Effects of a Vegetarian Diet on Cardiometabolic Risk Factors, Gut Microbiota, and Plasma Metabolome in Subjects With Ischemic Heart Disease: A Randomized, Crossover Study.

Background A vegetarian diet (VD) may reduce future cardiovascular risk in patients with ischemic heart disease. Methods and Results A randomized crossover study was conducted in subjects with ischemic heart disease, assigned to 4-week intervention periods of isocaloric VD and meat diet (MD) with individually designed diet plans, separated by a 4-week washout period. The primary outcome was difference in oxidized low-density lipoprotein cholesterol (LDL-C) between diets. Secondary outcomes were differences in cardiometabolic risk factors, quality of life, gut microbiota, fecal short-chain and branched-chain fatty acids, and plasma metabolome. Of 150 eligible patients, 31 (21%) agreed to participate, and 27 (87%) participants completed the study. Mean oxidized LDL-C (-2.73 U/L), total cholesterol (-5.03 mg/dL), LDL-C (-3.87 mg/dL), and body weight (-0.67 kg) were significantly lower with the VD than with the MD. Differences between VD and MD were observed in the relative abundance of several microbe genera within the families Ruminococcaceae, Lachnospiraceae, and Akkermansiaceae. Plasma metabolites, including l-carnitine, acylcarnitine metabolites, and phospholipids, differed in subjects consuming VD and MD. The effect on oxidized LDL-C in response to the VD was associated with a baseline gut microbiota composition dominated by several genera of Ruminococcaceae. Conclusions The VD in conjunction with optimal medical therapy reduced levels of oxidized LDL-C, improved cardiometabolic risk factors, and altered the relative abundance of gut microbes and plasma metabolites in patients with ischemic heart disease. Our results suggest that composition of the gut microbiota at baseline may be related to the reduction of oxidized LDL-C observed with the VD. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02942628.

Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease.

BACKGROUND: The reasons behind low adherence to the Mediterranean diet (Med-diet) are still not entirely known. We aimed to evaluate the effect of biological (i.e., sex-related) and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence. METHODS: Baseline Med-diet adherence was measured using a self-administered questionnaire among adults with ischemic heart disease (IHD) from the EVA (Endocrine Vascular Disease Approach) study. A multivariable analysis was performed to estimate the effect of sex- and gender-related factors (i.e., identity, roles, relations, and institutionalized gender) on low adherence. RESULTS: Among 366 participants (66 ± 11 years, 31% women), 81 (22%) adults with low adherence demonstrated higher rates of diabetes, no smoking habit, lower male BSRI (Bem Sex Role Inventory) (median (IQR) 4.8 (4.1 to 5.5) vs. 5.1 (4.5 to 5.6) and p = 0.048), and higher Perceived Stress Scale 10 items (PSS-10) (median (IQR) 19 (11 to 23) vs. 15 (11 to 20) and p = 0.07) scores than those with medium-high adherence. In the multivariable analysis, only active smoking (odds ratio, OR = 2.10, 95% confidence interval, CI 1.14 to 3.85 and p = 0.017), PPS-10 (OR = 1.04, 95% CI 1.00 to 1.08, and p = 0.038) and male BSRI scores (OR = 0.70, 95% CI 0.52 to 0.95, and p = 0.021) were independently associated with low adherence. CONCLUSIONS: Male personality traits and perceived stress (i.e., gender identity) were associated with low Med-diet adherence regardless of the sex, age, and comorbidities. Therefore, gender-sensitive interventions should be explored to improve adherence in IHD.

Dietary interventions in cardiac rehabilitation - The gap between guidelines and clinical practice.

BACKGROUND & AIMS: An unhealthy diet is a risk factor for ischemic heart disease (IHD) and therefore cardiac rehabilitation (CR) should include dietary interventions. In 2007, CR became a shared responsibility between Danish hospitals and municipalities. Later, a national clinical guideline including recommendations on dietary interventions was developed to facilitate implementation of CR. The aim of the present study is: 1) To describe provision of dietary interventions in CR for IHD patients in Denmark in 2013 and 2015 emphasizing differences between hospitals and municipalities, and 2) To evaluate the implementation of the national clinical guideline in clinical practice. METHODS: A repeated nationwide cross-sectional electronic survey was carried out in 2013 and 2015. Participation was mandatory for all Danish hospital departments offering CR (n = 36), but voluntary for municipalities (n = 98) reaching response rates of 82% and 89% in 2013 and 2015, respectively. The electronic survey covered the core components of dietary interventions in CR as described in the national clinical guideline. RESULTS: In 2015, 72% of municipalities provided dietary interventions. This proportion was significantly higher in hospitals (94%, p = 0.007). 26% and 38% of hospitals screened systematically for dietary intervention needs in 2013 and 2015, respectively. Corresponding results from municipalities were 26% and 29%. No significant differences were seen in clinical practice over time. CONCLUSIONS: The results of this study identified a major gap between recommendations in the national clinical guideline and actual clinical practice on dietary interventions in CR in Danish hospitals and municipalities. The study confirmed that implementation of guidelines in clinical practice takes time and requires an intensive effort.

Intake of carp meat from two aquaculture production systems aimed at secondary prevention of ischemic heart disease - a follow-up study.

Our previous study showed that a diet enriched with 400 g of carp per week improved plasma lipids in subjects after aortocoronary bypass (CABG). The aim of the present study is to determine whether the different carp farming systems have an impact on the effects of carp meat in secondary cardiovascular prevention. We examined 3 groups of patients after CABG over a 4-week period of spa treatment (108 persons, 73 males, 35 females, age over 60 years). We found no differences in baseline values of blood pressure or plasma lipids. The patients were given a standard spa diet (controls; N=36) or a diet enriched of 400 g of carp meat per week, enriched omega 3 (N=37) or cereal carp (N=35). Plasma lipid parameters were examined at start and after 4 weeks in a routine laboratory setting. Group consuming omega-3 carp showed the largest decline in total cholesterol, LDL cholesterol, triglycerides and an increase in HDL cholesterol (all p<0.01). We found that carp meat from the two production systems showed significantly different effects on plasma lipids. Further trials should be performed to clarify the exact causes of the differences.

The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes.

BACKGROUND/OBJECTIVE: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended). SUBJECTS: Ages 35-70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months. METHODS: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation. RESULTS: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m-2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l-1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l-1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m-2 BMI points and 0.55 (±0.54, P=0.05) mmol l-1 total cholesterol. No serious harms were reported. CONCLUSIONS: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.

Consumption of nuts and risk of total and cause-specific mortality over 15 years.

BACKGROUND AND AIMS: The published literature shows that nut consumption has a favorable impact on health. We aimed to assess the association between nut consumption and risk of 15-year total mortality, and mortality from cardiovascular disease (CVD) (including ischemic heart disease, IHD, and stroke), and cancer. METHODS AND RESULTS: Prospective analyses involved 2893 participants aged ≥49 years at baseline. Dietary data were collected by using a semi-quantitative food-frequency questionnaire, and nut intakes were calculated. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Over 15 years, 1044 participants had died, of these 430 had died from stroke and another 430 had died from IHD. Participants in the second tertile of nut consumption versus those in the first tertile of intake had reduced risk of total mortality: multivariable-adjusted HR 0.76 (95% CI 0.65-0.89). Participants in the second tertile compared to those in the first tertile had 24% and 23% reduced risk of 15-year CVD and IHD mortality, respectively. Associations were more marked in women compared to men. Women in the second versus first tertile of nut consumption had 27%, 39%, 34% and 49% reduced risk of death from all causes (n = 489), CVD (n = 258), IHD (n = 188) and stroke mortality (n = 101), respectively. CONCLUSIONS: Nut consumption was independently associated with a decreased risk of overall and vascular-disease mortality, particularly in women.

Ischemic heart disease and the Mediterranean diet.

Lifestyle modification is primary in cardiovascular (CV) disease prevention. A major contribution is the Mediterranean diet (MedDiet), defined by two of seven components. Italian investigators determined a significant decrease in peripheral arterial disease of 56 % for a high score. Multiple specific CV risk factors are also favorably modified by the MedDiet. This includes beneficial effect on inflammation, vascular endothelium, and insulin resistance. There is also evidence that coronary heart disease, diabetes mellitus, and metabolic syndrome are decreased. Benefit appears to extend to new migrants in France. The economics of dietary adherence are favorable with decreased total lifetime health costs. Although mixed nuts appear to be a major factor in the MedDiet, special emphasis goes to extra virgin olive oil. Benefit also extends to other noncommunicable diseases with a decrease in cancer, Parkinson's disease, and Alzheimer's disease. Further quantitation of benefit and understanding of mechanisms involved in dietary benefit is essential.

Relationships between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population.

AIMS: The serum resistin level is associated with the incidence of ischemic heart disease in the general population. We analyzed the associations between serum resistin and fat intake, serum lipid concentrations and adiposity in the general population. METHODS: A cross-sectional study of 6,637 randomly recruited adults was conducted. The resistin levels were measured in thawed aliquots of serum using an enzyme immunoanalysis technique. RESULTS: The resistin level exhibited a positive nonparametric correlation with saturated fat intake(p < 0.001) and an inverse correlation with adherence to the Mediterranean diet(p < 0.001), monounsaturated fat intake(p < 0.05), total serum cholesterol(p < 0.001), non-HDL cholesterol(p < 0.001), LDL cholesterol(p < 0.001), body mass index(p < 0.001), waist circumference(p < 0.001) and the waist/height ratio(p < 0.001). An elevated resistin concentration(fifth quintile) was associated with adherence to the Mediterranean diet(OR=0.82 CI95%=0.71-0.93), saturated fat intake(OR=1.34 CI95%=1.16-1.56), monounsaturated fat intake(OR=0.88 CI95%=0.78-0.99), a total cholesterol level of ≥200 mg/dL(OR=0.81 CI95%=0.72-0.91), a low HDL cholesterol level(OR=0.84 CI95%= 0.76-0.93), a high non-HDL cholesterol level(OR=0.84 CI95%=0.72-0.99), a high LDL cholesterol level(OR=0.82 CI95%=0.70-0.97) and a waist/height ratio of ≥0.55(OR=0.76 CI95%=0.67-0.85). The multivariate models corroborated the positive associations between the resistin level and saturated fat intake(p < 0.001) and serum triglycerides(p=0.004) and the inverse associations between the resistin level and adherence to the Mediterranean diet(p=0.002), total serum cholesterol(p < 0.001) and cholesterol fractions and the waist/height ratio(p=0.02). CONCLUSIONS: In the general population, the serum resistin level is associated with fat intake: positively with saturated fat intake and inversely with monounsaturated fat intake. As a consequence, the resistin level is also inversely associated with adherence to the Mediterranean diet. In addition, the resistin level is inversely associated with the serum cholesterol level and adiposity.

Effect of flaxseed supplementation and exercise training on lipid profile, oxidative stress and inflammation in rats with myocardial ischemia.

BACKGROUND: Flaxseed has recently gained attention in the area of cardiovascular disease primarily because of its rich contents of α-linolenic acid (ALA), lignans, and fiber. Although the benefits of exercise on any single risk factor are unquestionable, the effect of exercise on overall cardiovascular risk, when combined with other lifestyle modifications such as proper nutrition, can be dramatic.This study was carried out to evaluate the protective role of flaxseed and exercise on cardiac markers, lipids profile and inflammatory markers in isoproterenol (ISO)-induced myocardial ischemia in rats. METHODS: The research was conducted on 40 male albino rats, divided into 4 groups (n=10): group I served as control, group II has acute myocardial ischemia induced by isoproterenol, groups III and IV have acute myocardial ischemia induced by isoproterenol pretreated with flaxseed supplementation orally for 6 weeks, additionally group IV practiced muscular exercise through swimming. RESULTS: Alterations of lipid profile, cardiac and inflammatory markers (Il-1ß, PTX 3 and TNF- α) were observed in myocardial ischemia group. Flaxseed supplementation combined with exercise training showed significant increase of HDL and PON 1, on the other hand cardiac troponin, Il- 1ß and TNF- α levels significantly decreased as compared to myocardial ischemic group. Receiver Operating Characteristics (ROC) analysis of cTnI, PTX 3, Il-1ß and TNF- α revealed a satisfactory level of sensitivity and specificity. CONCLUSION: Regular exercise enhances the improvement in plasma lipoprotein levels and cardiovascular protection that results from flaxseed supplementation by mitigating the pathophysiology of atherosclerosis. Elevation of HDL, the antioxidant PON 1 and the cardioprotective marker PTX 3 emphasizes the protective effects of flaxseed and muscular exercise mutually against the harmful effects of acute myocardial ischemia.

Fish, n-3 fatty acids, and cardiovascular diseases in women of reproductive age: a prospective study in a large national cohort.

Previous studies have indicated a protective effect of long-chain n-3 polyunsaturated fatty acids (LCn3FAs) against cardiovascular disease; however, women are underrepresented in cardiovascular research. The aim of this study was to explore the association between intake of LCn3FAs and the risk of cardiovascular disease in a large prospective cohort of young women (mean age at baseline: 29.9 years [range: 15.7-46.9]). Exposure information on 48 627 women from the Danish National Birth Cohort was linked to the Danish National Patients Registry for information on events of hypertensive, cerebrovascular, and ischemic heart disease used to define a combined measure of cardiovascular diseases. Intake of fish and LCn3FAs was assessed by a food-frequency questionnaire and telephone interviews. During follow-up (1996-2008; median: 8 years), 577 events of cardiovascular disease were identified. Low LCn3FA intake was associated with an increased risk of cardiovascular disease (adjusted hazard ratio for women in lowest versus highest LCn3FA intake group: 1.91 [95% CI: 1.26-2.90]). Restricting the sample to women who had consistently reported similar frequencies of fish intake across 3 different dietary assessment occasions tended to strengthen the relationship (hazard ratio for lowest versus highest intake: 2.91 [95% CI: 1.45-5.85]). Furthermore, the observed associations were consistent in supplementary analyses where LCn3FA intake was averaged across the 3 dietary assessment occasions, and the associations were persistent for all 3 of the individual outcomes. Our findings based on a large prospective cohort of relatively young and initially healthy women indicated that little or no intake of fish and LCn3FAs was associated with an increased risk of cardiovascular disease.

The consumption of the carp meat and plasma lipids in secondary prevention in the heart ischemic disease patients.

OBJECTIVES: Omega-3 fatty acids (FA) have been shown to be protective against cardiovascular diseases (CVD). The effect of the consumption of carp meat on CVD risk factors has not yet been examined in detail. We ascertained the influence of a diet enriched with carp meat with an elevated content of omega-3FA (200 g twice weekly for 4 weeks) in a group of subjects after cardiac revascularization surgery for ischemic heart disease with a follow-up spa treatment. DESIGN: After cardiac revascularization surgery, the probands consumed either a standard spa diet (56 individuals, 41 males, 15 females, age 41-80 years) or a diet enriched with two portions of carp meat (87 individuals, 64 males, 23 females, age 50-82 years). The differences in body mass index (kg/m²), blood pressure, plasma lipids and C-reactive protein (CRP) of the groups were analyzed. RESULTS: In the group with a higher consumption of carp meat, significantly greater improvements in lipid parameters in comparison to the standard spa diet were detected (total cholesterol p<0.001, triglycerides p<0.001, LDL-C p<0.001, CRP p<0.001, HDL-C p<0.001). No differences between these groups in blood pressure and body mass index were found. CONCLUSION: We conclude that the diet enriched with carp meat significantly improved plasma lipid parameters in patients after major cardiac revascularization surgery.

Dietary broccoli sprouts protect against myocardial oxidative damage and cell death during ischemia-reperfusion.

Cruciferous vegetables are known for antioxidant and anti-carcinogenic effects. In the current study we asked whether dietary broccoli sprouts can protect the heart from ischemia-reperfusion. Rats were fed either control diet (sham and control groups) or a diet mixed with 2% dried broccoli sprouts for 10 days. After 10 days the isolated hearts were subjected to ischemia for 20 min and reperfusion for 2 h, and evaluated for cell death, oxidative damage, and Nrf2-regulated phase 2 enzyme activities. Broccoli sprouts feeding inhibited markers of necrosis (lactate dehydrogenase release) and apoptosis (caspase-3 activity) by 78-86%, and decreased indices of oxidative stress (thiobarbituric acid reactive substances and aconitase inactivation) by 82-116%. While broccoli sprouts increased total glutathione and activities of the phase 2 enzymes glutamate cysteine ligase and quinone reductase in liver, they did not affect these in ischemic-reperfused heart. While the mechanism is not clear, the results show that a relatively short dietary treatment with broccoli sprouts can strongly protect the heart against oxidative stress and cell death caused by ischemia-reperfusion.

[Effectiveness of using low-calorific food supplement in diet of patient with hypertension and ischemic heart disease].

A positive effect on metabolic processes in hypertension and coronary heart disease in remission of a low-calorie dietary supplement containing a small amount of carbohydrates and fats was determined. The food substance, which contains a negligible amount of carbohydrates and fats, compensated a daily need in proteins and made a regulative impact on gastrointestinal tract function. The effectiveness of the food substance became apparent: in lipid metabolism normalization, glucose level in blood decreased to standard values, functions of liver and cardio-vascular system became normal.

[Modern view of vegetarianism through the position of metabolic concept of food assimilation].

In this review modern performance of the vegetarian nutrition was presented through the metabolic concept of assimilation of food. It presents the history of this line in the science of nutrition, development of its scientific-method base and also describes more perspective directions of using of vegetarianism in practice. The analysis of some foreign investigations and results long-term own studies confirm the efficiency of lactoovovegetarian diets in the treatment and prevention of atherosclerosis and its complications. It gives the proof of necessity of more expensive use of this system of nutrition in dietetics.

A cholesterol-rich diet improves resistance to ischemic insult in mouse hearts but suppresses the beneficial effect of post-conditioning.

BACKGROUND: Conflicting evidence is reported about the beneficial effects of post-conditioning (Post-C) in pathologic conditions. A pathologic mouse model of hypercholesterolemia was used. The study examined the effect of Post-Con cardiac recovery after the ischemia-reperfusion sequence and the effect of Post-Con on low-density lipoprotein receptor-deficient (LDLR(-/-)) mice and control animals. METHODS: LDLR(-/-) and C57bl/6 mice were fed for 8 weeks with a high-cholesterol (1.25%) or normal diet. The hearts were isolated and perfused on a working heart apparatus. The hearts underwent 20 minutes of global total ischemia, followed by 36 minutes of reperfusion. Post-Con was applied at the onset of reperfusion with three 10-second cycles of ischemia-reperfusion. Tissue injury was evaluated (triphenyl-tetrazolium chloride staining), and superoxide anion production was assessed (dihydroethidium). RESULTS: Post-ischemia recovery was very low in the control and LDLR(-/-) groups, and Post-C induced an increase in functional recovery (p < 0.05). The high-cholesterol groups showed better cardiac recovery, but Post-C did not accentuate this improvement. Post-C was associated with a significant reduction in tissue injury and superoxide production in LDLR(-/-) and C57bl/6 (p < 0.05), but these effects were not observed in animals fed the high-cholesterol diet. CONCLUSIONS: Our results demonstrated that control and LDLR(-/-) mice may be protected by Post-C, and an 8-week high-cholesterol diet led to improved recovery of the myocardium after the ischemia-reperfusion sequence in both series. However, the endogenous protective mechanism of Post-C appears to be lost in the presence of hypercholesterolemia.

[Clinical efficiency of using laminaria jam enriched with selenium].

Effectivity was studied of a new dietary product enriched with organic form of selenium--laminaria gel in patients with ischemic heart disease and hypertonia. Functional condition of nervous and cardiovascular systems improved after intake of testing product. There were no any adverse changes in biochemical indices of patients receiving studied product. Intake of the product gave reliable increase in the selenium levels of blood serum only in patients with low content of this trace element.

[Experience of phytosterols' application in dietetic cardiovascular diseases].

The investigation of influent of antiatherosclerotic diets with phytosterols on clinical and metabolic parameters in patients with cardiovascular diseases. Results of the study show that enrichment of a diets with phytosterols in patients with ischemic heart disease and hypertension improved clinic status, antropometric levels and lipid spectrum of blood. The research has shown, that the use in the treat-preventive purposes phytosterols is rather perspective.