Dietary Modification and CVD Prevention

摘要: CARDIOVASCULAR DISEASE (CVD) IS THE LEADING cause of mortality in women the United States and throughout most world. The contemporary approach to prevention CVD includes lifestyle modification for all adults medical therapy those with risk factors (hypertension, hypercholesterolemia, or diabetes). report this issue JAMA by Howard et al from Women’s Health Initiative (WHI) is timely, given recent major initiatives that focus on women. In 1991, National Institutes launched WHI research program, a series clinical trials large observational studies addressed common causes death disability postmenopausal women—CVD, cancer, osteoporosis. program involved extraordinary commitment effort part numerous investigators staff members more than 100 000 participants. Their efforts already have will continue advance health One studies, Dietary Modification Trial, was randomized controlled trial tested whether behavioral intervention designed lower total intake dietary fat increase intakes fruits, vegetables, grains would decrease breast colorectal cancer. Cardiovascular disease prespecified secondary outcome. As noted authors, Trial not optimally test hypotheses related CVD; however, they reasoned reducing could collateral benefits lowering saturated trans fatty acids thereby CVD. enrolled 48 835 (mean age, 62.3 years)—20% whom were nonwhite. Women assigned active attended group sessions promote changes reduce 20% energy, fruits/vegetables at least 5 servings/d, grain 6 servings/d. intensity moderate—18 during first 12 months 4 times per year thereafter. trials, mean achieved levels fell short goal. group, decreased 37.8% 28.8% while servings day fruits vegetables increased 3.6 4.9. Mean essentially unchanged, ie, approximately 4.5 baseline follow-up. Concomitantly, there reductions (12.7% 9.5% energy), acid (2.8% 1.6% polyunsaturated (7.8% 6.1% monounsaturated (14.4% 10.8% energy). On average, comparison made few changes. result, differences between groups minimal—eg, 3, net 3.55 mg/dL low-density lipoprotein cholesterol less 1 mm Hg blood pressure. main findings are had no effect coronary heart disease, stroke, Hazard ratios each outcomes close 1. without baseline, trends toward risk. Paradoxically, among 3.4% prior CVD, associated slightly This latter finding occurred chance alone, number statistical tests. A thorough exposition data subset should be conducted published before any conclusion drawn. question one might ask why null study? commonplace study population healthier anticipated. Specifically, fewer events expected. addition, minimal major, diet-related factors. Its impact pressure small because did implement modifications pressure—eg, reduced salt intake, potassium DASH (Dietary Approach Stop Hypertension) diet, weight loss. fats (saturated acids) but also protective (polyunsaturated fats). Most participants overweight obese body mass index, 29.1), address weight, primary factor diabetes. Over