Category Archives: Coronary Heart Disease

From Larry Husten: Saturated Fats Linked To Heart Disease Once Again

“A prominent group of nutrition researchers have once again linked saturated fats to increased coronary heart disease.

The new paper, published in BMJ, is the third paper in the past year to decry saturated fats. Along with the previous two papers, published in JACC and JAMA Internal Medicine, the BMJ paper uses data from two large observational studies to support the widely held view that high intake of saturated fat should be replaced with unsaturated fats, complex carbohydrates, or plant-based proteins. The senior author of all three papers is Frank Hu, the Harvard University nutrition researcher who has been a leading figure in the prosecution of saturated fats.

But some critics, including a BMJ editorialist, continue to raise concerns that observational data like this is not capable of demonstrating the negative effect of saturated fats. The new paper also raises additional concerns about the role of co-authors who work in the food industry.’

Source: Saturated Fats Linked To Heart Disease Once Again

Would You Rather Die of Heart Disease or Cancer?

These cows may give you cancer

Carcinogenic cows?

The idea that heart attacks and other cardiovascular diseases are caused by dietary saturated fats is losing credibility. I lost faith in that theory in 2009.

Instead, cardiovascular disease is now linked to high consumption of carbohydrates, particularly those carbs that are rapidly absorbed and turned into blood sugar.

Unfortunately, the diet that reduces risk of cardiovascular disease may increase your risk of cancer. Keep reading.

If you’re a nutrition science nerd, here’s a pertinent report from researchers at Masaryk University in the Czech Republic:

“The results of our study show that high-glycaemic carbohydrates or a high overall proportion of carbohydrates in the diet are the key ecological correlates of cardiovascular disease (CVD) risk. These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs. The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products, which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.The role of the high glycaemic index/load can be explained by the hypothesis linking CVD risk to inflammation resulting from the excessive spikes of blood glucose (‘post-prandial hyperglycaemia’). Furthermore, multiple clinical trials have demonstrated that when compared with low-carbohydrate diets, a low-fat diet increases plasma triglyceride levels and decreases total cholesterol and HDL-cholesterol, which generally indicates a higher CVD risk. Simultaneously, LDL-cholesterol decreases as well and the number of dense, small LDL particles increases at the expense of less dense, large LDL particles, which also indicates increased CVD risk. These findings are mirrored even in the present study because cereals and carbohydrates in general emerge as the strongest correlates of low cholesterol levels.

In light of these findings, the negative correlation of refined sugar with CVD risk may seem surprising, but the mean daily consumption of refined sugar in Europe is quite low (~84 g/day), when compared with potato and cereal carbohydrates (~235 g/day), and makes up only ~20% of CA energy. Refined sugar is also positively tied to many animal products such as animal fat and total fat and animal protein, and negatively to % PC CARB energy and % CA energy. Therefore, a high consumption of refined sugar is accompanied by a high consumption of animal products and lower intakes of other carbohydrates. Furthermore, the glycaemic index of refined sugar (sucrose) is rather moderate (~65).”

Source: Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries | Grasgruber | Food & Nutrition Research

Elsewhere in this long article:

“Current rates of cancer incidence in Europe are namely the exact geographical opposite of CVDs. In sharp contrast to CVDs, cancer correlates with the consumption of animal food (particularly animal fat), alcohol, a high dietary protein quality, high cholesterol levels, high health expenditure, and above average height. These contrasting patterns mirror physiological mechanisms underlying physical growth and the development of cancer and CVDs. The best example of this health paradox is again that of French men, who have the lowest rates of CVD mortality in Europe, but the highest rates of cancer incidence. In other words, cancer and CVDs appear to express two extremes of a fundamental metabolic disbalance that is related to factors such as cholesterol and IGF-1 (insulin-like growth factor).”

I wish these researchers had looked at over death rates associated with various ways of eating. Perhaps that will be in a future paper.

I’d rather die of a heart attack than cancer.

Steve Parker, M.D.

Eating Fish Is Still Good For You

Dead whole fish aren't very appealing to many folks

Dead whole fish aren’t very appealing to many folks

Heart disease is still the #1 killer in the U.S., followed by cancer and chronic lower respiratory tract disease. “Heart disease” is a broad category; the primary killer is heart attacks.

Eating fish regularly seems to reduce your risk of heart attack. I favor the cold-water fatty fish like salmon, trout, herring, and sardines.

I quote the NYT:

“Numerous studies have found that people who eat fish on a regular basis are less likely to die of a heart attack than those who don’t eat it or eat it less than once a month, and a 2006 Harvard review concluded that eating one to two servings of fish rich in omega-3s every week cut the risk of dying of a heart attack by one-third.”

Source: Why Is Fish Good for You? Because It Replaces Meat? – The New York Times

PS: Accidents are the #4 cause of death, and suicide is #10.

PPS: Click for ideas on reducing your risk of cancer.

A Pharmacist Asks: Should we use PCSK9 inhibitors?

PCSK9 inhibitors are a new class of drug that dramatically lowers LDL cholesterol. LDL is the “bad cholesterol” implicated in blocked arteries that cause heart attacks and strokes. PCSK9 inhibitors are injected every several weeks. They are expensive.

Pharmacist Catherine writes:

“We know this drug lowers LDL cholesterol.  But what we really care about (or should care about) is whether this medication lowers the risk of having a heart attack or a stroke.  This data isn’t yet available.   From what data I could easily access, it seems that the PCSK9 inhibitors can halve your risk of having heart attack over one year.  This might sound good, but when you look at actual numbers, not so good.  Of the ~4500 people studied, about 2% in the control group had an ‘event’ (heart attack, stroke or other cardiovascular event) compared to about 1% in the treatment group.  And the difference between the groups was only about 60 people.  The study size just simply isn’t big enough, nor has it run for long enough to really tell if these medications are worth it.  A bigger study is in progress, but we won’t get the results before 2017.   Even then, we may not have the long-term risk/benefit data.  A systematic review on the medications in 2014 concluded that there is currently insufficient data to show benefit.”

Source: Should we use PCSK9 inhibitors? | Lifestyle Before Medication

I also want to know the effect of these drugs on death rates. As they say, “more studies are needed.”

Hey, guess what? The Mediterranean diet prevents heart attacks and strokes, and extends lifespan.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Mediterranean Diet Prevents Cardiovascular Disease

From American Family Physician:

“Cardiovascular disease (CVD) is the leading cause of death in the United States. One-third of these deaths may be preventable through healthy lifestyle choices including diet and physical activity. The Mediterranean diet is associated with reduced cardiovascular mortality [deaths], whereas the Dietary Approaches to Stop Hypertension (DASH) eating plan is associated with a reduced risk of coronary artery disease.”

Source: Diet and Physical Activity for Cardiovascular Disease Prevention – American Family Physician

There are at least a couple versions of the DASH diet. The most common one is low in total and saturated fats and cholesterol, moderate in low-fat dairy products, high in fruits and vegetables, low in salt, low in sweetened beverages, moderate in whole grains, and low in animal protein but has substantial amounts of plant protein from nuts and legumes.

The Mediterranean diet also has several versions. My favorite ones are here:

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Forty Years of Dietary Advice Was Wrong

Dr. Axel Sigurdsson is a cardiologist who focuses his blogging on cardiovascular disease and lipid disorders. I bet he agrees with me that dietary saturated fat is not the malevolent force we were taught in medical school.

From his blog:

“The [PURE study] suggests that placing carbohydrates at the bottom of the food pyramid based on their effect on blood cholesterol was a mistake. In fact, the data show that replacing dietary carbohydrates with different types of fat may improve lipid profile.

In an interview on Medscape, Dr. Mahshid Dehghan, the principal author of the abstract said: “To summarize our findings, the most adverse effect on blood lipids is from carbohydrates; the most benefit is from consumption of monounsaturated fatty acids; and the effect of saturated and polyunsaturated fatty acids are mixed. I believe this is a big message that we can give because we are confusing people with a low-fat diet and all the complications of total fat consumption, and WHO and AHA all suggest 55% to 60% of energy from carbohydrates.”

Today, most experts agree that diets high in saturated fatty acids or refined carbohydrates are not be recommended for the prevention of heart disease. However, it appears that carbohydrates are likely to cause a greater metabolic damage than saturated fatty acids in the rapidly growing population of people with metabolic abnormalities associated with obesity and insulin resistance.”

Source: High Carbohydrate Intake Worse than High Fat for Blood Lipids

PS: A diet naturally high in monounsaturated fat is one you may have heard of: the Mediterranean diet. The Advanced Mediterranean Diet (2nd Ed.) contains both a low-carb Mediterranean diet and a portion-controlled traditional Mediterranean diet.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Eat Nuts to Improve Your Blood Lipids and Reduce Risk of Cardiovascular Disease

natural cashews, cashew apple

Cashews fresh off the tree. They’re actually fruits, not nuts.

Most of the diets I recommend to my patients include nuts because they are so often linked to improved cardiovascular health in scientific studies. Walnuts are associated with reduced risk of type 2 diabetes in women, and established type 2 diabetics see improved blood sugar control and lower cholesterols when adding nuts to their diets.

Nut consumption lowers total and LDL cholesterol levels, and if triglycerides are elevated, nuts lower them, too. Those changes would tend to reduce heart disease.

Conner Middelmann-Whitney has a good nutty article at Psychology Today.

Steve Parker, M.D.

Reference: Joan Sabaté, MD, DrPH; Keiji Oda, MA, MPH; Emilio Ros, MD, PhD. Nut Consumption and Blood Lipid Levels: A Pooled Analysis of 25 Intervention Trials. Archives of Internal Medicine, 2010, Vol. 170 No. 9, pp 821-827. Abstract:

Background  Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary intervention trials investigated the effects of nut consumption on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects.

Methods:  We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications. In a pooled analysis, we used mixed linear models to assess the effects of nut consumption and the potential interactions.

Results:  With a mean daily consumption of 67 g of nuts [about 2 ounces or 2 palms-ful], the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets.

Conclusion:  Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI.