Diet and Health Implications for Reducing Chronic Disease Risk (1989) / Chapter Skim
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19 Atherosclerotic Cardiovascular Diseases
19 Atherosclerotic Cardiovascular Diseases
Pages 529-548
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From page 529... ...
The major risk factors, hypercholesterolemia and hypertension, are closely associ
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All these syndromes (angina pectoris, myocardial infarction, sudden car' diac death) are included in the term coronary heart disease.
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LDL cholesterol and ODIN cholesterol levels, and the ratio of the rive lipoprotein cholesterol concentrations to one another are highly predictive of lesions in laboratory animals. High blood pressure combined with hyperlipidemia accelerates experimentally induced atherosclerosis.
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The responses of serum lipids and lipoproteins to dietary cholesterol and SFAs vary among animal species, but experimentally induced atherosclerosis is strongly and consistently associated with elevated serum cholesterol levels. In, particular, LDL cholesterol concentrations are directly associated, and HDL cholesterol is inversely associated, with experimentally induced atherosclerosis.
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From page 533... ...
Coffee consumption has been associated with slight elevations in serum cholesterol in some epidemiologic studies, but there is no consistent evidence that tea or other nonnutritive dietary components affect serum lipid concentrations (see Chapter 17~. Observational Souses on Diet, Serum Cholesterol Levels, and CHD The percentage of calories derived from SFAs in the food supply is strongly associated with mean population cholesterol levels and CHD rates (Keys, 1970, 1980)
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From page 534... ...
in within population studies carefully designed to reduce variation and in which the Keys equation was used, both SFAs alone and SFAs combined with PUFAs and cholesterol have been associated with serum cholesterol levels or CHD risk in individuals. Until recently, epidemiologic studies failed to show any association between a person's dietary cholesterol intake and serum cholesterol levels or CHD risk (see Chapter 7~.
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From page 535... ...
For example, CHD incidence in the Honolulu Heart Study was positively associated with body mass index as well as subscapular skinfold thickness, even after controlling for other CHD risk factors (Donahue et al., 1987~. Other studies (Lapidus et al., 1986; Larsson et al., 1984)
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From page 536... ...
Investigators hope to find many new associations between genetic variants and serum lipoprotein levels as well as genetic markers for susceptibility tO the serum cholesterol raising effect of dietary fat and cholesterol. A family history of CHD is also a risk factor for the disease, even after adjusting for other known CHD risk factors (Barrett-Connor and Khaw, 1984; Colditz et al., 1986; Hammond et al., 1971; Sholtz et al., 1975; ten Kate et al., 1982; and reviewed by Goldbourt and Neuield, 1986~.
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From page 537... ...
Evidence on the level of physical activity required to reduce risk is conflicting. Psychosocial Factors Research completed in the 1970s supported the hypothesis that the Type A behavior pattem a pattern composed primarily of competitiveness, excessive drive, and an enhanced sense of time urgency was associated with increased risk of CHD independently of other known risk factors (Review Pane} on Corona~y-Prone Behavior and Coronary Heart Disease, 19811.
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From page 538... ...
Multiple Risk Factors Age, smoking, diabetes and fasting plasma glucose level, and systolic blood pressure were associated with PAD, whereas obesity and levels of LDL and HDL cholesterol were only marginally related to large-vessel PAD (Criqui et al., 1980~. More important is the difference emerging in risk-factor configurations associated with each major atherosclerotic end point, i.e., CHD, stroke, and PAD.
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Evidence suggests a different combination of risk factors for PAD than for other atherosclerotic manifestations, with an emphasis on diabetes, glucose intolerance, smoking, and plasma triglyceride concentrations. Because CHD risk factors strongly predict PAD risk in the U.S.
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Despite little change in hospital case-fatality and survival rates, stroke deaths in the United States have been declining for several decades. Blood pressure is the most consistent characteristic associated with the risk of stroke in populations and in individuals, but all the major risk factors for atherosclerosis, including diet, serum lipids, and smoking, contribute to the risk of stroke.
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From page 541... ...
Smoking and diabetes are the most important risk factors for PAD, and hypertension is the most important risk factor for cerebral infarction and cerebral hemorrhage. Congruence of evidence from laboratory, clinical, and population studies concerning the etiology 541 and potential for prevention of atherosclerotic cardiovascular diseases provides a strong basis for public health recommendations.
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1986. A prospective study of parental history of myocardial infarction and coronary heart disease in women.
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1954. Coronary Heart Disease in Young Adults; a Multidisciplinary Study.
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Psychosomatic Risk Factors and Coronary Heart Disease: Indications for Specific Preventive Therapy. Hans Huber Publishers, Bern, Switzerland.
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1984. Ten~year incidence of coronary heart disease in the Honolulu Heart Program: relationship to nutrient intake.
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1982. Familial aggregation of coronary heart disease and itS relation to known genetic risk factors.
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1988. Low plasma cholesterol levels caused by a short deletion in the apolipoprotein B gene.
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