Muncan B. Cardiovascular disease in racial/ethnic minority populations: illness burden and overview of community-based interventions. Public Health Rev. 2018;39:32. Published 2018 Dec 3. doi:10.1186/s40985-018-0109-4

This association study used a prospective cohort of a nationally representative sample of US adults of the National Health and Nutrition Examination Survey (NHANES, 1988-1994, 1999-2004, and 2005-2010) and NHANES III Linked Mortality cohort, to examine time trends of added sugar consumption as percentage of daily calories in the United States and investigate the association of this consumption with cardiovascular disease (CVD) mortality. 

This study is important because Americans consume a large part of their calories from added sugar sources, particularly sugar sweetened beverages.  Most adults (71%) consume 10% or more calories from added sugar.  The authors observed a significant relationship between added sugar consumption and increased risk for CVD mortality.

 The key findings from this study are that most US adults consume more added sugar than is recommended for a healthy diet. A higher percentage of calories from added sugar is associated with significantly increased risk of CVD mortality. In addition, regular consumption of sugar-sweetened beverages is associated with elevated CVD mortality.  Adjusted hazard ratios were 1.30  and 2.75, respectively, comparing participants who consumed 10.0%to 24.9% or 25.0%or more calories from added sugar with those who consumed less than 10.0%of calories from added sugar.

Clinical implication of this study support current recommendations to limit the intake of calories from added sugars in US diets.1 Since the majority of Americans do not follow the current recommendations to limit sugar consumption, we need to educate the public to limit their added sugar consumption.  Society may choose to tax added sugar to discourage over consumption.  And public information campaigns could create a stigma against added sugars just as we have created a stigma against fats, trans fats and cholesterol.

Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(4):516-524. doi:10.1001/jamainternmed.2013.13563

 Posted by Richard Proudfoot

 

 

The chemical additives market for electronic cigarettes is an unregulated wild west. It allows for modification and backyard chemists to make their own concoctions far from safety guidelines. This lack of oversight lead to an INCREASE in harmful chemicals then what is seen in cigarette smoke. 



Tsai M, Byun MK, Shin J, Crotty Alexander LE. Effects of e-cigarettes and vaping devices on cardiac and pulmonary physiology. J Physiol. 2020 Nov;598(22):5039-5062. doi: 10.1113/JP279754. Epub 2020 Oct 12. PMID: 32975834.

This randomized, controlled trial worked to determine if there was a link between the amounts of olive oil consumption and cardiovascular disease. The participants included 7,216 men and women ranging from age 55-80 on either Mediterranean diet with supplements of nuts or extra-virgin olive oil, or on a controlled low-fat diet (2014). With this study they were randomized to follow each diet regimen with the inclusion of olive oil in one group, then were followed up with about 5 years later to determine how many developed cardiovascular diseases, had a cardiac event, or died due to cardiac causes. This study found that consuming “extra-virgin olive oil was linked to reduction of risk of cardiovascular disease and mortality in individuals at high cardiovascular risk.” This is an important aspect to mention for patients with cardiovascular disease or at risk for development and connects to nutrition through the consumption of olive oil and dietary recommendations. The clinical implications of this study are evidence supporting consumption of olive oil with potential benefits for patients at high cardiovascular risk. 

Guasch-Ferré, Marta et al. “Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study.” BMC medicine vol. 12 78. 13 May. 2014, doi:10.1186/1741-7015-12-78

According to this trial, the clinical implication of this study is that a Mediterranean diet could be beneficial to CVD patients. Enhancing blood flow is a critical aspect of a healthy cardiovascular system. On the other hand, a low-fat diet does not seem beneficial for CVD patients.

A key finding is that “high adherence to the Med diet, and not the DASH diet, was associated with a reduction in the frequency and time to occurrence of 10 year fatal and non-fatal CVD.” (p. 2752) People that had high adherence to the DASH diet as compared to low adherence to the DASH diet had similar rates of 10 year CVD manifestation. People with high adherence to the Med diet compared to low adherence had a 4 fold-lower risk of developing CVD even after they adjusted for confounding factors like age, gender, physical activity, weight, smoking, hypertension, etc. Important to note that DASH focuses on lowering hypertension, which is not the only cause of CVD. 

The clinical importance of this is that it would be more beneficial to advocate for high adherence to Med diet in Mediterranean populations as well as to try to encourage non-Mediterranean populations to adopt it. One interesting thing that they mentioned is that the Med-diet, in contrast to the westernized DASH diet, has an emphasis that went beyond nutrient intake and encompassed lifestyle practices like physical activity and active social networks which help psychosocial and cognitive function. So even if the food groups of the Med diet are not within your patients palate range, it could be beneficial to encourage social interaction, leisure activities and better sleep quality like the Med diet does in addition to whichever diet your patient is most likely/able to comply with. 

 

The authors discuss that inflammation and oxidative stress are two important factors that influence the development of atherosclerosis and cardiovascular disease (CVD). Therefore, they focused on the role of the phenolic compounds in red wine and chocolate and its effects on CVD. These polyphenols have anti-inflammatory, antioxidant, and antiplatelet properties that are theoretically beneficial in CVD prevention and treatment.

 

The authors referenced several different clinical trials, but overall they found that the data suggests a beneficial dose of dark chocolate of 30 to 50 grams per day and for wine 130 to 250 mL per day. For reference, a standard Hershey’s chocolate bar is 43 grams. For wine, a standard serving is 5 ounces (150 mL). Though the authors mentioned cardiovascular risk reduction peaked at 6 to 8 grams of alcohol per day. A standard serving of wine with 12% alcohol would have 14 grams. So risk reduction would potentially peak at half a serving of wine.

 

Clinically, this review supports the consumption of chocolate and red wine. The antioxidant content of these functional foods may be helpful in the prevention and treatment of atherosclerosis and other cardiovascular diseases. I think this also ties into the benefits of the Mediterranean diet; wine polyphenols may have a synergistic effect with the nutrients and compounds in this dietary pattern.

 

Though, it is important to note that patients using medications for CVD should be aware of the risk of certain drug-nutrient interactions. I think it’s also important to note about the saturated fat content of chocolate and how this may counteract the benefits of its polyphenols. Though this is potentially debatable with recent research.

 

Sperkowska, B., Murawska, J., Przybylska, A., Gackowski, M., Kruszewski, S., Durmowicz, M., & Rutkowska, D. (2021). Cardiovascular Effects of Chocolate and Wine-Narrative Review. Nutrients, 13(12), 4269.

 

Rezk-Hanna, & Benowitz, N. L. (2019). Cardiovascular Effects of Hookah Smoking: Potential Implications for Cardiovascular Risk. Nicotine & Tobacco Research, 21(9), 1151–1161. https://doi.org/10.1093/ntr/nty065

Artinian, Nancy T et al. “Eating Patterns and Cardiovascular Disease Risk in a Detroit Mexican American Population.” Public health nursing (Boston, Mass.) 21.5 (2004): 425–434. Web.

This study is important because it emphasizes the importance of researching nutrition in cardiovascular disease as a treatment, as well as a preventative measure. The earlier those at-risk for CVD can address it in their diet, the better the outcome will be for the patient. This study focused on the importance of emphasizing whole foods/well-rounded diets to patients instead of just macronutrients. They addressed the constant development of nutritional sciences, and how that puts a strain on the patient. Focusing on the whole food makes it easier for patients to develop a diet, with the help of their physicians, that they can tailor to their specific needs. The clinical implications of this study include collaborations between physicians, dietitians, and the patient to develop a personalized diet that addresses CVD, as well as any other comorbidities the patient may be facing. Personalization of the diet makes it easier for the patient to follow it, in comparison to being told to increase or decrease specific macronutrients. 

Butler, Tom & Kerley, Conor & Altieri, Nunzia & Alvarez, Joe & Green, Jane & Hinchliffe, Julie & Stanford, Dell & Paterson, Katherine. (2020). Optimum nutritional strategies for cardiovascular disease prevention and rehabilitation (BACPR). Heart. 106. heartjnl-2019. 10.1136/heartjnl-2019-315499.