Cardiovascular disease: diet, nutrition and emerging risk factors

Despite improvements in death rates from cardiovascular disease (CVD) around the world, CVD remains a leading cause of death and ill health in the UK, where death rates are amongst the highest in the world. Reducing death rates from this disease remains high on the Government’s agenda, yet attention to the classical risk factors may not provide all the answers.

CVD is a multi-factorial disease, which arises out of interactive effects of different combinations of risk factors. The major classical markers of CVD risk, including high blood pressure, high blood cholesterol levels and smoking, have been well recognised for a number of years. But in recent years a number of other ‘novel’ risk markers have emerged, and understanding of the physiology of and risk factors for heart disease has progressed. The British Nutrition Foundation Task Force Report, launched today, considers these emerging risk markers and in particular their relationship to diet.

A better understanding of the impact of diet on these may help to identify new ways of determining those at risk and provide additional approaches to prevent and treat the condition. Professor Keith Frayn from the University of Oxford, Chairman of the Task Force, said ‘this timely and comprehensive report provides an authoritative and independent account of the relationship between diet and the emerging risk factors for cardiovascular disease. It will be of use to policy makers, health professionals, the food industry, students of health related subjects and the media’.

UK dietary guidelines in relation to CVD date back to the 1994 report published by the Government’s Committee on Medical Aspects of Nutrition (COMA) and largely focus on reduction of total fat and saturates intake as a means of modifying blood cholesterol levels. The emerging evidence that has been reviewed by the Task Force supports the need to re-examine these dietary guidelines. The Task Force’s analysis of the interaction of diet with emerging risk factors suggests that other risk factors (in addition to the classical ones) are also influenced by diet, in particular the type of dietary fat, and that greater emphasis on dietary fat quality (the overall fatty acid profile of the diet) is now justified, in the context of a varied diet, rich in fruit, vegetables and whole grain cereals. This means that for the majority of the population, moderation in fat intake still needs to be advised, but there needs to be more emphasis on partial replacement of saturates with unsaturated fatty acids (mono- and polyunsaturates). In particular, average intakes of long chain n-3 fatty acids (as found in oily fish) are well below recommendations, as highlighted recently by the Food Standards Agency.

The report also emphasises the importance of a physically active lifestyle, which is linked to improving some risk factors for CVD, and avoidance of obesity. Other risk factors that have been reviewed by the Task Force include subtle alterations in types of fat other than cholesterol in the blood stream, factors associated with inflammation and with blood clotting, lowered resistance to oxidative stress, abnormal insulin responses, raised blood homocysteine and impaired functioning of blood vessels. The evidence concerning the influence of experiences in early life, even before birth, on later disease risk has also been considered.

http://www.nutrition.org.uk/