Efficacy of alcohol for coronary heart disease

Efficacy of alcohol for coronary heart disease

Alcohol consumption has a complex effect on cardiovascular diseases (CVD). Observational studies have shown that consuming large amounts of alcohol increases total mortality (OS) and mortality from cardiovascular disease (CVD).

In contrast,> 100 prospective studies showed an inverse relationship between low and moderate alcohol consumption and the risk of heart attacks, ischemic stroke, peripheral arterial disease (PAD), sudden cardiac death (SCD) and death from all cardiovascular causes. The effect is relatively permanent and corresponds to a risk reduction of 20-45%.
Moderate alcohol consumption is associated with a decrease in USA in primary and secondary prevention in both men and women. The mechanisms underlying the effect of moderate alcohol consumption (1-2 servings per day) contribute to the increase in cholesterol level of cholesterol levels, improve fibrinolytic ability, reduce platelet aggregation and CRP levels.

Studies have clearly shown the protective effect of alcohol on cholesterol. Although there is an assumption about the unique cardioprotective properties of red wine, most studies have found the same positive effect of different types of alcohol when it is moderately consumed.

Recommendations for taking alcohol. Although the association of alcohol with a reduced risk of coronary heart disease (CHD) is probably causal, individual and community recommendations must take into account the complexity of the metabolic, nutritional and psychological effects of alcohol. The consumption of small or moderate portions of alcohol or a large amount of alcohol causes a protective or harmful effect, respectively.

All patients should be advised to avoid excessive alcohol consumption. For certain patients, a discussion about alcohol can be part of routine preventive counseling. In general, 1-2 servings of alcohol (drink) are safe for men, but for women it is more reasonable to limit themselves to smaller doses, because they usually have less body mass (MT) and there are differences in hepatic metabolism.

However, counseling must be strictly individual; when discussing the problem of alcohol consumption, other coronary risk factors (RF) (especially hypertension and diabetes), as well as a family history of liver disease, alcoholism, breast cancer or colon should be taken into account.

Endpoints for nutritional studies of patients with coronary heart disease (CHD)

Endpoints for nutritional studies of patients with coronary heart disease (CHD)

There are very few studies that have studied the effect on KBS of only a modified diet. In the Lyon Diet Heart Study, in which 605 patients undergoing myocardial infarction participated, patients were randomized into 2 groups: (1) on a diet of the Mediterranean type; (2) on a typical western diet. After 46 months of follow-up, the risk of cardiovascular death or MI was 65% less in the Mediterranean diet group.

Recommendations for diet. Taking into account the limited research results, it is difficult to answer the patient’s question: “What should I eat to prevent heart disease?” However, based on observational studies, patients should be advised to follow a few general principles that arise from the available data. The basis of an improved diet should be a simple set of rules:

• Total calorie intake must be balanced with energy costs. If body weight (MT) is desirable to reduce, then you need to consume less calories than you spend.
• Avoid simple carbohydrates (sugars and starch) that create a high glycemic load, and replace them with sources of carbohydrates that contain a lot of fiber (whole grains, beans) to slow down the absorption of sugars and reduce the insulin response.
• Maximize the consumption of fruits and vegetables. U.S. The Department of Agriculture recommends 1-2.5 servings of fruit and 1-4 servings of vegetables per day.
• Minimize the consumption of saturated fatty acids and trans fats. Instead, you should choose monounsaturated and polyunsaturated fatty acids, whole grains. It is shown that adequate consumption of omega-3 fatty acids reduces the frequency of CVD, especially the sun. The inclusion in the diet of 2-3 servings of fish per week (especially fat) can help prevent cardiovascular events (SSSob).
• Products containing a lot of unhealthy fats should be replaced by sources of proteins containing low saturated fatty acids (FA) or trans fats. It is necessary to limit salt intake, especially to persons with salt-sensitive blood pressure.

Efficacy of diet for coronary heart disease

Efficacy of diet for coronary heart disease

Diet has a significant effect on the risk of developing coronary heart disease (CHD). Cross-cultural studies have shown that diet plays an important role in relation to both KBS and other chronic diseases. For example, a Ni-Hon-San study found that Japanese immigrants who moved to Hawaii or California, often suffer from coronary heart disease (CHD) and ischemic stroke, like the natives of the United States.

However, understanding the specific components of the Western diet that affect this risk remains in question. Dietary research is difficult because of the complexity of the measurements. Nevertheless, some dietary habits have been well studied. This section will discuss macronutrients (fats, carbohydrates, proteins), as well as alcohol. Supplements, nutraceuticals and specific products are discussed below.

Observational studies of the effectiveness of the diet. In observational studies, nutritional patterns were identified that may affect the risk of CHD. One of the key features of the Western lifestyle is excessive calorie intake compared to their costs. One of the constant findings of observational studies is the fact that people consuming a lot of vegetables and fruits are less likely to develop CHD and stroke.

Other components of the Western diet, which can increase the risk of KBS, are saturated fatty acids and trans fats, simple carbohydrates that create an increased glycemic load, and lack of fiber.

Metabolic studies of the effectiveness of the diet. Metabolic studies have shown that diet is an important component of any prevention program. Diet can have a pronounced effect on weight loss (MT), which, in turn, can positively affect DLP, hypertension and diabetes.

Even without weight loss (MT), a healthy diet can improve the lipid profile and provide the body with nutrients that have a beneficial effect on cardiovascular events (SSSob). The study DASH 459 adults with CAD <160 mmHg. st. and dad <80-95 mm Hg. st. were randomly divided into the following groups:
(1) on a control diet with a small amount of fruits, vegetables, and dairy products with a fat content of 37%;
(2) on a diet rich in vegetables and fruits;
(3) on a combination diet that includes a lot of vegetables and fruits and low-fat dairy products. Both therapeutic diets significantly reduced SBP and DBP in individuals with and without AH.

A review of the results of 147 metabolic studies, prospective cohort and clinical studies showed that at least 3 nutritional strategies are effective in preventing KBS: replacing saturated fatty acids and trans fats with non-hydrogenated unsaturated fatty acids; increased consumption of omega-3 fatty acids in the form of fish or fish oil, or from plant sources; use of a diet rich in fruits, vegetables, nuts, whole grains, and containing a small amount of refined cereal products.

The benefits of physical training.

The benefits of physical training.

Termination of FA leads to an increased risk of CHD. The absence of large-scale randomized primary prevention studies that have studied the beneficial effects of FA makes it difficult to assess the benefits of FA in reducing the risk of CHD. However, FA clearly demonstrated a beneficial effect on cardiovascular RF. Exercise increases the level of HDL cholesterol, lowers cholesterol LDL and TG, increases insulin sensitivity and lowers blood pressure in people with elevated and normal blood pressure. Exercise also improves endothelial function and reduces CRP levels.

In the secondary prevention of the cardio-rehabilitation program with components of physical exercises, they showed a favorable effect in reducing the follow-ups. Combined data from many studies have revealed a decrease in OS and cardiovascular mortality by 25%.

Recommendations on physical inactivity. The ANA recently issued revised dietary and lifestyle guidelines starting at 2 years of age. They recommend FA> 30 minutes on most days of the week, even if the FA is divided into short periods. In addition, the ANA proposes to draw attention to the need to increase the FA, guided by the principle “it is better to move every day than to be moved”.

Previous ACC / ANA recommendations for secondary prevention also motivated patients to be physically active. Exercise may include walking, jogging, cycling, swimming, or other aerobic activities for 30–60 minutes on most days of the week, supplemented by increased activity in everyday life, such as climbing the stairs, whenever possible, instead of using an elevator or an escalator Strength training can give an additional favorable effect. Structured exercise programs can reinforce the patient’s long-term commitment to FT.

U.S. recommendations Primary Prevention Surgeon General’s are a great start — every adult should practice 30-minute moderate or intense FA on most days of the week and higher-intensity FA if it is desirable to reduce MT.

From a practical point of view, advice on physical activity (FA) should begin with her buds at the moment, including FA at work and during leisure. If the estimate indicates that FA is less than optimal, then obstacles to an active lifestyle should be examined. Potential obstacles can usually be the lack of time, energy, desire, and also a safe and convenient place to practice. Other barriers include certain medical conditions, such as osteoarthritis or transferred MI. After evaluating the FA, you should follow the advice to increase the cost of calories in everyday life, for example, advice on walking instead of traveling by car. The physician should recommend a steady increase in FA at rest up to> 30 min per day.

The effectiveness of the treatment of obesity in coronary heart disease

Prevalence of obesity. In the United States, over the past 40 years, the proportion of the population with excess MT (BMI> 25 kg / m2) and obesity (BMI> 30 kg / m2) has steadily increased. According to the 1960-1962 NHANES data, 31.6% of men and women had excess MT (BMI of 25.0-29.9 kg / m2), of which 13.4% were obese.

Today, almost 2 out of 3 Americans are overweight (MT) or obese; according to the NHANES 1999-2000, 64.5% of men and women had excess MT, 30.5% of which were obese.

The prevalence of overweight (MT) and obesity among children and adolescents is increasing in parallel with those in adults. At the age of 6-19 years, 15%, and at the age of 2-5 years, 10.4% were overweight (MT) or obesity. This is an alarming trend, because early obesity is a strong predictor of cardiovascular disease (CVD) in adulthood. It is particularly alarming that excess MT can lead to a dramatic increase in the incidence of DM-2 among children. In some areas of the United States,> 30% of new cases of DM-2 were observed among children, with most cases due to obesity.

Obesity risk. Obesity and overweight (MT) are strongly associated with the risk of coronary heart disease (CHD) and cerebral stroke (MI). Since different criteria were used to determine excess MT and obesity, the information and magnitude of this association with coronary heart disease (CHD) do not fully match. The question of whether overweight (MT) is an independent FD KBS, remains a matter of debate, because impact on the risk of coronary heart disease (CHD) may be mediated by arterial hypertension (AH), dyslipidemia (DLP), impaired glucose tolerance (NTG), inflammatory and hemostatic factors.

However, given the strong association with coronary heart disease (CHD), obesity remains an important and easily measurable risk marker.

Data from a number of cohort and metabolic studies provide similar evidence for a link between excess MT, NFA and impaired health. In a recent, long-term study, women studied obesity and NFA as predictors of CHD risk. Although BMI, the ratio of waist to hip volume, NFA independently contributed to the development of CHD, a study that lasted> 20 years showed that obesity increased the risk more than NFA.

Overweight (MT) increases the risk of metabolic disorders such as AH, DLP, IL and NTG. For example, in the Marks and Spenser Cardiovascular Risk Factor Study 14 077 middle-aged women, there were highly reliable, age-adjusted differences between 7 categories of BMI (from <20 to> 30 kg / m2) for GARDEN and DAD, total cholesterol, serum LDL, cholesterol HDL, TG, apo AI, apo B and fasting glucose levels. Excessive MT is associated in adults and children with increased markers of inflammation, such as CRP and fibrinogen, which are associated with an increased risk of CVD. There is a strong relationship between excess MT and an increased risk of CHD, ischemic MI, DMD-2, and other chronic diseases.

Overweight (MT) is an aggravating individual and economic factor. Estimates for 6 large prospective cohorts indicate that in the US, 280–320 thousand deaths per year are associated with overweight (MT), of which 80% occur in individuals with a BMI> 30 kg / m2. According to a national study of 10 thousand adult Americans, obesity is associated with a large number of chronic disorders and a worse quality of life than smoking or alcohol abuse.

Medical expenses for overweight conditions in 1998 were estimated at $ 78 billion (9% of total medical expenses in the United States). This amount is comparable to the cost of treating diseases associated with smoking. A study that examined the effect of increasing MT among men and women aged 35–65 years with initially excessive MT showed that the 3-year increase in health care costs was $ 561 more in individuals with an increase in MT by> 9 kg over this period compared with individuals whose MT remained stable.

The effectiveness of the treatment of metabolic syndrome in coronary heart disease

The effectiveness of the treatment of metabolic syndrome in coronary heart disease

Risk associated with metabolic syndrome. Metabolic syndrome is a cluster of metabolic disorders, which includes insulin resistance (IR), dyslipidemia (DLP), arterial hypertension (AH), proinflammatory state and overweight (MT), especially abdominal obesity.

The prevalence of the syndrome in the United States: 27% of adults and 10% of adolescents aged 12-19 years meet the criteria for metabolic syndrome (MS). Persons with MS have an increased risk of death from cardiovascular disease (CVD). Not all patients with metabolic syndrome (MS) have the same risk of developing type 2 diabetes mellitus (DM-2) or vascular events; results from several studies suggest that there are other factors, such as inflammation, that can determine high-risk subgroups.

The benefits of treating metabolic syndrome (MS). Two randomized clinical studies have shown that lifestyle changes are of considerable benefit to patients with metabolic syndrome (MS) or impaired glucose tolerance (IGT). In the Finnish Diabetes Prevention Study 522 people. overweight (MT) and impaired glucose tolerance (IGT) did not undergo any intervention or received individual advice regarding weight loss, total fat intake and increase in physical activity (FA).

After 3.2 years of follow-up, the reduction in body weight (MT) was significantly more pronounced in the active intervention group, the incidence of diabetes-2 decreased from 23 to 11%, and the risk decreased by 60% (p <0.001). With such a simple intervention, treatment for 5 years, 5 patients with impaired glucose tolerance (IGT) will prevent 1 case of DM-2.

Further support for this hypothesis was obtained in the course of the Diabetes Prevention Program, in which 3234 patients without diabetes but with impaired glucose metabolism were randomly divided into a group on lifestyle changes aimed at reducing MT and increasing FA, metformin group or placebo. In this study, the implementation of a lifestyle change program resulted in a 58% reduction in diabetes-2 cases compared with the placebo group, while metformin reduced the risk by 31%. It is important that lifestyle changes led to a significantly greater risk reduction than drug therapy.

These two studies have shown that diabetes mellitus-2 can be prevented or delayed, which in turn will reduce atherosclerotic complications in this high-risk group.

However, accurate estimates of reductions in cardiovascular events (SSSob) are not known, therefore cost-effectiveness ratio data are not available.

Interventions related to lifestyle modification can have a large impact on a population. In a prospective study of women, diabetes developed in> 90% of cases of those who did not exercise, had a BMI> 25 kg / m2 and had poor dietary habits, and also smoked.

The effect of exercise should not be underestimated, because in 30% of patients with diabetes, minimal FN was noted during their lifetime. Moreover, although the determination of glycemia 2 hours after FN has the best sensitivity in assessing the risk in patients without diabetes compared to determining fasting glucose, the clinical benefit of this approach remains very modest.

Recommendations. ATP III and JNC-7 guidelines relate to metabolic syndrome (MS). Patients are classified as having metabolic syndrome (MS) in the presence of> 3 of the following symptoms: • waist size> 102 cm in men and> 88 cm in women; • Blood pressure> 135/85 mm Hg. v .; • cholesterol cholesterol level <40 mg / dL for men and <50 mg / dL for women; • TG level> 150 mg / dL; • fasting glucose level> 100 mg / dL.

The main goal of therapy is the underlying insulin resistance (IR). The most safe and effective strategy to reduce insulin resistance (IR) is to reduce body weight (MT) and increase physical activity (FA). Although drugs have been developed that can improve IR, there is no clear evidence that they reduce the risk of CHD in patients with MS. Drug therapy aimed at improving the lipid profile, lowering blood pressure and treating a prothrombotic state reduces cardiac risk in this population.