Globally, death rates from cardiovascular disease are increasing, rising 41% between 1990 and 2013, and are often attributed, at least in part, to poor diet quality. With urbanization, economic development, and mass marketing, global dietary patterns have become more Westernized to include more sugar-sweetened beverages, highly processed foods, animal-based foods, and fewer fruits and vegetables, which has contributed to increasing cardiovascular disease globally. In this paper, we will examine the trends occurring globally in the realm of nutrition and cardiovascular disease prevention and also present new data that international nutrition knowledge amongst cardiovascular disease providers is limited. In turn, this lack of knowledge has resulted in less patient education and counseling, which is having profound effects on cardiovascular disease prevention efforts worldwide.
Introduction
Cardiovascular disease is the leading cause of death globally, accounting for 31% of all deaths in 2013.1 In the United States, recent decreases in cardiovascular disease mortality appear to have plateaued.2, 3, 4 However, worldwide death rates from cardiovascular disease are increasing, rising 42% between 1990 and 20135(Figure 1). Poor diet quality is a leading cause of cardiovascular disease, both internationally and in the United States.6, 7, 8 With urbanization, economic development, and mass marketing, global dietary patterns have become more Westernized to include more sugar-sweetened beverages, highly processed foods, animal-based foods, and fewer fruits and vegetables.9, 10 Concurrently, cardiovascular disease rates have increased around the world.10, 11, 12, 13 As such, the World Health Organization and other groups are pursuing initiatives to improve dietary habits.14, 15, 16, 17, 18, 19
Modifying Eating Habits and Risk Factors
Modifying eating habits to decrease cardiovascular risk is a time-tested approach.20, 21, 22, 23, 24, 25, 26, 27, 28 As early as the 1950s, Ancel Keys with the Seven Countries Study showed that certain dietary patterns, especially those with a higher composition of saturated fat and cholesterol, were associated with increased risk of cardiovascular disease. In contrast, societies with diets of <10% saturated fat had a low risk of cardiovascular disease, even after accounting for varying amounts of total fat in the diet, blood pressures, and tobacco use.29 In the 1980s, the Lifestyle Heart Study was conducted in which 48 patients with moderate-to-severe coronary artery disease were directed to eat a 10% fat vegetarian diet, do moderate aerobic exercise, undergo stress management training and smoking cessation counseling, and participate in support groups. Over 1 and 5 years post intervention, plaque regression occurred in the treatment group, while progression was observed in the control group.30
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– Monica Aggarwal, MD, Stephen Devries, MD, Andrew M. Freeman, MD, Robert Ostfeld, MD, Hanna Gaggin, MD, Pam Taub, MD, Anne K. Rzeszut, MA, Kathleen Allen, BA, Richard C. Conti, MD
This article originally appeared in the April issue of The American Journal of Medicine.
