Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors

Contents......Page 5
Foreword......Page 15
Terms of Reference......Page 16
Task Force Membership......Page 17
1.1.2 Cerebrovascular disease......Page 21
1.2.1 Atherosclerosis......Page 22
1.2.2 Blood clotting......Page 23
1.2.4 Relationship of risk factors to the pathological processes......Page 24
1.3.2 Temporal trends......Page 25
1.3.3 Variation in cardiovascular disease in the UK......Page 28
1.4.2 Approaches used to investigate the relationship between risk factors and disease......Page 30
1.4.3 Interpretation of the association......Page 31
1.4.4 Conventional risk factors for CHD......Page 32
1.4.5 Conventional risk factors for cerebrovascular disease......Page 34
1.4.7 Trends in the classic cardiovascular risk factors......Page 35
1.5.1 Dietary recommendations to reduce cardiovascular disease......Page 36
1.5.3 Paradoxes in CHD epidemiology......Page 38
1.6 Structure of the report......Page 40
1.8 Key references......Page 41
2.3.1 Concept/definition of insulin resistance......Page 42
2.3.2 The insulin resistance syndrome......Page 43
2.3.3 Mechanism(s) of insulin resistance......Page 47
2.4 Obesity......Page 48
2.4.1 Definitions and measurement......Page 49
2.4.2 Body fat distribution, ethnic and gender issues......Page 50
2.4.3 Epidemiology of obesity......Page 51
2.4.4 Obesity and cardiovascular disease......Page 52
2.4.5 Cardiovascular disease and other co-morbidities of obesity......Page 53
2.4.6 Clinical manifestations of obesity-related cardiovascular disease......Page 55
2.4.7 Obesity as a cause of insulin resistance......Page 56
2.4.10 Childhood obesity......Page 57
2.5.1 Epidemiology......Page 60
2.5.2 Prevention of type 2 diabetes......Page 61
2.6 Hypertension......Page 63
2.7.2 Diet and insulin resistance......Page 64
2.8 Physical activity......Page 65
2.8.1 Effects of physical activity on cardiovascular disease......Page 66
2.9 Genetics......Page 67
2.11 Key points......Page 68
2.12 Key references......Page 69
3 Lipid-Related Factors......Page 70
3.2 Postprandial lipaemia – atherogenic lipoprotein phenotype......Page 71
3.2.2 The effect of fatty acid type......Page 74
3.3 Remnant-like particles......Page 75
3.4 Small, dense low-density lipoprotein (LDL)......Page 77
3.5 High-density lipoprotein (HDL) subfractions......Page 78
3.6 Free fatty acids......Page 79
3.7 Lipoprotein(a)......Page 80
3.8 Genetic variability and cardiovascular risk......Page 81
3.11 Key references......Page 82
4.2 Estimates of endothelial dysfunction......Page 83
4.2.1 Endothelium-dependent vasodilatation or ‘direct’ measures......Page 84
4.2.4 Measurement of excreted factors......Page 87
4.3.1 Classical risk factors (i.e. parameters incorporated in current risk factor stratification tables)......Page 88
4.3.2 Novel risk factors......Page 90
4.5 Endothelial function measures as independent predictors of CHD......Page 91
4.6 Relevant genetic studies......Page 92
4.8 Effects of CHD preventative modalities on other risk factor pathways......Page 93
4.9.2 Micronutrients......Page 94
4.10 Do nutrient-induced endothelial effects correlate with results from endpoint studies?......Page 95
4.11 Key points......Page 96
4.13 Key references......Page 97
5.2 The normal role of LDL......Page 98
5.3 Free radicals......Page 99
5.4.1 Protein oxidation......Page 100
5.5 Reactive nitrogen species......Page 101
5.6 Cardiovascular disease and oxidative reactions......Page 103
5.8 Nature of the oxidising species causing LDL oxidation......Page 104
5.9 Cardiovascular disease and the consumption of fruit and vegetables......Page 106
5.10 Therapeutic use of antioxidants: evidence from intervention trials......Page 108
5.12 Measurable factors for oxidative stress in cardiovascular disease......Page 110
5.12.1 Measurable products of lipid peroxidation......Page 111
5.12.2 Methods for detection of protein oxidation......Page 113
5.13 Markers of oxidant stress in cardiovascular disease......Page 114
5.14 Relationships of the markers of oxidant stress to general nutrition and antioxidants......Page 116
5.15 Conclusions......Page 117
5.17 Recommendations for future research......Page 118
5.18 Key references......Page 119
6 The Haemostatic System: Coagulation, Platelets and Fibrinolysis......Page 120
6.1 The haemostatic system......Page 121
6.1.1 The coagulation pathway......Page 122
6.1.3 Inhibitors of coagulation......Page 124
6.1.4 The platelet......Page 126
6.2.1 Fibrinolytic factors......Page 127
6.2.2 Inhibitors of fibrinolysis......Page 128
6.3 The concept of hypercoagulability......Page 129
6.4.3 Fibrinolytic factors......Page 130
6.4.4 Platelets......Page 131
6.5.1 Established tests of platelet function......Page 132
6.6.2 Factor IX and Factor X peptides......Page 133
6.8 Established and emerging phenotypic risk factors for venous thromboembolism......Page 134
6.9.3 Fibrinogen......Page 135
6.9.8 Plasminogen activator inhibitor......Page 136
6.10 Dietary characteristics and haemostasis......Page 137
6.10.2 Alcohol......Page 138
6.10.3 Dietary fat and coagulation......Page 139
6.10.4 Dietary fat and fibrinolysis......Page 140
6.10.5 Dietary fat and platelet function......Page 141
6.10.6 Dietary fish oil/supplements and haemostasis......Page 142
6.10.8 Micronutrients......Page 143
6.11 Key points......Page 145
6.12 Recommendations for future research......Page 146
6.13 Key references......Page 147
7.2 The immune system......Page 148
7.3 Inflammation and atherosclerosis......Page 149
7.4.1 C-reactive protein (CRP)......Page 150
7.4.3 Serum amyloid A......Page 153
7.4.7 Circulating immune complexes......Page 154
7.4.8 Cytokines, growth factors and other secreted products......Page 155
7.4.9 Adhesion molecules......Page 156
7.4.11 Phospholipase A2......Page 157
7.6 Infectious burden, inflammation and atherosclerosis......Page 158
7.7.2 Lipid lowering agents......Page 160
7.8.1 Fatty acids......Page 161
7.8.2 Antioxidants......Page 164
7.8.6 Micronutrients and the inflammatory response......Page 165
7.11 Key references......Page 166
8.2 Biochemistry......Page 167
8.3 Laboratory measurement of homocysteine......Page 168
8.4.1 Initial epidemiological evidence......Page 169
8.4.3 Relevance of genetically determined differences in homocysteine levels to risk of CHD......Page 170
8.5 Pathophysiology of vascular disease......Page 172
8.7 Genetic influences......Page 174
8.10 Large trials of homocysteine lowering vitamin supplements......Page 175
8.11 Folic acid fortification......Page 177
8.12 Key points......Page 178
8.14 Key references......Page 179
9.1.2 Adipose tissue-derived signals and cardiovascular disease......Page 180
9.2 Leptin......Page 181
9.2.1 Leptin and cardiovascular risk......Page 182
9.3.1 Acylation stimulating protein and cardiovascular disease......Page 183
9.4.1 Actions of adiponectin......Page 184
9.5.1 Cytokine receptors......Page 185
9.5.4 Effects of acute elevation in IL-6......Page 186
9.5.5 Effects of chronic elevation of IL-6......Page 187
9.5.6 IL-6 and CHD......Page 188
9.8 Peroxisome proliferator-activated receptors (PPARs)......Page 189
9.10 Nutritional regulation of adipocyte factors......Page 190
9.10.2 Regulation of acylation stimulating protein......Page 191
9.10.5 Regulation of angiotensinogen......Page 192
9.11 Physical activity and adipokines......Page 193
9.12.4 IL-6 genotype......Page 194
9.13 Conclusion......Page 195
10.5 Variation with ethnicity......Page 11
9.16 Key references......Page 196
10.1 Low birthweight and adult cardiovascular disease......Page 197
10.2.2 Lipids and clotting factors......Page 198
10.2.4 Obesity......Page 199
10.3 Post-natal growth and adult obesity......Page 201
10.4 Variation with sex......Page 203
10.6 The ‘Fetal Origins of Adult Disease (FOAD)’ hypothesis......Page 204
10.6.1 Genes versus environment......Page 206
10.7 Clinical importance of the effects of poor fetal growth......Page 208
10.8 The role of nutrition......Page 209
10.8.1 Maternal nutritional status and cardiovascular disease risk in the offspring......Page 210
10.9 Maternal diabetes and fetal macrosomia......Page 213
10.10 Key points......Page 214
10.12 Key references......Page 215
11.2 Structure of the chapter......Page 216
11.3 Diet and body fatness: amount and distribution......Page 217
11.3.2 Glycaemic index......Page 218
11.4 Diet and hypertension......Page 224
11.5 Diet and diabetes......Page 225
11.6.2 n-3 polyunsaturates and insulin sensitivity......Page 226
11.7 Amount of dietary fat......Page 229
11.7.1 Low fat versus moderate fat diets......Page 230
11.8 Type of dietary fat......Page 231
11.8.2 n-6 versus n-3 polyunsaturated fatty acids......Page 234
11.8.3 Long chain n-3 fatty acids......Page 235
11.8.5 Alpha-linolenic acid......Page 237
11.9.2 Dietary .bre......Page 238
11.9.7 Conjugated linoleic acid (CLA)......Page 241
11.10.2 Oxidative stress......Page 242
11.11 Conclusions......Page 249
11.11.1 Dietary fat......Page 250
11.11.4 Areas of uncertainty......Page 251
11.12 Key points......Page 252
12.1 Introduction......Page 254
12.2 Role of physical activity in promoting cardiovascular health......Page 255
12.2.1 Cardiovascular endpoints......Page 256
12.2.2 Cardiovascular risk factors......Page 259
12.2.3 Summary......Page 260
12.3 How much is required?......Page 261
12.5 Recent initiatives in the UK......Page 262
12.6 Key points......Page 263
12.8 Key references......Page 264
13.1.1 Approaches in the UK......Page 265
13.2 Current dietary recommendations for primary prevention in the UK......Page 266
13.3 Recommendations in other countries......Page 268
13.3.2 Finland......Page 270
13.4.2 Fat and fatty acids......Page 271
13.4.3 Sodium and salt......Page 273
13.4.4 Fruit and vegetables......Page 275
13.4.5 Starchy foods and dietary fibre......Page 276
13.5.1 Dietary fat......Page 277
13.5.3 Dietary patterns......Page 278
13.6.2 Obesity in children......Page 279
13.6.5 Summary......Page 280
13.7.2 Ethnic minority groups......Page 281
13.8 Barriers to change – the role of the food industry......Page 282
13.9.1 Approaches used for successful lifestyle/dietary modification......Page 283
13.10 Looking to the future: gene–nutrient interactions......Page 284
13.11 Key points......Page 285
14.1 Chapter 1......Page 286
14.4 Chapter 4......Page 287
14.6 Chapter 6......Page 288
14.8 Chapter 8......Page 289
14.11 Chapter 11......Page 290
14.13 Chapter 13......Page 292
15.1.1 Relationship between emerging risk factors, diet and cardiovascular disease......Page 294
15.1.3 Relationship between emerging cardiovascular disease risk factors and physical activity......Page 296
15.3 Priorities for future research: identifying effective dietary interventions......Page 297
15.4.1 Recommendations to policy makers......Page 298
15.4.4 Recommendations to caterers......Page 299
15.4.5 Recommendations to workplaces/employers......Page 14
15.5 Key references......Page 300
16.2 Epidemiology of cardiovascular disease......Page 301
16.3 Definitions and prevalence of diabetes, the insulin resistance syndrome and obesity......Page 304
16.4 Lipid-related factors......Page 306
16.5 The role of the endothelium......Page 308
16.6 Diet and oxidative stress......Page 309
16.7 Diet and blood clotting......Page 310
16.8 Inflammation......Page 311
16.9 Homocysteine......Page 312
16.10 Factors relating to adipose (fat) tissue......Page 313
16.11 Nutrition during pregnancy and fetal growth......Page 314
16.12 The effect of different diets on heart disease risk......Page 315
16.14 Public health recommendations to reduce cardiovascular disease risk......Page 316
16.15 Key references......Page 317
Glossary......Page 318
References......Page 332
Index......Page 391