Diet Therapy for Cardiovascular Disease

Numerous study findings demonstrate a strong correlation between elevated serum cholesterol levels (especially LDL-Cholesterol) and increased risk of coronary heart disease (CHD). Conversely, serum cholesterol management results in a decrease risk of CHD. Clinical trials also show that serum cholesterol lowering will reduce morbidity and mortality from CHD in patients with existing CHD.

Since diet is considered the cornerstone treatment for hypercholesterolemia, the National Cholesterol Education Program (NCEP) panel of experts has established dietary guidelines for the general American population as well as individuals with high cholesterol levels. This medical nutrition therapy is also supported by the American Heart Association (AHA).

The NCEP diet is a nutritionally balanced eating pattern that focuses on reducing intakes of saturated fat and dietary cholesterol in two phases. The NCEP Step I diet is the first line of defense for the dietary management of hypercholesterolemia. If the patient’s blood lipid goals are not met with this treatment, the NCEP Step II diet is recommended because it offers more restrictive guidelines on intakes of saturated fat and dietary cholesterol.

The NCEP Dietary Guidelines

	STEP I	STEP II
Total calories	To achieve and maintain desired weight	same as Step I
Total fat	30% or less total calories	same as Step I
Saturated fat	8-10 % total calories	up to 7% total calories
Polyunsaturated fat	Up to 10% total calories	same as Step I
Monounsaturated fat	Up to 15% total calories	same as Step I
Dietary Cholesterol	Less than 300 mg/day	less than 200 mg/day

Nutrition Facts
(shown on food labels)

The NCEP dietary guidelines are consistent with the Daily Values for a 2,000 calorie diet which appears on the Nutrition Facts of food products. The Nutrition Facts panel can serve as a widely accessible teaching tool for consumers concerned about their heart health.

Daily Values

(based on the Nutrition Education and Labeling Act of 1990)

Total calories	2000
Total fat	65 g
Saturated fat	20 g
Total Carbohydrate	300 g
Protein	50 g
Cholesterol	300 mg
Sodium	2400 mg
Potassium	3500 mg
Dietary fiber	25 g

Sample Menu that meets the AHA Step I Dietary Guidelines

Translating NCEP dietary guidelines into sensible heart-healthy eating plan can present challenges to health care professionals. The sample menu shown below exemplifies a practical application of the NCEP dietary guidelines:

Breakfast

Item	Amount	Calories	Fat (g)	Sat Fat (g)	Cholesterol (mg)	Sodium (mg)	Fiber(g)
Cinnamon raisin toast	2 slices	142	2.30	0.6	0.0	203	2.2
Light tub margarine	1 Tbl	77	8.70	1.9	0.0	142	0.0
Raisin bran cereal	1 cup	156	0.71	0.0	0.0	241	5.3
2% Reduced fat milk	1 cup	121	4.70	3.0	18.3	122	2.2
Banana	1 small	84	0.00	0.0	0.0	0	0.0
Orange juice	6 oz	84		0.0	0.0	0	0.5
Total		664	16.40	5.5	18.3	708	10.2

Lunch

Item	Amount	Calories	Fat (g)	Sat Fat (g)	Cholesterol (mg)	Sodium (mg)	Fiber(g)
Sausage Pizza	2 med sl	330	13.7	5.6	60.0	778	1.90
Salad:
Romaine lettuce	2 cups	10	0.0	0.0	0.0	5	1.44
Carrots	4 Tbl	12	0.0	0.0	0.0	10	0.80
Cherry tomatoes	6	21	0.0	0.0	0.0	9	5.00
Light French dressing	2 Tbl	48	1.6	0.0	0.6	291	0.00
Coke	12 oz	152	0.0	0.0	0.0	15	0.00
Total		543	15.3	5.6	29.0	1108	9.14

Dinner

Item	Amount	Calories	Fat (g)	Sat Fat (g)	Cholesterol (mg)	Sodium (mg)	Fiber(g)
Grilled Salmon	3 oz	155	6.9	1.1	60.4	48	0.0
Baked potato w/skin	1 med	133	0.0	0.0	0.0	10	2.9
Light Sour Cream	2 Tbl	40	2.0	1.3	10.0	30	0.0
Peas & carrots	1 cup	77	0.7	0.0	0.0	109	5.8
Dinner roll	1 med	122	1.6	0.4	0.0	150	1.4
Light tub margarine	1 Tbl	77	8.7	1.9	0.0	142	0.0
2% Reduced fat milk	1 cup	121	4.7	2.9	18.3	122	0.0
Nonfat frozen yogurt	1 cup	200	0.3	0.0	2.6	100	0.0
Fresh strawberries	4 Tbl	12	0.0	0.0	0.0	0	1.0
Total		937	24.9	7.6	91.3	711	11.1

Daily Totals:

Total calories	2144.0
Total Fat	56.6 g	24% Calories from total fat
Saturated fat	18.7 g	8% Calories from saturated fat
Cholesterol	170.2 mg
Sodium	2527.0 mg
Fiber	30.4 g	9 Fruit & Vegetable Servings 6 Grain Servings

Recommended Websites for Cardiovascular Disease

The websites shown below have been reviewed and found to be helpful and informative. Below each link is a brief description of the content of the site.

http://www.amhrt.org/Scientific/CME/Campbells/Home.html
Incorporating Nutrition Therapy Into Primary Care: A Guide for Reducing Cardiovascular Risk

http://www.amhrt.org/Scientific/statements/1997/039702.html
When to Start Cholesterol-Lowering Therapy in Patients With Coronary Heart Disease.

http://www.amhrt.org/Scientific/statements/1999/019901.html
Homocyst(e)ine, Diet, and Cardiovascular Diseases

http://www.amhrt.org/Scientific/statements/1997/069704.html
Fiber, Lipids, and Coronary Heart Disease

http://www.amhrt.org/Scientific/statements/1996/1203.html
Summary of the Scientific Conference on the Efficacy of Hypocholesterolemic Dietary Interventions

http://www.acsh.org/press/releases/alcohol021199.html
New Report Clarifies Health Effects of Moderate Alcohol Consumption - Summary of ETOH on CAD

http://www.eatright.org/nufactsheet.html
Nutrition Fact Sheets on a variety of topics

http://www.amhrt.org/Health/Diet_and_Nutrition/index.html
Nutrition Facts-AHA position on a variety of nutrition topics

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/step1.html
Step I and Step II diets

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/trigly.html
Triglycerides

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/veggie.html
Vegetables and fruits

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/cholr.html
Cholestrol ratio

http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/eggs.html
Eggs