Optimal Diets for Prevention of Coronary Heart Disease

Frank B. Hu, MD, PhD; Walter C. Willett, MD, DrPH

JM. !""!;!##$!%&'(!%)#.
Conte*t Coronary heart +isease ,CHD- remains the lea+in. /ause of
mortality
in in+ustriali0e+ /ountries an+ is rapi+ly 1e/omin. a primary /ause of
+eath
2orl+2i+e. 3hus, i+entifi/ation of the +ietary /han.es that most
effe/tively
prevent CHD is /riti/al.
O14e/tive 3o revie2 meta1oli/, epi+emiolo.i/, an+ /lini/al trial
evi+en/e
re.ar+in. +iet an+ CHD prevention.
Data 5our/es an+ 5tu+y 5ele/tion We sear/he+ M6D7896 throu.h May !""!
for
epi+emiolo.i/ an+ /lini/al investi.ations of ma4or +ietary fa/tors ,fat,
/holesterol, ome.a(: fatty a/i+s, trans(fatty a/i+s, /ar1ohy+rates,
.ly/emi/
in+e*, fi1er, folate, spe/ifi/ foo+s, an+ +ietary patterns- an+ CHD. We
sele/te+ ;<) ori.inal investi.ations an+ revie2s of meta1oli/ stu+ies,
epi+emiolo.i/ stu+ies, an+ +ietary intervention trials of +iet an+ CHD.
Data 6*tra/tion Data 2ere e*amine+ for relevan/e an+ =uality an+
e*tra/te+
1y ; of the authors.
Data 5ynthesis Compellin. evi+en/e from meta1oli/ stu+ies, prospe/tive
/ohort stu+ies, an+ /lini/al trials in the past several +e/a+es
in+i/ates
that at least : +ietary strate.ies are effe/tive in preventin. CHD$
su1stitute nonhy+ro.enate+ unsaturate+ fats for saturate+ an+ trans(
fats;
in/rease /onsumption of ome.a(: fatty a/i+s from fish, fish oil
supplements,
or plant sour/es; an+ /onsume a +iet hi.h in fruits, ve.eta1les, nuts,
an+
2hole .rains an+ lo2 in refine+ .rain pro+u/ts. Ho2ever, simply lo2erin.
the
per/enta.e of ener.y from total fat in the +iet is unlikely to improve
lipi+
profile or re+u/e CHD in/i+en/e. Many issues remain unsettle+, in/lu+in.
the
optimal amounts of monounsaturate+ an+ polyunsaturate+ fats, the optimal
1alan/e 1et2een ome.a(: an+ ome.a(& polyunsaturate+ fats, the amount an+
sour/es of protein, an+ the effe/ts of in+ivi+ual phyto/hemi/als,
antio*i+ant vitamins, an+ minerals.
Con/lusions 5u1stantial evi+en/e in+i/ates that +iets usin.
nonhy+ro.enate+
unsaturate+ fats as the pre+ominant form of +ietary fat, 2hole .rains as
the
main form of /ar1ohy+rates, an a1un+an/e of fruits an+ ve.eta1les, an+
a+e=uate ome.a(: fatty a/i+s /an offer si.nifi/ant prote/tion a.ainst
CHD.
5u/h +iets, to.ether 2ith re.ular physi/al a/tivity, avoi+an/e of
smokin.,
an+ maintenan/e of a healthy 1o+y 2ei.ht, may prevent the ma4ority of
/ar+iovas/ular +isease in Western populations.
uthor ffiliations$ Departments of 9utrition an+ 6pi+emiolo.y, Harvar+
5/hool of Pu1li/ Health, an+ Channin. 7a1oratory, Department of
Me+i/ine,
Bri.ham an+ Women>s Hospital an+ Harvar+ Me+i/al 5/hool, Boston, Mass.