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treatment\tdecisions.\tThe\tguidelines\tadvise\tassessing\n\tfactors\tsuch\tas\tage,\tgender,\trace,\twhether\ta\npatient\tsmokes,\tblood\tpressure\tand\twhether\tit\tis\tbeing\ttreated,\twhether\ta\tperson\thas\tdiabetes,\tand\nblood\tcholesterol\tlevels\tin\tdetermining\trisk.\tThey\talso\tsuggest\tthat\thealth\tcare\tproviders\tshould | [
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consider\tother\tfactors,\tincluding\tfamily\thistory.\tOnly\tafter\tthat\tvery\tpersonalized\tassessment\tis\ta\ndecision\tmade\ton\twhat\ttreatment\twould\twork\tbest.\tThe\tASCVD\n\tRisk\tCalculator\tdeveloped\tby\tthe\nACC/AHA\texpert\tpanel\tis\tavailable\tat\tthe\t\nACC.org\n\twebsite.\nInflammatory\tmarkers | [
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inflammatory\tmarkers\tC-reactive\tprotein\t(hs-CRP),\tinterleukin-6\t(IL-6),\tfibrinogen,\tand\nhomocysteine\t(\nKalogeropoulos\tet\tal,\t2010\n).\tAn\tinflammatory\tmarker\tspecific\tto\tvascular\ninflammation\thas\tbecome\tavailable.\tThe\tPLAC™\ttest\tmeasures\tLp-PLA2\t(\nJellinger\tet\tal,\t2012\n).\tLp- | [
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Jellinger\tet\tal,\t2012\n).\tLp-\nPLA2\tlevels\tindicate\tASCVD\trisk\tindependent\tfrom\tother\tmarkers\tand\tprovides\tinformation\ton\tthe\nrelationship\tbetween\tinflammation\tand\tatherosclerosis\t(see\t\nChapters\t5\n\tand\t\n7\n).\nBOX\t32.3\nInflammatory\tMarkers\tfor\tCardiovascular\tRisk\nGenetic\tmarkers:\tangiotensin\n\tII\treceptor\ttype-1\tpolymorphism | [
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Genetic\tmarkers:\tangiotensin\n\tII\treceptor\ttype-1\tpolymorphism\nOxidized\tlow-density\tlipoprotein\tcholesterol\nAdhesion\tmolecules\nSelectins\nFree\tfatty\tacids\nCytokines\nInterleukin-1\nInterleukin-6\nTumor\tnecrosis\tfactor-alpha\nAcute-phase\treactants\nFibrinogen\nC-reactive\tprotein\nSerum\tamyloid\tA\nWhite\tblood\tcell\tcount\nErythrocyte\tsedimentation\trate | [
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] |
Serum\tamyloid\tA\nWhite\tblood\tcell\tcount\nErythrocyte\tsedimentation\trate\nTrimethylamine\tN-oxide\t(TMAO) | [
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Derived\tfrom\tFung\tMM,\tet\tal:\n\tEarly\tinflammatory\tand\tmetabolic\tchanges\tin\tassociation\twith\tAGTR1\npolymorphisms\tin\tprehypertensive\tsubjects,\t\nAm\tJ\tHypertens\n\t24:225,\t2011;\tPearson\tTA,\tet\tal:\tMarkers\tof\ninflammation\tand\tcardiovascular\tdisease:\tapplication\tto\tclinical\tand\tpublic\thealth\tpractice:\ta\tstatement | [
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for\thealthcare\tprofessionals\tfrom\tthe\tCenters\tfor\tDisease\tControl\tand\tPrevention\tand\tthe\tAmerican\tHeart\nAssociation,\t\nCirculation\n\t107:499,\t2003.\nFibrinogen.\nMost\tMIs\tare\tthe\tresult\tof\tan\tintracoronary\tthrombosis.\tProspective\tstudies\thave\tshown\tthat\tplasma | [
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fibrinogen\tis\tan\tindependent\tpredictor\tof\tASCVD\trisk.\tFactors\tassociated\twith\tan\televated\tfibrinogen\nare\tsmoking,\tdiabetes,\thypertension,\tobesity,\tsedentary\tlifestyle,\televated\ttriglycerides,\tand\tgenetic\nfactors.\tMore\tclinical\ttrials\tare\tneeded\tto\tdetermine\twhether\n\tfibrinogen\tis\tinvolved\tin\tatherogenesis | [
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disease;\tthe\televated\tlevels\tare\tindependent\tof\tother\trisk\tfactors\t(see\t\nChapter\t5\n).\tDespite\ta\tlack\tof\nspecificity\tfor\tthe\tcause\tof\tthe\tinflammation,\tdata\tfrom\tmore\tthan\t30\tepidemiologic\tstudies\thave\nshown\tsignificant\tassociation\n\tbetween\televated\tblood\tlevels\tof\ths-CRP\tand\tthe\tprevalence\tof\natherosclerosis\t(\nMorrow\tand\tCrea,\t2014\n). | [
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] |
atherosclerosis\t(\nMorrow\tand\tCrea,\t2014\n).\nHs-CRP\tlevels\tare\tcategorized\tfor\trisk\tas\tlow\t(<1\tmg/L),\taverage\t(2\tto\t3\tmg/L),\tand\thigh\t(>3\tmg/L)\nafter\tthe\taverage\tof\ttwo\tmeasurements\tare\ttaken\tat\tleast\t2\tweeks\tapart.\tThe\tMediterranean\tdiet\npattern\t(\nAppendix\t23\n)\tis\tmost\teffective\tin\tinhibiting\tinflammation.\tThe\tDietary\tApproaches\tto\tStop | [
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Hypertension\tmodel\t(described\tlater\tin\tthe\tchapter\tand\tin\t\nAppendix\t17\n)\tand\tthe\tplant\tnutrition\nmodel\talso\thave\tproven\tto\tbe\tbeneficial.\tThe\tdata\ton\tlow-fat\tand\tlow-carbohydrate\tdiets\tare\ninconclusive\t(\nLee\tet\tal,\t2014\n;\t\nSmidowicz\tand\tRegula,\t2015\n).\nHomocysteine.\nHomocysteine | [
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0.019168132916092873
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;\t\nSmidowicz\tand\tRegula,\t2015\n).\nHomocysteine.\nHomocysteine\n\tis\tan\tamino\tacid\tmetabolite\tof\tmethionine.\tElevated\tcirculating\ttotal\thomocysteine\n(tHcy)\tconcentrations\thave\tbeen\tregarded\n\tas\tan\tindependent\trisk\tfactor\tfor\tCVD.\tHowever,\tseveral\nlarge\tclinical\ttrials\tto\tcorrect\thyperhomocysteinemia\tusing\tB-vitamin\tsupplements\t(particularly\tfolic | [
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acid)\thave\tlargely\tfailed\tto\treduce\tthe\trisk\tof\tCVD\t(\nBaggot\tand\tTamura,\t2015\n).\nAlthough\tsome\tevidence\tsuggests\tthat\thomocysteine\tmay\tpromote\tatherosclerosis,\tno\tcausal\tlink\nhas\tbeen\testablished.\tAnd\tit\tappears\tmore\tlikely\tthat\tincreased\n\thomocysteine\tlevels\tare\tmarkers\nrather\tthan\tcauses\tof\tCVD.\tGiving\tsupplemental\tvitamins\tfolate,\tB\n6\n\tand\tB\n12 | [
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6\n\tand\tB\n12\n,\thave\tbeen\tshown\tto\nlower\thomocysteine\tlevels\tin\tsome\tindividuals\tand\tis\tbeing\tinvestigated\tactively\tas\ta\ttreatment\tfor\nCVD\tbut\tas\tof\tnow\tis\tnot\twidely\trecommended.\nTrimethylamine-N-oxide.\nTrimethylamine-N-oxide\t(TMAO)\n\tis\ta\tgut\tmicrobiota-dependent\tmetabolite\tthat\tcontributes\tto\nheart\n\tdisease\t(\nTang\tet\tal,\t2013 | [
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heart\n\tdisease\t(\nTang\tet\tal,\t2013\n).\tIt\tis\tproduced\tby\tthe\tliver\tafter\tintestinal\tbacteria\thave\tdigested\nanimal\tprotein.\tTMAO\thas\tbeen\tshown\tto\tpredict\tcardiac\trisk\tin\tindividuals\tnot\tidentified\tby\ntraditional\trisk\tfactors\tand\tblood\ttests.\tThis\tis\tspeculated\tto\tbe\ta\tfactor\tin\tthe\temerging\tevidence | [
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that\ta\tplant-based\tdiet\tis\tcardioprotective\tcompared\twith\tone\tthat\tincludes\tanimal\tsources\t(\nTuso,\n2015\n).\nLifestyle\tguidelines\nLifestyle\tmodification\tremains\tthe\tbackbone\tof\tCVD\tprevention\tand\ttreatment.\tAdhering\tto\ta\theart-\nhealthy\tdiet,\tregular\texercising,\tavoidance\tof\ttobacco\tproducts,\tand\tmaintenance\tof\ta\thealthy\tweight | [
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are\tknown\tlifestyle\tfactors\tthat,\talong\twith\tgenetics,\tdetermine\tCVD\trisk.\tThree\tcritical\tquestions\n(CQs)\twere\taddressed\tin\tthe\t2013\tACC/AHA\tlifestyle\tmodification\tguidelines.\n\tCQ1\tpresents\tevidence\non\tdietary\tpatterns\tand\tmacronutrients\tand\ttheir\teffect\ton\tblood\tpressure\tand\tlipids,\tCQ2\tpresents | [
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evidence\ton\tthe\teffect\tof\tdietary\tsodium\tand\tpotassium\tintake\ton\tblood\tpressure\tand\tCVD\toutcomes,\nand\tCQ3\tpresents\tthe\tevidence\ton\tthe\teffect\tof\tphysical\tactivity\ton\tlipids\tand\tblood\tpressure.\tThe\nrecommendations\tare\tsummarized\tin\t\nBox\t32.4\n.\nBOX\t32.4\nSummary\tof\tAmerican\tCollege\n\t\nof\tCardiology\t(ACC)/\tAmerican | [
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BOX\t32.4\nSummary\tof\tAmerican\tCollege\n\t\nof\tCardiology\t(ACC)/\tAmerican\nHeart\tAssociation\t(AHA)\tRecommendations\tfor\tLifestyle\nManagement\nDiet\nLDL-C\nAdvise\tadults\twho\twould\tbenefit\tfrom\tLDL-C\tlowering\tto\n1.\t\nConsume\ta\tdietary\tpattern\tthat\temphasizes\tintake\tof\tvegetables,\tfruits,\tand\twhole\tgrains; | [
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includes\tlow-fat\tdairy\tproducts,\tpoultry,\tfish,\tlegumes,\tnontropical\tvegetable\toils\tand\tnuts;\nand\tlimits\tintake\tof\tsweets,\tsugar-sweetened\n\tbeverages,\tand\tred\tmeats. | [
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a.\n\tAdapt\tthis\tdietary\tpattern\tto\tappropriate\tcalorie\trequirements,\tpersonal\tand\tcultural\nfood\tpreferences,\tand\tnutrition\ttherapy\tfor\tother\tmedical\tconditions\t(including\ndiabetes\tmellitus).\nb.\n\tAchieve\tthis\tpattern\tby\tfollowing\tplans\tsuch\tas\tthe\tDASH\tdietary\tpattern,\tthe\tUSDA\nFood\tPattern,\tor\tthe\tAHA\tDiet.\n2. | [
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intake\tof\tsweets,\tsugar-sweetened\tbeverages,\tand\tred\tmeats.\na.\n\tAdapt\tthis\tdietary\tpattern\tto\tappropriate\tcalorie\trequirements,\tpersonal\tand\tcultural\nfood\tpreferences,\tand\tnutrition\ttherapy\tfor\tother\tmedical\tconditions\t(including\ndiabetes\tmellitus).\nb.\n\tAchieve\tthis\tpattern\tby\tfollowing\tplans\tsuch\tas\tthe\tDASH\tdietary\tpattern,\tthe\tUSDA | [
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intensity\tphysical\tactivity.\nEckel\tRH,\tJakicic\tJM,\tArd\tJD,\tet\tal.\t2013\tAHA/ACC\tguideline\ton\tlifestyle\tmanagement\tto\treduce\ncardiovascular\trisk:\tA\treport\tof\tthe\tAmerican\tCollege\tof\tCardiology\t/American\tHeart\tAssociation\tTask\nForce\ton\tPractice\tGuidelines.\tCirculation\t129:\tS76-S99,\t2014.\nDiet\nThe\timportance\tof\tdiet\tand\tnutrition\tin\tmodifying | [
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Diet\nThe\timportance\tof\tdiet\tand\tnutrition\tin\tmodifying\n\tthe\trisk\tof\tCVD\thas\tbeen\tknown\tfor\tsome\ttime.\nHowever,\tin\tgeneral,\tindividual\tdietary\tcomponents\thave\tbeen\tthe\tpredominant\tfocus.\tBecause\tfoods\nare\tconsumed\ttypically\tin\tcombinations\trather\tthan\tindividually\tand\tbecause\tof\tthe\tpossibility\tof | [
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with\tan\nemphasis\ton\tlean\tmeats,\tlower\tfat\tdairy\tproducts,\tabundant\tnuts\tand\tlegumes,\tand\tuse\tof\tolive\toil,\ncanola\toil,\tnut\toil,\tor\tmargarine\tblended\twith\trapeseed\toil\tor\tflaxseed\toil\t(see\t\nAppendix\t23\n).\tThe\nMeD\tdietary\tpatterns\tthat\thave\tbeen\tstudied\twere\tmoderate\tin\ttotal\tfat\t(32%\tto\t35%),\trelatively\tlow | [
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Macronutrient\tIntake\tTrial\tfor\tHeart\tHealth\t(OmniHeart)\ttrial,\tone\tthat\treplaced\t10%\tof\ttotal\tdaily\nenergy\tfrom\tcarbohydrate\twith\tprotein;\tthe\tother\tthat\treplaced\tthe\tsame\tamount\tof\tcarbohydrate\nwith\tunsaturated\tfat.\tThe\tformer\tshowed\tbetter\tresults\tthan\tthe\tlatter\n\tin\tlowering\tCVD\trisk\t(\nSwain\net\tal,\t2008\n;\tsee\t\nAppendix\t17 | [
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in\tlowering\tCVD\trisk\t(\nSwain\net\tal,\t2008\n;\tsee\t\nAppendix\t17\n).\tThe\t2013\tACC/AHA\tlifestyle\tguidelines\trecommend\tthe\tDASH\tdiet\tas\nbest\tfor\tprevention\tof\tCVD,\tbut\talso\tsuggest\tthat\ta\tMeD\tpattern\tis\tcardioprotective.\nVegan\tdiet\nA\tvegan\tdiet\tis\ta\tstrict\tvegetarian\tdiet\tthat\tincludes\tno\tdietary\tsources\tfrom\tanimal\torigins\t(see | [
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] |
Appendix\t30\n).\tThere\tis\tongoing\tresearch\tto\tsuggest\tonly\tthis\ttype\tof\tvery\n\trestricted\tdiet\tcan\tactually\nreverse\tASCVD\t(\nEsselstyn\tand\tGoulubic´,\t2014\n;\t\nTuso,\t2015\n).\nPhysical\tinactivity\nPhysical\tinactivity\tand\ta\tlow\tlevel\tof\tfitness\tare\tindependent\trisk\tfactors\tfor\tASCVD.\tPhysical\tactivity | [
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is\tassociated\twith\tASCVD,\tindependent\tof\tthe\tcommon\tcardiometabolic\trisk\tfactors\tof\tobesity,\tserum\nlipids,\tserum\tglucose,\tand\thypertension,\tin\tmen\tand\twomen.\tWith\tthe\thigh\tprevalence\n\tof\tobesity,\nphysical\tactivity\tis\ta\thigh\tpriority.\tPhysical\tactivity\tlessens\tASCVD\trisk\tby\treducing\tatherogenesis, | [
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increasing\tvascularity\tof\tthe\tmyocardium,\tincreasing\tfibrinolysis,\tincreasing\tHDL\tcholesterol,\nimproving\tglucose\ttolerance\tand\tinsulin\tsensitivity,\taiding\tin\tweight\tmanagement,\tand\treducing\nblood\tpressure.\nThe\tmost\trecent\tAHA\trecommendations\tfor\texercise\tfor\tadults\tare\tthe\tfollowing:\n• | [
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•\t\nGet\tat\tleast\t150\tminutes\tper\tweek\tof\tmoderate-intensity\taerobic\tactivity\tor\t75\tminutes\tper\nweek\tof\tvigorous\taerobic\tactivity,\tor\ta\tcombination\tof\tboth,\tpreferably\tspread\tthroughout\nthe\tweek.\n•\t\nAdd\tmoderate-\tto\thigh-intensity\tmuscle-strengthening\tactivity\t(such\tas\tresistance\tor\nweights)\ton\tat\tleast\t2\tdays\tper\tweek.\n• | [
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The\tAHA\trecommendations\tfor\tchildren\tare\tthe\tfollowing:\n•\t\nChildren\t3\tto\t5\tyears\told\tshould\tbe\tphysically\tactive\tand\thave\tplenty\tof\topportunities\tto\nmove\tthroughout\tthe\tday.\n•\t\nKids\t6\tto\t17\tyears\told\tshould\tget\tat\tleast\n\t60\tminutes\tper\tday\tof\tmoderate-\tto\tvigorous-\nintensity\tphysical\tactivity,\tmostly\taerobic.\n• | [
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modification\tguidelines.\nDiabetes\nDiabetes\tis\ta\tdisease\tthat\tis\tan\tindependent\trisk\tfactor.\tThe\tprevalence\tof\tdiabetes\tmirrors\tthat\tof\nobesity\tin\tthe\tUnited\tStates.\tType\t2\tdiabetes\thas\tcontinued\tto\tincrease\tin\tincidence\t(see\t\nChapter\n29\n).\tAny\tform\tof\tdiabetes\tincreases\tthe\trisk\tfor\tASCVD,\twith\toccurrence\tat\tyounger\tages.\tMost | [
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people\twith\tdiabetes\tactually\tdie\tof\tCVD.\tSome\tof\tthe\tincreased\trisk\n\tseen\tin\tpatients\twith\tdiabetes\tis\nattributable\tto\tthe\tconcurrent\tpresence\tof\tother\trisk\tfactors,\tsuch\tas\tdyslipidemia,\thypertension,\tand\nobesity.\tThus\tdiabetes\tis\tnow\tconsidered\tan\tASCVD\trisk\tfactor\t(see\t\nChapter\t29\n). | [
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] |
Chapter\t29\n).\nThe\tLook\tAHEAD\t(Action\tfor\tHealth\tin\tDiabetes)\tstudy,\tconducted\tfrom\t2001\tto\t2012,\tprovided\nextensive\tlongitudinal\tdata\ton\tthe\teffect\tof\tan\tintensive\tlifestyle\tintervention,\ttargeting\n\tweight\nreduction\tthrough\tcaloric\trestriction\tand\tincreased\tphysical\tactivity,\ton\tCVD\trates\t(the\tprimary | [
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factors\n\twithout\ta\tconcomitant\tincrease\tin\tthe\trisk\tof\tcardiovascular\tevents\t(\nFox\tet\tal,\t2015\n).\nMetabolic\tsyndrome\nSince\tthe\tearly\tfindings\tof\tthe\tFramingham\tHeart\tStudy,\tit\thas\tbeen\tknown\tthat\ta\tclustering\tof\trisk\nfactors\tmarkedly\tincreases\tthe\trisk\tof\tCVD\t(see\t\nChapter\t20\n\tfor\tan\tin-depth\tdiscussion\tof\tmetabolic\nsyndrome).\nObesity | [
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for\tan\tin-depth\tdiscussion\tof\tmetabolic\nsyndrome).\nObesity\nObesity\thas\tnow\treached\tepidemic\tlevels\tin\tchildren\tand\tadults\tin\n\tmany\tdeveloped\tcountries.\tBody\nmass\tindex\t(BMI)\tand\tCVD\tare\tpositively\trelated;\tas\tBMI\tgoes\tup,\tthe\trisk\tof\tCVD\talso\tincreases. | [
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The\tprevalence\tof\toverweight\tand\tobesity\tis\tthe\thighest\tthat\tit\thas\tever\tbeen\tin\tthe\tUnited\tStates\n(see\t\nChapter\t20\n).\tObesity\trates\tvary\tby\trace\tand\tethnicity\tin\twomen.\tNon-Hispanic\tblack\twomen\nhave\tthe\thighest\tprevalence,\tfollowed\tby\tMexican\tAmerican\twomen,\tAmerican\tIndians,\n\tAlaskan\nnatives,\tand\tnon-Hispanic\twhites. | [
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Alaskan\nnatives,\tand\tnon-Hispanic\twhites.\nAn\tobese-years\tmetric\twas\tdeveloped\tusing\tmore\tthan\t5000\tparticipants\tof\tthe\tFramingham\tHeart\nStudy\tthat\tcaptures\tthe\tcumulative\tdamage\tof\tobesity\tover\tyears.\tThe\tobese-years\tmetric\tis\ncalculated\tby\tmultiplying\tthe\tnumber\tof\tBMI\tunits\tabove\t29\tkg/m\n2\n\tby\tthe\tnumber\tof\tyears\tlived\tat | [
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dysfunction,\tand\ndyslipidemia\t(small\tdense\tLDL,\tincreased\tapo\tB,\tlow\tHDL,\thigh\ttriglyceride\tlevels).\tMany\ninflammatory\tproteins\tare\tnow\tknown\tto\tcome\tfrom\tthe\tadipocyte\t(see\t\nChapters\t7\n\tand\t\n20\n).\tThese\nconcurrent\trisk\tfactors\tmay\thelp\tto\texplain\tthe\thigh\tmorbidity\tand\tmortality\trates\tobserved\tin\npeople\twho\tare\tobese. | [
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people\twho\tare\tobese.\nWeight\tdistribution\t(abdominal\tversus\tgynoid)\tis\talso\tpredictive\tof\tCVD\trisk,\n\tglucose\ttolerance,\nand\tserum\tlipid\tlevels.\tCentral\tor\tabdominal\tlength\tof\tadiposity\talso\thas\tbeen\tstrongly\trelated\tto\nmarkers\tof\tinflammation,\tespecially\ths-CRP.\tTherefore\ta\twaist\tcircumference\tof\tless\tthan\t35\tinches | [
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for\twomen\tand\t40\tinches\tfor\tmen\tis\trecommended\t(see\t\nChapter\t20\n).\nSmall\tweight\tlosses\t(10\tto\t20\tlb)\tcan\timprove\tLDL\tcholesterol,\tHDL\tcholesterol,\ttriglycerides,\thigh\nblood\tpressure,\n\tglucose\ttolerance,\tand\ths-CRP\tlevels,\teven\tif\tan\tideal\tBMI\tis\tnot\tachieved.\tWeight | [
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loss\talso\thas\tbeen\tcorrelated\twith\tlower\ths-CRP\tlevels.\tHowever,\tto\trestore\tvascular\tfunction,\tthe\namount\tof\tweight\tthat\tmust\tbe\tlost,\tthe\ttime\tof\tweight\tmaintenance,\tor\tthe\tamount\tof\timprovement\nin\tendothelial\tfunction\tthat\tlessens\tcardiovascular\tevents\tis\tstill\tunknown.\nNonmodifiable\trisk\tfactors\nAge\tand\n\tsex | [
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] |
considered.\tA\tfamily\thistory\tis\tconsidered\tto\tbe\tpositive\twhen\tMI\tor\tsudden\tdeath\toccurs\tbefore\tthe\nage\tof\t55\tyears\tin\ta\tmale\tfirst-degree\trelative\tor\tthe\tage\tof\t65\n\tin\ta\tfemale\tfirst-degree\trelative\n(parents,\tsiblings,\tor\tchildren).\tThe\tpresence\tof\ta\tpositive\tfamily\thistory,\talthough\tnot\tmodifiable, | [
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] |
influences\tthe\tintensity\tof\trisk\tfactor\tmanagement.\nMenopausal\tstatus\nEndogenous\testrogen\tconfers\tprotection\tagainst\tASCVD\tin\tpremenopausal\twomen,\tprobably\tby\npreventing\tvascular\tinjury.\tLoss\tof\testrogen\tafter\tnatural\tor\tsurgical\tmenopause\tis\tassociated\twith\nincreased\tASCVD\trisk.\tRates\tof\tASCVD\tin\tpremenopausal\twomen\tare\tlow\texcept\tin\twomen\twith | [
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multiple\trisk\tfactors.\tDuring\tthe\tmenopausal\tperiod\ttotal\tcholesterol,\tLDL\tcholesterol,\tand\ntriglyceride\tlevels\tincrease;\tHDL\tcholesterol\tlevel\tdecreases,\tespecially\tin\twomen\twho\tgain\tweight.\nMedical\tnutrition\ttherapy\nMedical\tnutrition\ttherapy\t(MNT),\twhich\tincludes\tdiscussion\tof\tphysical\tactivity,\tis\n\tthe\tprimary | [
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the\tprimary\nintervention\tfor\tpatients\twith\televated\tLDL\tcholesterol\t(see\t\nBox\t32.4\n).\tPhysicians\tare\tencouraged\tto\nrefer\tpatients\tto\tregistered\tdietitian\tnutritionists\t(RDNs)\tto\thelp\tpatients\tmeet\tgoals\tfor\ttherapy\nbased\ton\tLDL\tcholesterol\tlevels.\nWith\tdiet,\texercise,\tand\tweight\treduction,\tpatients\tcan\tdecrease\tLDL\tcholesterol\tand\treduce\tbody | [
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inflammation.\tThe\tcomplexity\tof\tchanges,\tnumber\tof\tchanges,\n\tand\tmotivation\tof\tthe\tpatient\twill\ndictate\thow\tmany\tpatient\tvisits\tit\twill\ttake\tfor\tthe\tadherent\tto\tbe\tsuccessful.\tAn\tinitial\tvisit\tof\t45\tto\n90\tminutes\tfollowed\tby\ttwo\tto\tsix\tvisits\tof\t30\tto\t60\tminutes\teach\twith\tthe\tRDN\tis\trecommended | [
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(Academy\tof\tNutrition\tand\tDietetics\tEvidence\tAnalysis\tLibrary\t[EAL],\t2011).\tConsequently\tthese\ninterventions\tare\ttried\tbefore\tdrug\ttherapy\tand\talso\tcontinue\n\tduring\tpharmacologic\ttreatment\tto\nenhance\teffectiveness\tof\tthe\tmedication\t(see\t\nPathophysiology\tand\tCare\tManagement\tAlgorithm:\nAtherosclerosis\n). | [
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enough\tto\tdraw\tconclusions.\tIn\tgeneral,\tthe\tMeD\tpattern\t(\nFig.\t32.5\n)\tfits\tthe\trecommendations.\tA\nstudy\trecently\tpresented\tat\tthe\tACC\tsupports\tthe\tMeD\tpattern\tfor\tCVD\trisk\treduction\n\t(\nACC,\t2015\n).\nThe\tstudy\tincluded\tmore\tthan\t2500\tGreek\tadults\tover\tmore\tthan\t10\tyears.\tNearly\t20%\tof\tmen\tand | [
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] |
12%\tof\twomen\tin\tthe\tstudy\tdeveloped\tor\tdied\tfrom\theart\tdisease.\tPeople\twho\tclosely\tfollowed\tthe\nMeD\twere\t47%\tless\tlikely\tto\tdevelop\theart\tdisease\tthan\tthose\twho\tdid\tnot\tfollow\tthe\tdiet.\tThe\tMeD\nScore\tTool\twas\tused\t(see\t\nFig.\t32.5\n)\tto\tvalidate\tthe\tdietary\tpattern.\tA\tMeD\tmay\talso\treduce\trecurrent | [
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)\tto\tvalidate\tthe\tdietary\tpattern.\tA\tMeD\tmay\talso\treduce\trecurrent\nCVD\tby\t50%\tto\t70%\tand\thas\tbeen\tshown\tto\taffect\tlipoprotein\tlevels\tpositively\tin\thigh-risk\npopulations\t(\nCarter\tet\tal,\t2010\n). | [
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FIG.\t32.5\nMediterranean\tDiet\tScore\tTool.\n\tSource:\t(Courtesy\tAlison\tHornby\tand\tKatherine\tPaterson.)\nSaturated\tfatty\tacids.\nCurrently\tin\tthe\tUnited\tStates\tthe\taverage\tintake\tof\tsaturated\tfat\tis\t11%\tof\tcalories.\tThe\nrecommendation\tfor\tdecreasing\tLDL\tcholesterol\tis\t5%\tto\t6%.\tThe\tguidelines\thave\tno\tspecific | [
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Trans\tfatty\tacids.\nTrans\tfatty\tacids\n\t(stereoisomers\tof\tthe\tnaturally\toccurring\tcis-linoleic\tacid)\tare\tproduced\tin\tthe\nhydrogenation\tprocess\tused\tin\tthe\tfood\tindustry\tto\tincrease\tshelf\tlife\tof\tfoods\tand\tto\tmake\nmargarines,\tmade\tfrom\n\toil,\tfirmer.\tMost\ttrans\tfatty\tacids\tintake\tcomes\tfrom\tthese\tpartially | [
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hydrogenated\toils\t(PHOs).\tIn\t2013\tthe\tFDA\tmade\ta\tdecision\tto\tremove\tPHOs\tfrom\tthe\t“generally\nrecognized\tas\tsafe”\tlist.\tThis\twas\tbased\ton\tthe\tmounting\tevidence\tthat\ttrans\tfats\tcontributed\tto\nASCVD\tand\twas\tassociated\twith\tincreased\tLDL\tcholesterol\tlevels.\tTrans\tfat\tintake\tis\tinversely\nassociated\twith\tHDL\tlevels\t(\nYanai\tet\tal,\t2015\n). | [
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associated\twith\tHDL\tlevels\t(\nYanai\tet\tal,\t2015\n).\nMonounsaturated\tfatty\tacids.\nOleic\tacid\t(C18:1)\tis\tthe\tmost\tprevalent\tmonounsaturated\tfatty\tacid\t(MUFA)\tin\tthe\tAmerican\tdiet.\nSubstituting\toleic\tacid\tfor\tcarbohydrate\thas\talmost\tno\tappreciable\teffect\ton\tblood\tlipids.\tHowever, | [
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replacing\tsaturated\tfatty\tacids\t(SFAs)\twith\tMUFAs\t(as\twould\thappen\twhen\tsubstituting\tolive\toil\tfor\nbutter)\tlowers\tserum\tcholesterol\tlevels,\tLDL\tcholesterol\tlevels,\n\tand\ttriglyceride\tlevels.\tOleic\tacid\tas\npart\tof\tthe\tMeD\t(\nFig.\t32.6\n)\thas\tbeen\tshown\tto\thave\tantiinflammatory\teffects. | [
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FIG.\t32.6\nThe\tTraditional\tHealthy\tMediterranean\tDiet\tPyramid.\n\tSource:\t(Courtesy\tOldways\tPreservation\tand\tExchange\nTrust,\t\t\nhttps://www.oldwayspt.org\n.)\t(\t\nhttp://www.cardiacrehabilitation.org.uk/docs/Mediterranean-Diet-Score.pdf\n.)\nPolyunsaturated\tfatty\tacids. | [
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intervention\t(\nKhandelwal\tet\tal,\t2013\n).\nOmega-3\tfatty\n\tacids.\nThe\tmain\tomega-3\tfatty\tacids\t(eicosapentaenoic\tacid\t[EPA]\tand\tdocosahexaenoic\tacid\t[DHA])\tare\nhigh\tin\tfish\toils,\tfish\toil\tcapsules,\tand\tocean\tfish.\tSome\tstudies\thave\tshown\tthat\teating\tfish\tis | [
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] |
associated\twith\ta\tdecreased\tASCVD\trisk.\tThe\tAHA\trecommendation\tfor\tthe\tgeneral\tpopulation\tis\tto\nincrease\tfish\tconsumption\tspecifically\tof\tfish\thigh\tin\tomega-3\tfatty\tacids\t(salmon,\ttuna,\tmackerel,\nsardines)\n\tand\teat\ta\t3.5-ounce\tserving\ttwice\ta\tweek.\tConsumption\tof\tomega-3\tfat\tin\tthe\tform\tof\tfish | [
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] |
oil\thas\tbeen\tassociated\twith\thigher\tlevels\tof\tHDL\tcholesterol\tand\tlower\tlevels\tof\tserum\ttriglycerides\n(\nYanai\tet\tal,\t2015\n;\tsee\t\nAppendix\t26\n).\tThe\tAHA\trecommends\ta\tdiscussion\twith\ta\tphysician\tbefore\ntaking\tfish\toil\tsupplements.\nAn\tomega-3\tfatty\tacid\tfrom\tvegetables,\talpha-linolenic\tacid\t(ALA),\thas\tantiinflammatory\n\teffects\n(see\t\nChapter\t7 | [
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effects\n(see\t\nChapter\t7\n).\tOmega-3\tfatty\tacids\tare\tthought\tto\tbe\tcardioprotective\tbecause\tthey\tinterfere\twith\nblood\tclotting\tand\talter\tprostaglandin\tsynthesis.\tOmega-3\tfat\tstimulates\tproduction\tof\tNO,\ta\nsubstance\tthat\tstimulates\trelaxation\tof\tthe\tblood\tvessel\twall\t(vasodilation).\tUnfortunately,\thigh | [
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intakes\t(above\t3\tg\tEPA/DHA)\tprolong\tbleeding\ttime,\ta\tcommon\tcondition\tamong\tArctic\tNative\npopulations\n\twith\thigh\tomega-3\tfat\tdietary\tintakes\tand\tlow\tincidence\tof\tASCVD.\nDietary\tcholesterol.\nPrevious\trecommendations\thave\tbeen\tto\tdecrease\tdietary\tcholesterol\tto\tdecrease\tLDL\tcholesterol | [
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] |
and\treduce\tASCVD\trisk.\tThe\tACC/AHA\t2013\tguidelines\tno\tlonger\tmake\tthis\trecommendation,\tand\nthey\tspecifically\tstate\tthat\tdietary\tcholesterol\tdoes\tnot\traise\tLDLs\t(see\t\nChapter\t9\n).\tThe\t2015\tU.S.\nDietary\tGuidelines\n\talso\teliminate\tthe\trecommendation\tto\trestrict\tcholesterol.\tHowever\tit\tis | [
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] |
levels\thave\tantioxidant\troles\tin\tthe\tbody.\tVitamin\tE\tis\tthe\tmost\tconcentrated\tantioxidant\tcarried\ton\nLDLs,\tthe\tamount\tbeing\t20\tto\t300\n\ttimes\tgreater\tthan\tany\tother\tantioxidant.\tA\tmajor\tfunction\tof\nvitamin\tE\tis\tto\tprevent\toxidation\tof\tPUFAs\tin\tthe\tcell\tmembrane.\tThe\tAHA\tdoes\tnot\trecommend | [
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] |
vitamin\tE\tsupplementation\tfor\tCVD\tprevention.\tA\tdietary\tpattern\tthat\tincludes\tincreased\tamounts\tof\nwhole\tgrains,\tnuts,\tand\tseeds\t(especially\tsunflower\tseeds)\thas\tincreased\tamounts\tof\tvitamin\tE.\nFoods\twith\tconcentrated\tamounts\tof\tantioxidants\tare\n\tfound\tin\tphytochemicals\tknown\tas\tcatechins | [
-0.048835694789886475,
-0.02708503231406212,
0.0447959266602993,
0.005897314753383398,
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0.0016914426814764738,
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0.05890808254480362,
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