ABSTRACT
Coronary heart disease (CHD) is the leading cause of death in both men and women in developed countries. Mortality rates vary from ~50/100,000 in Japanese women to 436/ 100,000 in Scottish men.
In the U.S. 32% of women and 50% of men will develop CHD, and CHD is the cause of death in 31% of men and 24% of women. The current concepts of the role of the diet in the etiology of cardiovascular disease (CVD) relate components of the diet to the pathogenesis of atherosclerosis. Primarily dietary fats, especially saturated fat and cholesterol, impact on the levels of circulating lipids to raise total and lowdensity lipoprotein (LDL) cholesterol that increase CHD risk. Dietary factors increase triacylglycerol (TG) levels that also increase the risk of CHD and/or decrease high density lipoprotein (HDL) cholesterol the lipoprotein that lessens CHD risk. Thus, diets that lower LDL cholesterol and/or TG and/or raise (or do not lower) HDL are protective against CHD. Other dietary components such as antioxidants (carotenoids, vitamin C, vitamin E) may lessen the risk of CVD by decreasing oxidized LDL, which is more atherogenic. High blood levels of homocysteine are atherogenic, and the levels of this amino acid are decreased by intake of folate, vitamin B
and vitamin B
. This section will review:
• The background for these hypotheses and associations • The dietary factors that influence circulating lipids and lipoproteins (Table 51.1)
and their mechanisms of atherogenesis • The role of some nutrients in vascular biology • The diet that may best prevent CHD in those without the disease or in individuals
post-myocardial infarction
The fat content and fatty acid composition of the diet were determined to be important factors in the pathogenesis of atherosclerosis as an inference from the decline in cardio-
vascular mortality that was observed during the depression and with World War II.
