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Unformatted text preview: Practical Revie^ws The Power of a Balanced Diet and Lifestyle in Preventing Cardiovascular Disease Rachel Herder, B.A., and Barbara Demmig-Adams, Dr. rer. nat. ABSTRACT We examine the physiologic changes involved in the onset of cardiovascuiar disease (CVD) as weii as multi- pie dietary and iifestyie factors that either promote or prevent CVD. Dietary fats (saturated, monounsatu- rated, n-3 and n-6 poiyunsaturated, ond frons fats), antioxidants, ond carbohydrates, as weil as alcohol consumption, exercise, smoking, and infections, are evaluated. Epidemioiogic studies and ciinical trials ore discussed in light of the underlying mechanisms, Nutr Clin Care. 2004,7:46-55 KEY WORDS; atherosclerosis, gene regulation, infiorm- motion, oxidation, glycemic lood 2004 Inteniationat Life Sciences Insliliile INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death in industrialized countries.^ In the United States, an estimated one million people die annually from CVD, with myocardial infarctions (heart attacks) accounting for a large proportion of this mortality.- This review will summarize recent findings indicating that CVD can be prevented by "prudent" lilest^'le choices, including a well-balanced diet, weiglit man- agement, physical activity, not smoking, and other factors. For almost a centur}', a link between cardiovascular disease and diet has been suspected. In 1908, Igna- towksi reported a link between arterial plaque forma- Df. Demmig-Adoms and Ms, Herder are with the Deportment of Ecology and Evolutionary Biology, University of Coiorodo. Bouider, CO 80309- 0334. tion (atherosclerosis) and diets high in saturated fats.' Beginning in the 1950s, epidemiologic and controlled human diet studies showed an association between the intake of saturated fatty acids and blood choles- terol levels.^ Since this time, the hypothesis of a direct link between diet and CVD has dominated epidemio- logic and clinical investigations.^ Dietary (and other external) factors interact with the processes leading to CVD (Figures 1 and 2). Inap- propriate dietar)^ and lifest)ie choices, such as smok- ing, interfere with the regulation of metabolism and lead to inflammation, oxidation by free radicals, and other changes that cause CVD. In addition, a balanced diet and physical activity can reduce atherosclerosis and prevent CVD. BACKGROUND Wliile mounting evidence suggests that diet and life- st>'le factors strongly contribute to the onset of CVD, the hypotheses concerning the mechiinism of athero- sclerosis have changed dramatically over the past de- cade. Libb}-^ writes, "As recently as five years ago, most physicians would have confidently described atherosclerosis as a straight plumbing problem: fat- laden gunk gradually builds up on the surface of passive artery walls. If a deposit (plaque) grows large enough, it eventually closes off an affected 'pipe', preventing blood flow from reaching its intended tissue." Based on this hypothesis, a low-fat diet andtissue....
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