Most physicians are aware of the importance of lifestyle factors in preventing cardiovascular disease (CVD) -- and believe diet is as important as statin therapy and exercise, according to a new survey from NYU Langone Medical Center.
Researchers found that a majority of doctors would welcome additional training in diet and nutrition so that they can effectively inform patients on the subject. The study will be presented at the American College of Cardiology's 64th Annual Scientific Session as a poster presentation.
The 28-question online survey, created by a team from the NYU Langone Center for the Prevention of Cardiovascular Disease, was designed to identify gaps in nutritional knowledge and to evaluate physician attitudes and practices concerning diet in the prevention of CVD. The survey was completed by 236 cardiologists and internal medicine physicians and trainees.
Most of the survey respondents (78 percent) were open to additional training and thought it would result in better patient care. Just over half of the physicians said they currently spend three minutes or less educating patients on diet and lifestyle.
Overall the survey respondents did comparatively well, answering about two thirds of the knowledge-based questions correctly. Surprisingly, cardiologists scored no better than internal medicine physicians.
"We found physicians had a decent knowledge of general nutritional principles, but their practical knowledge was somewhat suboptimal," said lead study author Nicole Harkin, MD, chief cardiology fellow at the NYU Langone Center for the Prevention of Cardiovascular Disease. The majority knew that eating fruits and vegetables lowers blood pressure and that consuming soluble fiber reduces LDL-cholesterol (82 percent and 88 percent, respectively). About 70 percent correctly identified a vegetable high in soluble fiber, but just 31 percent identified an oily fish.
Nearly all of the physicians knew that the Mediterranean diet has been shown to reduce cardiovascular disease in randomized controlled trials. Just under half of the respondents also knew that low-fat diets have never been shown to do so. The Mediterranean diet was most often recommended by survey respondents, followed by low-fat, DASH, and low-glycemic-index diets.
According to the American College of Cardiology, heart-healthy diets are vital for CVD risk reduction. The ACC recommends physicians provide dietary guidance to those at risk for or with established CVD.
"The fact that most physicians would welcome additional training in diet is a useful--and hopeful--finding of the study," says Dr. Harkin. "It speaks to where we are now in medicine. Patients, too, are looking for additional ways to improve their cardiovascular risk."
Diet education for physicians could be expanded in a variety of venues: in medical school and in residency and fellowship training, as well as continuing education, according to senior study author Eugenia Gianos, MD, assistant professor of medicine in the Leon H. Charney Division of Cardiology and Director of the Preventive Cardiology Fellowship program at NYU Langone Medical Center.
Most of the physicians didn't routinely refer their patients to a dietitian or nutritionist. "There's room for change in that area," says Dr. Gianos, "because partnering with a dietitian is an optimal way to educate and support the patient and can enhance the physician's own expertise as well."
Improved physician knowledge concerning diet has the potential to translate into better patient outcomes because patients look to their doctors for guidance on lowering CVD risk. "If a physician emphasizes diet, a patient is likely to do so as well," says Dr. Gianos.
Higher diet quality associated with reduced risk of prostate cancer grade reclassification