Cardiac Trials Review

By pjain      Published Dec. 7, 2020, 12:14 a.m. in blog Health   

==== DIA/CVD Standard Care, Diet, Fitness Common "Knowledge" and Myths

Weight - Calories In/Out

DIA: Do whatever it takes to keep BG in control - Glipizide/Insulin

CVD: LowFatHighCarb - mostly Refined/processed foods

  • Starting with low dietary Cholesterol - PROBLEM: Bulk of Cholesterol made by body itself in liver, etc.
  • 1980s Saturated fats to avoid blockages
  • 2000s Trans-Fats

Even in 2020, the FDA, AHA, drug makers and food industry all still push the continued demonization and general avoidance of dietary fat in favor of "big 4 grains", dairy and animal proteins - the SAD.

The HUGE PROBLEM: Protein is hard to get more than 10-20%, With Fat 10-30% it ends up with Carbs 60-80%. Worse, as majority of calories are eaten outside home or from packaged goods (bread,pasta,mac-n-cheese), these carbs are REFINED with little fiber so taste is better and for longer shelf life.

Low Dose Aspirin 81mg/day helps inflammation

Use Statins - lower lipids

The powerful effects of statin drugs in lowering the levels of fasting cholesterol, combined with an unbalanced focus on fasting lipids (as opposed to postprandial fat and oxidative stress)

DIA/CVD Medium to Advanced Care Trials Review

BP: Tighten control to <125/75 - preferably by relaxation, sleep, breathing = not just drugs!

BP: DASH DIET - Plants/Veggies, Antioxidants REALLY worth it

BP: DIA Meds : Better BP control - better CVD outcomes now required

n3 PUFAs, MUFAs far better than Carbs - type/source of fats matter more than Macros

Evidence is clear that the types of foods supplying these nutrients – are more important than the total amounts of fats and carbohydrates in the diet.

  1. PROBLEM: CVD: Low Fat Diet only lowers LDL 5-10% vs Statin -50% Because the statins can lower fasting lipids by 50% to 60%, and a low-fat diet only lowers fasting cholesterol by 5% to 10%, this error of diets role being ignored is perhaps understandable.
  2. Replacing saturated fat with carbohydrates, specifically refined, has no benefit on CVD risk,

SOLUTION: substituting polyunsaturated fats for either saturated fat or carbohydrate reduces risk. Dietary patterns and foods that contain plant and marine sources of unsaturated fats. Yet, after decades of focus on low-fat diets, many consumers, food manufacturers, and restauranteurs remain confused about the role of dietary fats on disease risk and sources of healthy fats. Shifting dietary recommendations to focus on food-based dietary patterns would facilitate translation to the public and potentially remedy widespread misperceptions about what constitutes a healthful dietary pattern.

MicroNutriets matter: VitD really worth it!

CVD: MEDI diet lowers MI 60% vs AHA SAD diet

Reduce Extra Risks beyond Statins

hCare: Nutrition ignored vs Drugs

  • Diets Ignored for Meds - "Compliance" issues
  • FDA waffling
  • Drs Lack time - faith in wonder statin drugs have led many physicians and patients to not focus on diet role.

CVD Diet Modifications Trials Review

Cretan Mediterranean diet Study

  1. Cretan Mediterranean diet high in beneficial oils, whole grains, fruits, and vegetables and low in cholesterol and animal fat, has been shown to reduce stroke and myocardial infarction by 60% in 4 years compared with the American Heart Association diet.

  2. This may be related to the broad combination of antioxidants included in a healthy diet. A Cretan Mediterranean diet is probably more effective because it provides a wide range of antioxidants from fruits and vegetables of all colors.

  3. This effect is twice that of simvastatin for reduction of myocardial infarction by 40% in 6 years - Scandinavian Simvastatin Survival Study.

Homocysteine Controversy - Vitamin B12 MUCH LOWER levels

Vitamins for lowering plasma total homocysteine with folate, B6, and B12 may not conclusively been shown to be beneficial for reduction of stroke. A key issue is the high prevalence of unrecognized deficiency of vitamin B12, requiring higher doses of vitamin B12 than have been used in clinical trials to date. This is much worse in Vegetarians and the elderly than is commonly appreciated. Therefore higher doses of B12, and possibly additional therapies to lower homocysteine, may be required to achieve adequate reductions of total homocysteine. - Nutrition and Stroke Prevention J. David Spence, MD, FRCPC, 2020

  • PROBLEM: Duplication fruitless - little incremental value over balanced diets

Similarly, studies to duplicate results with vitamin supplementation the evidence of benefit for vitamins E, C, and beta carotene have been largely fruitless.

This may be related to the broad combination of antioxidants included in a healthy diet. A Cretan Mediterranean diet is probably more effective because it provides a wide range of antioxidants from fruits and vegetables of all colors.

Sat Fat to PUFAs, Fish oil intake, No TransFats

Study Years Result
Chowdhury 2014
Skeaff,Milelr 2009
Mente 2009
DART 1989
STARS 1992
Lyon Heart 1988-1992
LA Veterans 1969
MRC Soy 1968
Minnesota Coronary Svy 1968-73
Rose Corn Oil 1965
Oslo Diet Heart 1958-64
Sidney Diet Heart 1958-64

Stroke Prevention

Studies

Nutrition and Stroke Prevention J. David Spence, MD, FRCPC, 2020, dspence@robarts.ca


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