

0.6

atio (C

VD m

0.0

0.2

Hazard Ra

T 1 T 2 T 3

Mediterranean diet score quintile


Source: Swiss MONICA population, Faeh et al, unpublished data

Summary of the strength of evidence of dietary fat and coronary heart disease (CHD)dietary fat and coronary heart disease (CHD)


Source: Ann Nutr Metab 2009;55:173–201

n–3 LCPUFA: fishoil, T: trans, S: saturated, MU: momo-unsaturated, PU: poly-unsaturated, CHO: carbohydrates

Plasma Lipids Improve with Weight Loss

Total LDL C TG HDL C HDL C

Meta-analysis of 70 Clinical Trials

0.02Total

CholesterolLDL-C TG HDL-C

(weightstable)

HDL-C(activelylosing)

Loss

m0.5

0.00

Wei

ght L

mg/dL p*

*0.0

0 5-0.02

L kg

of W

er kg of ** * -0.5

-1.0

-0.04

m

mol

/L Weight *

-1.5

2 0-0.06

LDL-C=low density lipoprotein cholesterol; HDL-C=high-density lipoprotein cholesterol;*P<0.05.

Loss

-2.0

-2.5


LDL C low density lipoprotein cholesterol; HDL C high density lipoprotein cholesterol; TG=triglyceridesSource: Dattilo et al. Am J Clin Nutr 1992;56:320.

Effects of Exercise Level and Intensity on LDL and

24

HDL Particles in Overweight/Obese MendL

)

67

ol P=0.015

0

8

16

mal

l LD

Ler

ol (m

g/d

23456

Cho

lest

ero

mg/

dL)

-16

-8

0

S

mC

hole

ste

-2-101

H

DL

C(m

P=0.016

0.4

amet

er

m) 4

6

8

e H

DL

ol (m

g/dL

)

P=0.03 P=0.015 P=0.002 P=0.05

0.0

LD

L D

i(n

m

0

2

La

rge

Cho

lest

ero

Control HighAmountModerateI t it

-0.4Low

AmountHigh

Intensity

LowAmountModerateI t it

Control High AmountModerateI t it

-2Low

AmountHigh

I t it

LowAmount

HighI t it

C


Source: Kraus et al. N Engl J Med. 2002;347:1483-1492.

IntensityIntensityIntensity IntensityIntensityIntensity

Indication for drug therapyIndication for drug therapyPrimary prevention

Women Pre-Menopausal

Men, Women Post-Menopausal

Lipid Criteriap Menopausal

Other Risk Other Risk TCmmol/l TC / LDL-C

mmol/lfactors* factors* mmol/l (mg/dl) HDL-C mmol/l

(mg/dl)

0 or 1 0 >8.0 (309) >6.5 >5.0 (194)

2 1 >6.5 (252) >5.0 >4.0 (155)( ) ( )

* Risk factors: 1. Family history of CHD; 2. Age (Men > 50y / women > 60 y); 3. Smoking; 4. Hypertension; 5. (C t l) Ob it ( BMI 30 k / 2) t l H t i l id i 2 0 l / l (175 /dl ) Ph i l i ti it


(Central) Obesity ( BMI >30 kg/m2), central; Hypertriglyceridemia >2,0mmol / l (175mg/dl ); Physical inactivity

RecommendationsRecommendations

DASH Di t A h t St• DASH: Dietary Approaches to Stop Hypertension

• TLC: Therapeutic Lifestyle Changes• TLC: Therapeutic Lifestyle Changes

• VLCD: Very Low Carbohydrate Diet

• Mediterranean diet


Nutrient Composition of TLC DietNutrient Composition of TLC Diet

Nutrient Recommended Intake• Saturated fat Less than 7% of total calories• Polyunsaturated fat Up to 10% of total calories• 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• Cholesterol Less than 200 mg/day• Total calories (energy) Balance energy intake and expenditure• Total calories (energy) Balance energy intake and expenditure

to maintain desirable body weight/prevent weight gain


Source: ATP III Guidelines, Therapeutic Lifestyle Changes (TLC)David Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Examples of daily dietary patterns consistent withAHA recommended dietary goals at 2000 calories

Eating Pattern DASH TLC

AHA-recommended dietary goals at 2000 calories

Grains 6–8 sv/d 7 sv/dVegetables 4–5 sv/d 5 sv/dFruits 4–5 sv/d 4 sv/dFat-free or low-fat dairy

d t 2–3 sv/d 2–3 sv/dproducts 2 3 sv/d 2 3 sv/d

Lean meats, poultry and fish <6oz./d ≤5 oz./d

Nuts, seeds, legumes 4–5 sv/wk Counted in vegetable servingsAmount depends onFats and oils 2–3 sv/d Amount depends on calorie level

Sweets and added sugars 5 or less sv/wk No recommendation


Source: Endocrinol Metab Clin North Am. 2009 Mar;38(1):45-78AHA, American Heart Association; DASH, dietary approaches to stop hypertension; TLC, Therapeutic Lifestyle Changes; sv, serving.

Summary of nutrition guidelines for dyslipidemiatreatment derived from a metanalysistreatment derived from a metanalysis

1. Mediterranean and portfolio diets are recommended.2 Reduce saturated fats to about 10% of total fat intake2. Reduce saturated fats to about 10% of total fat intake.3. Eliminate trans fats.4. Increase monounsaturated fats to 40% of total fat intake.5. Increase polyunsaturated fats (ω-3 fats) to 40%-50% of total fat intake.6. Increase viscous fiber to 50 g/d.7. Increase vegetables to 6 servings per day.8. Increase fruits to 4 servings per day.9 Add plant sterols and nuts to diet9. Add plant sterols and nuts to diet.10.Reduce refined carbohydrates and use low glycemic foods. Use more

complex carbohydrates.11.Consume high quality protein with cold water fish and organic lean meat

and poultry.12 Maintain ideal body weight and body composition


12.Maintain ideal body weight and body composition.

Source: Prog Cardiovasc Dis. 2009 Sep-Oct;52(2):61-94

Mediterranean Diet

1. An abundance of plant foods (eg, fruits, vegetables, potatoes,

breads, grains, beans, nuts, and seeds)

2. Minimally processed and seasonally fresh foods

3. Fresh fruits as the typical daily dessert

4. Olive oil as the principal source of dietary fat4. Olive oil as the principal source of dietary fat

5. Dairy, poultry, and fish in low to moderate amounts

6 Less than five eggs per week6. Less than five eggs per week

7. Red meat in low frequency and amounts

8 Wine in low to moderate amounts (one to two glasses per day for8. Wine in low to moderate amounts (one to two glasses per day for

men and one glass per day for women)


Source: Endocrinol Metab Clin North Am. 2009 Mar;38(1):45-78

Adjusted odds ratio for prevalence in 8 125 subjects fromAdjusted odds ratio for prevalence in 8,125 subjects fromNHANES III by increasing quantities of alcohol consumption

< AlcoholicD i k/M th

1–19 AlcoholicD i k /M th

≥20 AlcoholicD i k /M thDrink/Month Drinks/Month Drinks/Month

Low serum HDL-Cb 1.0 0.69 (0.60–0.78) 0.22 (0.16–0.29)

Elevated triglyceridesc 1.0 0.73 (0.62–0.87) 0.56 (0.43–0.74)


Source: Diabetes Care 2004;27(12):2954–9

Association between alcohol consumption, cardiovascular risk factors and 10 year CAD riskcardiovascular risk factors, and 10-year CAD risk.

HDL cholesterol, systolic blood pressure (BP), and 10-year CAD risk according to last week alcohol consumption.


Source: Am J Cardiol. 2009 Feb 1;103(3):361-8

Approximate and cumulative LDL-C reductionachievable by dietary modification

Dietary Component Dietary Change LDL-C Reduction

achievable by dietary modification

y p y g

MajorSaturated fat <7% of calories 8% 10%Saturated fat <7% of calories 8%–10%

Dietary cholesterol <200 mg/d 3%–5%

Weight reduction Lose 10 lbs (4.5 kg) 5%–8%Other LDL-lowering optionsViscous fiber 5–10 g/d 3%–5%

Plant sterol/stanol esters 2 g/d 6%–15%Plant sterol/stanol esters 2 g/d 6% 15%

Cumulative estimate 20%–30%


Source: Endocrinol Metab Clin North Am. 2009 Mar;38(1):45-78

Recommondations for nutritional supplements ppfor improvement of blood lipids

1. γ-/δ-Tocotrienols: 200 mg per night with food.2. Pantethine: 300 mg 3 times per day (or 450 mg 2 times a day).3. ω-3 Fatty Acids: at 3 to 5 g/d at a ratio of 3 parts EPA, 2 parts DHA, and y g p , p ,

gamma Linoleic acid (GLA) at 75% to 90% of the total DHA and EPA. Vitamin E at 100 IU/d with mostly γ-/δ-tocopherol (80%) should be added to reduce oxidative stress.

4. Niacin (nicotinic acid): various forms at 500 to 3000 mg/d.5. Red yeast rice (high quality and standardized): 2400 mg per night. Doses

of 4800 mg may be safe and even more effective.6. Probiotics: standardized to provide the optimal bacterial count.7. Curcumin: 500 mg/d.8. Green tea extract: standardized to 250 to 500 mg of EGCG twice per day.9 Pl t St l 1 6 t 3 0 /d i di id d d ith f d9. Plant Sterols: 1.6 to 3.0 g/d in divided doses with food.


Source: Prog Cardiovasc Dis. 2009 Sep-Oct;52(2):61-94

Take Home MessagesTake-Home-Messages

• CVD mortality is decreasing in Switzerland but CVD are still a major cause of deathj

• In contrast CVD are increasing in• In contrast, CVD are increasing in developing countries

• Unfavourable blood lipid profile is a majorUnfavourable blood lipid profile is a major risk factor for CVD


Take Home Messages (cont )Take-Home-Messages (cont.)

• Blood lipids should be interpreted individually and in the context of other yCVD risk factors

• Besides age and sex, lifestyle factors strongly influence blood lipidsstrongly influence blood lipids

• An unfavorable blood lipid profile can p psubstantially be improved with lifestyle changes and this decreases CVD risk


changes and this decreases CVD riskDavid Faeh: Cardiovascular Diseases and Blood Lipids, 20.10.2010

Take Home Messages (cont )Take-Home-Messages (cont.)Lif t l h i l dLifestyle changes include1. Keeping a healthy body weightp g y y g2. Replace saturated by unsaturated FA3 Ch l t i t d f i l d t3. Choose plant instead of animal products4. Avoid simple sugar, particularly fructoseo d s p e suga , pa t cu a y uctose5. Increase fibre intake6. Consume alcohol in moderation7 Avoid smoking


7. Avoid smoking


Thank youyfor your attention


cardiovascular diseases andcardiovascular diseases and blood lipidsblood lipids · 2010-10-20 ·...

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