Coronary heart disease is a general term covering a number of specific disorders. There is some degree of blockage in the blood vessels in cases of coronary heart disease that restricts the blood supply to the heart.
1 : Risk factors for heart disease
Some risk factors for heart disease cannot be modified, such as age and family history. Others can be changed by appropriate interventions. The major modifiable risk factors for developing heart disease known to date are smoking, high blood cholesterol, hypertension, abdominal obesity (especially in men and postmenopausal women), high intakes of saturated and total fat and low physical activity levels. Hypertension and high blood cholesterol may be controlled by making lifestyle changes (eg eating more fruit and vegetables and using salt and fat in the diet sparingly), losing weight, being more active, taking medication if prescribed and limiting alcohol intake.
2 : Dietary advice to reduce the risk of coronary heart disease
Numerous expert advisory committees have concluded that there is no relationship between the consumption of sugars and heart disease. A recent FAO/WHO report on Carbohydrates in Human Nutrition concludes, "There is no evidence for a causal role of sucrose in the etiology of coronary heart disease. The cornerstone of dietary advice aimed at reducing coronary heart disease risk is to increase the intake of carbohydrate-rich foods, especially cereals, vegetables and fruits rich in non-starch polysaccharide, at the expense of fat." This advice is supported by an Expert Committee for WHO (2003) and an IOM Report (2002). A meta-analysis of 37 dietary interventions on cardiovascular risk factors showed that a reduction in total fat and saturated fat (replaced with carbohydrate) could improve blood fat (lipid) profile and reduce risk of coronary heart disease in free-living subjects. The review also showed that exercise and weight loss provided further beneficial effects on cardiovascular disease risk factors following the dietary intervention. The findings of this review are supported by a more recent randomised controlled trial in which replacing fat either with sugar or starches in the diet of overweight subjects had no deleterious effect on blood lipid levels. Sugar intakes typical of those seen in a western diet do not have an adverse effect on blood fats.
3 : Conclusion
There is good evidence that moderately low-fat, high-carbohydrate diets, rich in fruit and vegetables, reduce the risk of coronary heart disease and further benefits are attained by increasing physical activity levels. Sugar can make a low-fat diet more palatable.
4 : References
Department of Health (1994) Nutritional Aspects of Cardiovascular Disease. Report of the Cardiovascular Review Group. Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects No 46. HMSO, London
FAO Food and Nutrition Paper 66 (1998) Report of the Joint FAO/WHO Expert Consultation of Carbohydrates in Human Nutrition
Frayn KN, Kingman SM (1995) Dietary sugars and lipid metabolism in humans. American Journal of Clinical Nutrition Jul;62(1 Suppl):250S-261S; discussion 261S-263S. Review
Food and Nutrition Board (FNB), Institute of Medicine (IOM) (2002) Dietary reference intakes for energy, carbohydrates, fiber, fat, protein and amino acids (Macronutrients) (2002) USA. National Academic Press Ch 6, p25 and p42
Saris WHM Astrup A Prentice AM Zunft HJF Formiguera X. Verboeket-van de Venne WPHG Raben A Poppitt SD Seppelt B Johnston S. Vasilaras TH Keogh GF (2000)
Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. International Journal of Obesity 24(10):1310-1318
Yu-Poth S Zhao G Etherton T Naglak M Jonnalagadda S Kris-Etherton PM (1999) Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. American Journal of Clinical Nutrition 69(4): 632-46
World Health Organization and Food and Agriculture Organization (2003) “Diet, nutrition and the prevention of chronic diseases” Report of a Joint FAO/WHO Expert Consultation. WHO Technical Report Series 916. WHO Geneva, Switzerland