Food and cardiovascular heart disease Pedro Marques-Vidal IUMSP Lausanne, Switzerland

Coronary heart disease In the next 10 minutes, in Europe – 40 people will die of myocardial infarction – 80 will die of cardiovascular disease – At a cost of 3.2 million € Each year, one out of 40 Europeans is hospitalized for cardiovascular disease Cost estimated at 169 billion € in 2006, increasing to 192 billion € in European Journal of Cardiovascular Prevention and Rehabilitation, 14 (2007) Suppl2, E1 Leal et al. European Heart Journal 27 (2006):1610

Outline Cardiovascular risk factors and diet Case stories of dietary prevention ESC guidelines on dietary prevention Conclusion

What causes heart disease Smoking High cholesterol High blood pressure Diabetes Thomas et al, Archives des Maladies du Coeur et des Vaisseaux, 100 (2007): 57 80% of coronary deaths in France Modifiable by dietary interventions

High cholesterol / fat Decreasing saturated and increasing polyunsaturated fat can lead to – 14% in total cholesterol – 44% in the risk of heart disease 1. Increasing trans fatty acids can lead to a 28% increase in the risk of heart disease 2. 1 Turpeinen et al. International Journal of Epidemiology 8 (1979):99 2 Oomen et al., Lancet. 357 (2001):746

High blood pressure Effect on systolic blood pressure of: Less salt 1 : 5 mm Hg More fruit & vegs 2 : 3 mm Hg More fruit & vegs, less fat 2 : 5 mm Hg All together 3 : 11 mm Hg Stronger effect in subjects with hypertension 1 Forte et al, Journal of Human Hypertension, 3 (1989): Appel et al. New England Journal of Medicine 366 (1997): Sacks et al. New England Journal of Medicine. 344(2001):3

Diabetes Less weight Less total and saturated fat More fiber More physical activity = 58% decrease in the risk of developing type 2 diabetes Tuomilehto et al. New England Journal of Medicine. 344 (2001):1343

Effect of diet on CV deaths Salt (-3 g/day) 1 :16% Fish (4x/week) 2 :14% Fruit (+1 portion/day) 3 : 7% Vegetables (+1 portion/day) 3 : 4% Fat (replace SFA by PUFA) 4 : 12% Overall:53% Theoretical 5 :75% 1 Law et al, British Medical Journal. 302 (1991):819 2 Whelton et al, American Journal of Cardiology 93 (2004): Dauchet et al. Journal of Nutrition 136 (2006): Hu et al, Journal of the American Medical Association. 288 (2002): Franco et al. British Medical Journal. 329 (2004):1447

Finland: North Karelia Project % Use of vegetable oil for cooking % Use of vegetable oil for cooking (men age 30-59) Use of butter for cooking

Mortality per population Year North Karelia (-82%) Finland (-75%) start of the North Karelia Project extension of the Project nationally Finland: North Karelia Project Vartiainen et al, British Medical Journal 311(1995):589

Poland Zatonski et al, British Medical Journal 316 (1998): 1047

Czech Republic Bobak et al. Journal of Epidemiology and Community Health. 51 (1997)272-

Czech Republic Bobak et al. Journal of Epidemiology and Community Health. 51 (1997)272-

GISSI – Prevenzione trial: effect of Omega-3 PUFAs on mortality Marchioli R et al. Circulation 105 (2002): % in all deaths, 30% in cardiovascular deaths

Mediterranean diet Adherence to a Mediterranean-type diet – 30% the risk of dying from heart disease in the general population 1. – 37% the risk of cardiovascular events after myocardial infarction 2. – 18% the risk of dying among European elderly with previous myocardial infarction 3. 1 Trichopoulou et al, New England Journal of Medicine, 348 (2003): De Lorgeril et al, Journal of the American College of Cardiology. 28 (1996): Trichopoulou et al, European Journal of Epidemiology. 22 (2007):871

European Journal of Cardiovascular Prevention and Rehabilitation, 14 (2007) Suppl2, E1

Salt in breakfast cereals Current recommendations: <5 g/day Mancia et al, European Heart Journal 28 (2007): 1462

Salt in vegetable soups Current recommendations: <5 g/day Mancia et al, European Heart Journal 28 (2007): 1462

Conclusion Heart disease represents a health and economical issue in Europe Dietary prevention works at the population and individual level… …but has to be implemented!

Thank you!