Question

Calculate your risk of having a heart attack by completing the American heart association’s Risk Calculator.The calculator requires some health information that you may not know, in that case you will need to guess. However, consider getting that information if you don’t know.

Did the result surprise you? Why or why not? Discuss ways you think your diet can be modified to reduce the risk heart attack and/or discuss ways your diet already reduces the risk of heart attack.

Answer 1

Dietary and lifestyle changes reduce the incidence of chronic disease. Avoidance of smoking by preventing initiation or by cessation for those who already smoke is the single most important way to prevent CVD. Obesity is increasing rapidly worldwide (chapter 45). Even though obesity—a body mass index (BMI) of 30 or greater—has received more attention than overweight, overweight (BMI of 25 to 30) is typically even more prevalent and also confers elevated risks of many diseases. For example, overweight people experience a two- to threefold elevation in the risks of CAD and hypertension,

Medical experts have long recognized the effects of diet on the risk of CVD, but the relationship between diet and many other conditions, including specific cancers, diabetes, cataracts, macular degeneration, cholelithiasis, renal stones, dental disease, and birth defects, have been documented more recently.

• Replace saturated and trans fats with unsaturated fats, including sources of omega-3 fatty acids. Replacing saturated fats with unsaturated fats will reduce the risk of CAD (F. B. Hu and Willett 2002; Institute of Medicine 2002; WHO and FAO 2003) by reducing serum low-density lipoprotein (LDL) cholesterol. Also, polyunsaturated fats (including the long-chain omega-3 fish oils and probably alpha-linoleic acid, the primary plant omega-3 fatty acid) can prevent ventricular arrhythmias and thereby reduce fatal CAD. In a case-control study in Costa Rica, where fish intake was extremely low, the risk of myocardial infarction was 80 percent lower in those with the highest alpha-linoleic acid intake (Baylin and others 2003). Intakes of omega-3 fatty acids are suboptimal in many populations, particularly if fish intake is low and the primary oils consumed are low in omega-3 fatty acids (for example, partially hydrogenated soybean, corn, sunflower, or palm oil). These findings have major implications because changes in the type of oil used for food preparation are often quite feasible and not expensive.
• Ensure generous consumption of fruits and vegetables and adequate folic acid intake. Strong evidence indicates that high intakes of fruits and vegetables will reduce the risk of CAD and stroke (Conlin 1999). Some of this benefit is mediated by higher intakes of potassium, but folic acid probably also plays a role (F. B. Hu and Willett 2002). Supplementation with folic acid reduces the risk of neural tube defect pregnancies. Substantial evidence also suggests that low folic acid intake is associated with greater risk of the colon—and possibly breast—cancer and that use of multiple vitamins containing folic acid reduces the risk of these cancers (Giovannucci 2002). Findings relating folic acid intake to CVD and some cancers have major implications for many parts of the developing world. In many areas, consumption of fruits and vegetables is low. For example, in northern China, approximately half the adult population is deficient in folic acid.
• Consume cereal products in their whole-grain, high-fibre form. Consuming grains in a whole-grain, high-fibre form has double benefits. First, consumption of fiber from cereal products has consistently been associated with lower risks of CAD and type 2 diabetes (F. B. Hu, van Dam, and Liu 2001; F. B. Hu and Willett 2002), which may be because of both the fiber itself and the vitamins and minerals naturally present in whole grains. High consumption of refined starches exacerbates the metabolic syndrome and is associated with higher risks of CAD (F. B. Hu and Willett 2002) and type 2 diabetes (F. B. Hu, van Dam, and Liu 2001). Second, higher consumption of dietary fibre also appears to facilitate weight control (Swinburn and others 2004) and helps prevent constipation.
• Limit consumption of sugar and sugar-based beverages. Sugar (free sugars refined from sugarcane or sugar beets and high-fructose corn sweeteners) has no nutritional value except for calories and, thus, has negative health implications for those at risk of overweight. Furthermore, sugar contributes to the dietary glycemic load, which exacerbates the metabolic syndrome and is related to the risk of diabetes and CAD (F. B. Hu, van Dam, and Liu 2001; F. B. Hu and Willett 2002; Schulze and others 2004). WHO has suggested an upper limit of 10 percent of energy from sugar, but lower intakes are usually desirable because of the adverse metabolic effects and empty calories.
• Limit excessive caloric intake from any source. Given the importance of obesity and overweight in the causation of many chronic diseases, avoiding excessive consumption of energy from any source is fundamentally important. Because calories consumed as beverages are less well-regulated than calories from solid food, limiting the consumption of sugar-sweetened beverages is particularly important.
• Limit sodium intake. The principle justification for limiting sodium is its effect on blood pressure, a major risk factor for stroke and coronary disease (chapter 33). WHO has suggested an upper limit of 1.7 grams of sodium per day (5 grams of salt per day) (WHO and FAO 2003).