Low adherence of a clinically healthy Italian population to nutritional recommendations for primary prevention of chronic diseases

Background and aimSeveral data demonstrated that dietary habits significantly affect the health state of the population. During recent years all the major scientific associations have provided nutritional recommendations for primary prevention of chronic diseases but few data are available about prevalence of adherence to these recommendations in an otherwise healthy population. The aims of this study were to evaluate dietary habits, and to assess the adherence of the general population to the recommendations for correct nutritional behaviour.Methods and resultsDietary habits, anthropometric and biochemical parameters were evaluated in a population of 932 (367 M; 565 F) clinically healthy subjects living in Florence, enrolled in an epidemiologic study conducted between 2002 and 2004. By comparing the dietary pattern with the nutritional guidelines, the study population reported a hyperproteic and hyperlipidic nutritional pattern, with a considerably low contribution from polyunsaturated fats (PUFA). A low fibre intake is shown in both genders. In addition, food consumption pattern showed an increased consumption of some foods such as meat, both fresh and processed, and a low intake of some “healthy” foods like fruit and vegetables.ConclusionsWe found several nutritional flaws in the dietary habits of a clinically healthy Italian population. In particular, we reported a high intake of animal protein and total fats with a very low contribution from PUFA.     

Lipid-lowering therapy with statins for the primary and secondary prevention of cardiovascular disease

Cardiovascular disease (CVD) still ranks as the top cause of mortality worldwide. Lipid-modifying therapy has revolutionized the treatment of the disease and is partly responsible for the recent decline in deaths due to CVD. Treatment strategies have evolved since the introduction of the earlier lipid-lowering agents (fibrates, niacin, bile acid resins) to the advent of statins, which have become the standard drugs in cholesterol therapy. The strategy of using high-intensity statin therapy as the initial treatment approach in high-risk individuals, rather than focusing on specific cholesterol levels alone, remains a subject of debate.     

The association of dietary macronutrients composition with the incidence of cardiovascular disease,using iso-energetic substitution models: Tehran lipid and glucose study

Background and aimsDietary macronutrient composition plays an important role in the prevention of cardiovascular disease (CVD). This study aimed at assessing the iso-energetic substitution of dietary macronutrients in relation to the incidence of CVD.Materials and resultsThis prospective study was conducted on 5102 individuals of Tehran lipid and glucose study participants, aged 20–70 years who were followed for 5.3 years. A valid and reliable semi-quantitative food frequency questionnaire was used to assess dietary intakes. The hazard ratio of CVD for each 5% of energy from macronutrients at the expense of another macronutrient was calculated using the substitution model.During follow-up, a total of 206 CVD outcomes were identified. Mean age of participants (44.2% men) was 47.0 ± 12 and 45.6 ± 11 for men and women, respectively. Substituting 5% of energy from all types of macronutrients by 5% percentage of energy from combined saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) was associated with a decrease in the risk of CVD by almost 20%. Higher energy intake from total-, starchy-, and nonstarchy carbohydrates replaced by other macronutrients was not significantly associated with the risk of CVD. Each 5% of energy from animal protein (HR: 1.09 and CI: 1.02–1.16) independently increased the risk of CVD in the adjusted Cox proportional hazard regression analyses.ConclusionHigher percentage of energy from animal protein independently increased the risk of CVD, replacement of SFA and MUFA together with other macronutrients was inversely associated with CVD risk.     

Rheumatic heart disease in the developing world: prevalence,prevention, and control

Rheumatic heart disease (RHD) continues to be a common healthproblem in the developing world, causing morbidity and mortalityamong both children and adults. Although little longitudinaldata are available, evidence suggests that there has been littleif any decline in the occurrence of RHD over the past few decades.Recent reports from the developing world have documented rheumaticfever (RE) incidence rates as high as 206/100 000 and RHD prevalencerates as high as 18.6/1000. The high frequency of RHD in thedeveloping world necessitates aggressive prevention and controlmeasures. The major interventions for prevention and controlinclude: (1) reduction of exposure to group A streptococci,(2) primary prophylaxis to prevent initial episodes of RF, and(3) secondary prophylaxis to prevent recurrent episodes of RE.Because recurrent episodes of RE cause increasingly severe cardiaccomplications, secondary prophylaxis is the most crucial featureof an effective RHD programme. For some impoverished countries,secondary prophylaxis may be the only intervention that canrealistically be implemented. In addition to this intervention,however, financial and human resources must be committed, andall of these elements must be integrated into existing primaryhealth care systems. Because RHD continues to be a common healthproblem in the developing world, greater emphasis needs to beplaced on the simple and cost-effective prevention and controlmeasures that are currently available to combat this disablingdisease.     

从指南到临床:谈阿司匹林在心脑血管疾病一级预防中的应用

心脑血管疾病是全球性的健康问题,位居全球死亡原因之首。因其高发病率、高患病率、高病死率、高致残率以及高复发率,给社会和家庭带来沉重的负担。一级预防是减少心脑血管疾病发病和减轻其疾病负担的关键。阿司匹林是目前循证医学证据     

Associations of dietary protein intake with all-cause,cardiovascular disease,and cancer mortality: A systematic review and meta-analysis of cohort studies

Background and aimsThe relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD), and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence.Methods and resultsWe searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal, and plant proteins with all-cause, CVD, and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model was employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD, and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR = 0.92; 95% CI: 0.88, 0.96; each 3% increment of intake: RR = 0.97; 95% CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR = 0.90; 95% CI: 0.80, 1.01; each 3% increment of intake: RR = 0.95; 95% CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR = 1.11; 95% CI: 1.01, 1.22; each 3% increment of intake: RR = 1.02; 95% CI: 0.98, 1.06).ConclusionThis study demonstrates that higher plant protein intake is associated with a reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.     

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

Background

Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke.

Methods

A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20–70 years recruited into the EPIC-NL study during 1993–1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk.

Results

After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk.

Conclusion

The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke.     

Physical activity and the prevention of cardiovascular disease: from evolution to epidemiology

For most of human history, the environmental demands of survival necessitated prodigious amounts of physical exertion. The avoidance of predators, hunting, gathering, and the literal “chopping wood and carrying water” of daily existence provided a wholesome dose of physical activity that obviated the need for deliberate exercise. Nevertheless, 21st century humans are now immersed within an environment explicitly designed to eliminate physical labor. Over the past century and especially the past 50 years, an accrual of epidemiological evidence has established that the unintended consequence of humankind's predilection for labor-saving contrivances is an epidemic of hypokinetically induced cardiovascular disease, morbidity, and mortality. This review surveys data from observational studies supporting the premise that physical activity, exercise training, and improvements in cardiorespiratory fitness are essential elements in the prevention and treatment of the cardiovascular diseases induced by an environment in which survival no longer obligates physical exertion.     

Population implications of lipid lowering for prevention of coronary heart disease: data from the 1995 Scottish health survey

OBJECTIVE—To determine the proportion of the population, firstly, with cholesterol  5.0 mmol/l and, secondly, with any cholesterol concentration, who might benefit from statin treatment for the following: secondary prevention of coronary heart disease (CHD); primary prevention at CHD risk 30%, 20%, 15%, and 6% over 10 years; and primary prevention at projected CHD risk 20% over 10 years (CHD risk at age 60 years if actual age < 60 years).
SUBJECTS—Random stratified sample of 3963 subjects aged 35-64 years from the Scottish health survey 1995.
RESULTS—For secondary prevention 7.8% (95% confidence interval (CI) 6.9% to 8.6%) of the population with cholesterol  5.0 mmol/l would benefit from statins. For primary prevention, the prevalence of people at CHD risk 30%, 20%, 15%, and 6% over 10 years is 1.5% (95% CI 1.2% to 1.9%), 5.4% (95% CI 4.7% to 6.1%), 9.7% (95% CI 8.8% to 10.6%), and 32.9% (95% CI 31.5% to 34.4%), respectively. At projected CHD risk 20% over 10 years, 12.4% (95% CI 11.4% to 13.5%) would be treated with statins. Removing the 5.0 mmol/l cholesterol threshold makes little difference to population prevalence at high CHD risk.
CONCLUSIONS—Statin treatment would be required for 7.8% of the population for secondary prevention. For primary prevention, among other factors, guidelines should take into account the number of patients needing treatment at different levels of CHD risk when choosing the CHD risk to target. The analysis supports a policy of targeting treatment at CHD risk 30% over 10 years as a minimum, as recommended in current British guidelines, with a move to treating at CHD risk 15% over 10 years as resources permit.


Keywords: statins; coronary risk; secondary prevention; primary prevention     

Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease.

AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reductions in cholesterol and blood pressure. High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population. Aggressive pharmacological treatment (using statins, beta-blockers, ACE-inhibitors and aspirin) in individuals with a 10-year Framingham event risk of >or=30% (6% of population) would have reduced major CVD by at most 11%. This figure increased to 34% at a >or=20% treatment threshold (26% of population). In contrast, modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD. Taking regression dilution bias into account, 10% reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45%. CONCLUSIONS: If high-risk strategies are to have a major impact on CVD in the population, they need to be more widely used than previously envisaged. Population-wide reduction of major risk factors is needed if CVD is to be substantially reduced.     

Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention

A workshop was held September 27 through 29, 1999, to address issues relating to national trends in mortality and morbidity from cardiovascular diseases; the apparent slowing of declines in mortality from cardiovascular diseases; levels and trends in risk factors for cardiovascular diseases; disparities in cardiovascular diseases by race/ethnicity, socioeconomic status, and geography; trends in cardiovascular disease preventive and treatment services; and strategies for efforts to reduce cardiovascular diseases overall and to reduce disparities among subpopulations. The conference concluded that coronary heart disease mortality is still declining in the United States as a whole, although perhaps at a slower rate than in the 1980s; that stroke mortality rates have declined little, if at all, since 1990; and that there are striking differences in cardiovascular death rates by race/ethnicity, socioeconomic status, and geography. Trends in risk factors are consistent with a slowing of the decline in mortality; there has been little recent progress in risk factors such as smoking, physical inactivity, and hypertension control. There are increasing levels of obesity and type 2 diabetes, with major differences among subpopulations. There is considerable activity in population-wide prevention, primary prevention for higher risk people, and secondary prevention, but wide disparities exist among groups on the basis of socioeconomic status and geography, pointing to major gaps in efforts to use available, proven approaches to control cardiovascular diseases. Recommendations for strategies to attain the year 2010 health objectives were made.     

Dairy foods, dietary calcium and obesity: a short review of the evidence

The possible association between dairy products consumption and body weight regulation has been the subject of several recent publications. The interest in this issue arose after biologically plausible mechanisms for this association were identified: most of these suggested a key role for calcium intake from dairy products, although calcium-independent mechanisms have also been proposed. Data from cross-sectional epidemiological studies support the hypothesis that a dairy food-rich diet is associated with lower fat accumulation in adults and children; however, prospective studies and randomised controlled intervention trials have yielded inconsistent results. Different reasons could explain these findings that regard the evaluation of either the “exposure” (i.e. the methodological problems in the assessment of dietary intake of nutrients over a long time) and the “outcome” (i.e. multiple factors involved in the regulation of body weight). Moreover, it could also be hypothesised that high consumption of dairy foods would be a marker of healthier lifestyles, or that nutritional differences exist within dairy products. Available data do not unequivocally support the hypothesis that a causal relationship exists between high dairy food intake -and/or high dietary calcium intake- and lower fat mass deposition. However, research in this field should aim to define the health impact of dairy foods even beyond obesity.