Category Archives: Heart Disease

Parade Says Low-Carb Mediterranean Diet is the Best for Heart Health

Parade.com has an article touting the health benefits of a low-carb high-fat Mediterranean diet. Can you believe they didn’t even mention my books?!

In fairness to my readers, I must mention that I scanned the referenced AJCN article and didn’t see “Mediterranean” in it.

From Parade:

“If you’re looking to improve your heart health, you may want to try eating a low-carb, high-fat Mediterranean diet. Why? Because a new study published in The American Journal of Clinical Nutrition found that eating a low-carb (no more than 20% of daily calories from carbs), the high fat-style Mediterranean diet may reduce the risk of cardiovascular disease (CVD). For the study, obese study participants reported both improved insulin resistance and cholesterol levels compared to those who ate a moderate carb (40%) or high carb (60%) diet over a five-month period.”

Steve Parker, M.D.

PS: The Ketogenic Mediterranean Diet is obviously low-carb, and is included in both The Advanced Mediterranean Diet (2nd Ed.) and Conquer Diabetes and Prediabetes.

front cover of Conquer Diabetes and Prediabetes

Click to purchase at Amazon.com. E-book also available at Smashwords.com.

Mediterranean Diet Prevents Progression of Coronary Artery Disease

Heart attacks and chest pains are linked to blocked arteries in the heart

Most patients with a heart attack have underlying atherosclerosis (“hardening of the arteries”) in the heart, called coronary artery disease. Around the time of a heart attack (if not before), doctors and patients should focus on mitigating risk factors for future heart attacks and other cardiac events. This is called “secondary prevention.” Risk factor modification might include smoking cessation, regular exercise, stress reduction, and diet modification. For years, I’ve been recommending the Mediterranean diet. Many others recommend a low-fat diet instead. A recent study supports my diet recommendation.

One way to assess risk of progressive atherosclerosis is to measure the thickness of the the carotid artery wall by ultrasound. Increasing thickness of the artery wall is linked to higher risk of atherosclerotic complications like heart attack and stroke. To drill down deeper, it’s the thickness of the innermost two layers of the artery wall, called the intima-media, that matters. The study at hand showed a reduction in carotid artery intima-media thickness over five years on a Mediterranean diet compared to a low-fat diet. Here’s the abstract:

Background and Purpose:

Lifestyle and diet affect cardiovascular risk, although there is currently no consensus about the best dietary model for the secondary prevention of cardiovascular disease. The CORDIOPREV study (Coronary Diet Intervention With Olive Oil and Cardiovascular Prevention) is an ongoing prospective, randomized, single-blind, controlled trial in 1002 coronary heart disease patients, whose primary objective is to compare the effect of 2 healthy dietary patterns (low-fat rich in complex carbohydrates versus Mediterranean diet rich in extra virgin olive oil) on the incidence of cardiovascular events. Here, we report the results of one secondary outcome of the CORDIOPREV study. Thus, to evaluate the efficacy of these diets in reducing cardiovascular disease risk. Intima-media thickness of both common carotid arteries (IMT-CC) was ultrasonically assessed bilaterally. IMT-CC is a validated surrogate for the status and future cardiovascular disease risk.

Methods:

From the total participants, 939 completed IMT-CC evaluation at baseline and were randomized to follow a Mediterranean diet (35% fat, 22% monounsaturated fatty acids, <50% carbohydrates) or a low-fat diet (28% fat, 12% monounsaturated fatty acids, >55% carbohydrates) with IMT-CC measurements at 5 and 7 years. We also analyzed the carotid plaque number and height.

Results:

The Mediterranean diet decreased IMT-CC at 5 years (−0.027±0.008 mm; P<0.001), maintained at 7 years (−0.031±0.008 mm; P<0.001), compared to baseline. The low-fat diet did not modify IMT-CC. IMT-CC and carotid plaquemax height were higher decreased after the Mediterranean diet, compared to the low-fat diet, throughout follow-up. Baseline IMT-CC had the strongest association with the changes in IMT-CC after the dietary intervention.

Conclusions:

Long-term consumption of a Mediterranean diet rich in extravirgin olive oil, if compared to a low-fat diet, was associated with decreased atherosclerosis progression, as shown by reduced IMT-CC and carotid plaque height. These findings reinforce the clinical benefits of the Mediterranean diet in the context of secondary cardiovascular prevention.

Reference

Parker here again. Undoubtedly, it would be more helpful if the investigators reported the actual rates of heart attack, stroke, and death in the two diet groups over five years. I suspect that will be in a future report.

An article in Clinical Cardiology states the serious nature of coronary artery disease (CAD) in those with diabetes (DM): “CAD is the main cause of death in both type 1 and type 2 DM, and DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Over 70% of people >65 years of age with DM will die from some form of heart disease or stroke. Furthermore, in patients with DM there is an increased mortality after MI [myocardial infarction], and worse overall long-term prognosis with CAD.”

Steve Parker, M.D.

Aspirin 325 vs 81 mg/day: Which is Better?

Photo by Anna Shvets on Pexels.com

For patients with established cardiovascular disease, a recent study found that aspirin 81 mg/day was just as effective as 325 mg/day in preventing combined risk of death and hospitalization for heart attack or stroke. Rates of major bleeding were the same regardless of dose.

Click for details at NEJM.

Steve Parker, M.D.

PS: What else prevents heart attacks and strokes? The Mediterranean diet!

High Glycemic Index Eating Associated With Premature Death and Cardiovascular Disease

Naan, a type of flat bread with a high glycemic index

Haven’t we know this for years? From New England Journal of Medicine:

Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population.

METHODS

This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used country-specific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause.

RESULTS

In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease.

CONCLUSIONS

In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death.

Source: Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality | NEJM

The Advanced Mediterranean Diet (2nd edition) is low glycemic index.

Steve Parker, M.D.

Blood Pressure Lowering Barely Lowered the Incidence of Dementia in New Meta-Analysis

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss
“C’mon now! Let’s go Mediterranean before it’s too late.”

I haven’t read the entire article below and probably won’t ever. It will be used to promote treatment of mild to moderate hypertension in order to prevent dementia, despite cost and drug side effects. Results are distinctly unimpressive. Four years of drug therapy reduced the incidence of dementia and cognitive decline by less than 1%.

I was expecting and hoping for a much more significant reduction. Nevertheless, anti-hypertensive drug therapy is pretty well established as an effective preventative for cardiovascular disease, including stroke.

From JAMA Network:

Fourteen randomized clinical trials were eligible for inclusion (96 158 participants), of which 12 reported the incidence of dementia (or composite of dementia and cognitive impairment [3 trials]) on follow-up and were included in the primary meta-analysis, 8 reported cognitive decline, and 8 reported changes in cognitive test scores. The mean (SD) age of trial participants was 69 (5.4) years and 40 617 (42.2%) were women. The mean systolic baseline blood pressure was 154 (14.9) mm Hg and the mean diastolic blood pressure was 83.3 (9.9) mm Hg. The mean duration of follow-up was 49.2 months. Blood pressure lowering with antihypertensive agents compared with control was significantly associated with a reduced risk of dementia or cognitive impairment (12 trials; 92 135 participants) (7.0% vs 7.5% of patients over a mean trial follow-up of 4.1 years; odds ratio [OR], 0.93 [95% CI, 0.88-0.98]; absolute risk reduction, 0.39% [95% CI, 0.09%-0.68%]; I2 = 0.0%) and cognitive decline (8 trials) (20.2% vs 21.1% of participants over a mean trial follow-up of 4.1 years; OR, 0.93 [95% CI, 0.88-0.99]; absolute risk reduction, 0.71% [95% CI, 0.19%-1.2%]; I2 = 36.1%). Blood pressure lowering was not significantly associated with a change in cognitive test scores.

Conclusions and Relevance

In this meta-analysis of randomized clinical trials, blood pressure lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or cognitive impairment.

Source: Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis | Dementia and Cognitive Impairment | JAMA | JAMA Network

Steve Parker, M.D.

PS: You know what has been proven to reduce the risk of dementia? The Mediterranean diet!

Olive Oil Lowers Cardiovascular Disease Risk

Steve Parker MD, low-carb diet, diabetic diet
Olives, olive oil, and vinegar: classic Mediterranean foods

A new analysis of the Nurses Health Study confirms the headline above. Olive oil, of course, is a primary component of the healthy Mediterranean diet. From the American College of Cardiology:

Higher olive oil intake was associated with a lower risk of CHD [coronary heart disease] and total CVD [cardiovascular disease] in two large prospective cohorts of US men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD.

***

This study of well-educated health professionals is the first in the United States to show the relative value of higher intake of olive oil for preventing CHD and CVD. It was conducted in the era that margarine was primarily trans fatty acids and would not apply to the present soft and liquid margarines. The benefit attributed to olive oil is not simply the substitution for saturated fatty acid. The modest benefit of olive oil in the United States occurred at relatively low olive oil intake (average 12 g/day). In contrast, the Mediterranean diet generally has over 25 g/day. In European studies, a healthy cohort had a 7% reduction in CHD risk for each 10 g/d increase in olive oil; extra virgin olive oil reduced cerebrovascular events by 31% in a high-risk group, and regular olive oil was associated with a 44% lower risk of CHD after about 7.8 years in Italian women survivors of an MI. Amongst the benefits of olive oil include positive effects on inflammation, endothelial function, hypertension, insulin sensitivity, and diabetes.

Source: Olive Oil Consumption and Cardiovascular Risk – American College of Cardiology

Steve Parker, M.D.

If You’re Looking for Reasons to Avoid Processed Meats, Unprocessed Red Meat, and Poultry, Here You Go…

Steak vs vegetarian

Public health authorities in the West have been trying for years to scare us away from eating meat. Here’s an abstract of one of the weak studies that support that contention. Herein, heavier consumers of processed meats, unprocessed red meat, and poultry were a increased risk of cardiovascular disease. Fish and poultry were not linked to increased risk of death, while processed meat and unprocessed red meat were. And fish was not linked to cardiovascular disease. The authors admit that the differences in outcome were small.

Importance 

Although the associations between processed meat intake and cardiovascular disease (CVD) and all-cause mortality have been established, the associations of unprocessed red meat, poultry, or fish consumption with CVD and all-cause mortality are still uncertain.

Objective 

To identify the associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality.

Design, Setting, and Participants 

This cohort study analyzed individual-level data of adult participants in 6 prospective cohort studies in the United States. Baseline diet data from 1985 to 2002 were collected. Participants were followed up until August 31, 2016. Data analyses were performed from March 25, 2019, to November 17, 2019.

Exposures 

Processed meat, unprocessed red meat, poultry, or fish intake as continuous variables.

Main Outcomes and Measures 

Hazard ratio (HR) and 30-year absolute risk difference (ARD) for incident CVD (composite end point of coronary heart disease, stroke, heart failure, and CVD deaths) and all-cause mortality, based on each additional intake of 2 servings per week for monotonic associations or 2 vs 0 servings per week for nonmonotonic associations.

Results 

Among the 29 682 participants (mean [SD] age at baseline, 53.7 [15.7] years; 13 168 [44.4%] men; and 9101 [30.7%] self-identified as non-white), 6963 incident CVD events and 8875 all-cause deaths were adjudicated during a median (interquartile range) follow-up of 19.0 (14.1-23.7) years. The associations of processed meat, unprocessed red meat, poultry, or fish intake with incident CVD and all-cause mortality were monotonic (P for nonlinearity ≥ .25), except for the nonmonotonic association between processed meat intake and incident CVD (P for nonlinearity = .006). Intake of processed meat (adjusted HR, 1.07 [95% CI, 1.04-1.11]; adjusted ARD, 1.74% [95% CI, 0.85%-2.63%]), unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.06]; adjusted ARD, 0.62% [95% CI, 0.07%-1.16%]), or poultry (adjusted HR, 1.04 [95% CI, 1.01-1.06]; adjusted ARD, 1.03% [95% CI, 0.36%-1.70%]) was significantly associated with incident CVD. Fish intake was not significantly associated with incident CVD (adjusted HR, 1.00 [95% CI, 0.98-1.02]; adjusted ARD, 0.12% [95% CI, −0.40% to 0.65%]). Intake of processed meat (adjusted HR, 1.03 [95% CI, 1.02-1.05]; adjusted ARD, 0.90% [95% CI, 0.43%-1.38%]) or unprocessed red meat (adjusted HR, 1.03 [95% CI, 1.01-1.05]; adjusted ARD, 0.76% [95% CI, 0.19%-1.33%]) was significantly associated with all-cause mortality. Intake of poultry (adjusted HR, 0.99 [95% CI, 0.97-1.02]; adjusted ARD, −0.28% [95% CI, −1.00% to 0.44%]) or fish (adjusted HR, 0.99 [95% CI, 0.97-1.01]; adjusted ARD, −0.34% [95% CI, −0.88% to 0.20%]) was not significantly associated with all-cause mortality.

Conclusions and Relevance 

These findings suggest that, among US adults, higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality. These findings have important public health implications and should warrant further investigations.

Source: Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality | Cardiology | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

PS: The traditional Mediterranean diet is low in meat and prominently features fish.

Steve Parker MD, Advanced Mediterranean Diet

Low-Carb Diets Improve Cardiovascular Disease Risk Factors

Even with the mandarin oranges, this salad is low-carb

A meta-analysis by Chinese investigators found that low-carb diets improve cardiovascular risk factors. Specifically: body weight (lowered), triglycerides (lowered), HDL-cholesterol (raised), blood pressure (lowered systolic and diastolic, but less than 2 points).

Additionally, they found increases in total cholesterol and HDL-cholesterol. Some consider those to be going in the wrong direction, increasing cardiovascular risk. The study authors, however, considered these increases “slight,” implying lack of real-world significance.

I’ll not fisk the entire research paper. Have a go at it yourself by clicking the link to full-text below.

The researchers included 12 randomized controlled trials in their analysis. They defined low-carb diets as having less than 40% of calories derived from carbohydrates. If you’re eating 2200 calories a day, 39% of calories from carb would be 215 g of carbs/day. That’s a lot of carb, and wouldn’t be much lower than average in the U.S.. I scanned the report pretty quickly and didn’t run across an overall average for carb grams or calories in the low-carb diets. The “control diets” had 45–55% of calories from carbohydrate.

Here’s the abstract:

Background

Low-carbohydrate diets are associated with cardiovascular risk factors; however, the results of different studies are inconsistent.

Purpose

The aim of this meta-analysis was to assess the relationship between low-carbohydrate diets and cardiovascular risk factors.

Method

Four electronic databases (PubMed, Embase, Medline, and the Cochrane Library) were searched from their inception to November 2018. We collected data from 12 randomized trials on low-carbohydrate diets including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and blood pressure levels, as well as weight as the endpoints. The average difference (MD) was used as the index to measure the effect of a low-carbohydrate diet on cardiovascular risk factors with a fixed-effects model or random-effects model. The analysis was further stratified by factors that might affect the results of the intervention.

Results

From 1292 studies identified in the initial search results, 12 randomized studies were included in the final analysis, which showed that a low-carbohydrate diet was associated with a decrease in triglyceride levels of -0.15mmol/l (95% confidence interval -0.23 to -0.07). Low-carbohydrate diet interventions lasting less than 6 months were associated with a decrease of -0.23mmol/l (95% confidence interval -0.32 to -0.15), while those lasting 12–23 months were associated with a decrease of -0.17mmol/l (95% confidence interval -0.32 to -0.01). The change in the body weight in the observation groups was -1.58kg (95% confidence interval -1.58 to -0.75); with for less than 6 months of intervention, this change was -1.14 kg (95% confidence interval -1.65 to -0.63),and with for 6–11 months of intervention, this change was -1.73kg (95% confidence interval -2.7 to -0.76). The change in the systolic blood pressure of the observation group was -1.41mmHg (95% confidence interval—2.26 to -0.56); the change in diastolic blood pressure was -1.71mmHg (95% confidence interval—2.36 to -1.06); the change in plasma HDL-C levels was 0.1mmHg (95% confidence interval 0.08 to 0.12); and the change in serum total cholesterol was 0.13mmol/l (95% confidence interval 0.08 to 0.19). The plasma LDL-C level increased by 0.11mmol/l (95% confidence interval 0.02 to 0.19), and the fasting blood glucose level changed 0.03mmol/l (95% confidence interval -0.05 to 0.12),which was not significant.

Conclusions

This meta-analysis confirms that low-carbohydrate diets have a beneficial effect on cardiovascular risk factors but that the long-term effects on cardiovascular risk factors require further research.

Source: The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis

Steve Parker, M.D.

PS: You know what else reduces cardiovascular disease risk? The Mediterranean diet. The book below has a low-carb option. It’s two diets for the price of one.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Tea May Prolong Your Life and Prevent Heart Disease

One of my favorite green teas

For years we’ve been hearing about the potential longevity and cardiovascular benefits of green tea. If memory serves, most of the data comes from Japanese studies. Now a Chinese observational study finds 15–20% reductions in atherosclerotic cardiovascular disease (ASCVD) and death, compared to non-tea drinkers. Most of the participants drank green tea, and they did so at least thrice weekly.

From the European Journal of Preventive Cardiology:

Using large prospective cohorts among general Chinese adults, we have provided novel evidence on the protective role of tea consumption on ASCVD events and all-cause mortality, especially among those who kept the habit all along. The current study indicates that tea might be a healthy beverage for primary prevention against ASCVD and premature death.

Source: Tea consumption and the risk of atherosclerotic cardiovascular disease and all-cause mortality: The China-PAR project – Xinyan Wang, Fangchao Liu, Jianxin Li, Xueli Yang, Jichun Chen, Jie Cao, Xigui Wu, Xiangfeng Lu, Jianfeng Huang, Ying Li, Liancheng Zhao, Chong Shen, Dongsheng Hu, Ling Yu, Xiaoqing Liu, Xianping Wu, Shouling Wu, Dongfeng Gu,

The researchers point out that results may not apply to non-Chinese populations.

Steve Parker, M.D.

h/t to Jan at The Low Carb Diabetic (click link for more details about the study)

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Mediterranean Diet Ranked as Best Overall of 2020

Santorini, Greek seaside

Not surprising!

Every year, the U.S. News and World Report puts together a panel of experts to rank various diets.

From MedScape:

For the third year in a row, the Mediterranean diet has been named the best diet overall in the U.S. News & World Report annual rankings.

In 2018, the Mediterranean diet shared top honors with the DASH (Dietary Approaches to Stop Hypertension) diet. Both focus on fruits, vegetables, and whole grains. The ketogenic diet, one of the most popular, again fared well in the annual survey, but only in the fast weight loss category. Overall, it was not rated highly.

Angela Haupt, managing editor of health for the publication, says this year’s list has ”no surprises,” as it includes many diets that have been named outstanding before. Trendy diets typically won’t be found on its list, she says, explaining that its experts look for plans that have solid research and staying power.

Source: Mediterranean Diet Repeats as Best Overall of 2020

Click for the traditional Mediterranean diet.

Steve Parker, M.D.

Click pic to purchase book at Amazon.com. E-book versions are also at Smashwords.com.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.