1. Food and cardiovascular heart disease Pedro Marques-Vidal IUMSP Lausanne, Switzerland

2. Coronary heart disease In the next 10 minutes, in Europe – 40 people will die of myocardial infarction – 80 will die of cardiovascular disease – At a cost of 3.2 million € Each year, one out of 40 Europeans is hospitalized for cardiovascular disease Cost estimated at 169 billion € in 2006, increasing to 192 billion € in 2008. European Journal of Cardiovascular Prevention and Rehabilitation, 14 (2007) Suppl2, E1 Leal et al. European Heart Journal 27 (2006):1610

3. Outline Cardiovascular risk factors and diet Case stories of dietary prevention ESC guidelines on dietary prevention Conclusion

4. What causes heart disease Smoking High cholesterol High blood pressure Diabetes Thomas et al, Archives des Maladies du Coeur et des Vaisseaux, 100 (2007): 57 80% of coronary deaths in France Modifiable by dietary interventions

5. High cholesterol / fat Decreasing saturated and increasing polyunsaturated fat can lead to – 14% in total cholesterol – 44% in the risk of heart disease 1. Increasing trans fatty acids can lead to a 28% increase in the risk of heart disease 2. 1 Turpeinen et al. International Journal of Epidemiology 8 (1979):99 2 Oomen et al., Lancet. 357 (2001):746

6. High blood pressure Effect on systolic blood pressure of: Less salt 1 : 5 mm Hg More fruit & vegs 2 : 3 mm Hg More fruit & vegs, less fat 2 : 5 mm Hg All together 3 : 11 mm Hg Stronger effect in subjects with hypertension 1 Forte et al, Journal of Human Hypertension, 3 (1989): 179 2 Appel et al. New England Journal of Medicine 366 (1997): 1117 3 Sacks et al. New England Journal of Medicine. 344(2001):3

7. Diabetes Less weight Less total and saturated fat More fiber More physical activity = 58% decrease in the risk of developing type 2 diabetes Tuomilehto et al. New England Journal of Medicine. 344 (2001):1343

8. Effect of diet on CV deaths Salt (-3 g/day) 1 :16% Fish (4x/week) 2 :14% Fruit (+1 portion/day) 3 : 7% Vegetables (+1 portion/day) 3 : 4% Fat (replace SFA by PUFA) 4 : 12% Overall:53% Theoretical 5 :75% 1 Law et al, British Medical Journal. 302 (1991):819 2 Whelton et al, American Journal of Cardiology 93 (2004):1119 3 Dauchet et al. Journal of Nutrition 136 (2006):2588 4 Hu et al, Journal of the American Medical Association. 288 (2002):2569 5 Franco et al. British Medical Journal. 329 (2004):1447

9. Finland: North Karelia Project % Use of vegetable oil for cooking % Use of vegetable oil for cooking (men age 30-59) Use of butter for cooking

10. Mortality per 100 000 population 100 200 300 400 500 600 700 69727578818487909396992002 Year North Karelia (-82%) Finland (-75%) start of the North Karelia Project extension of the Project nationally Finland: North Karelia Project Vartiainen et al, British Medical Journal 311(1995):589

11. Poland Zatonski et al, British Medical Journal 316 (1998): 1047

12. Czech Republic Bobak et al. Journal of Epidemiology and Community Health. 51 (1997)272-

13. Czech Republic Bobak et al. Journal of Epidemiology and Community Health. 51 (1997)272-

14. GISSI – Prevenzione trial: effect of Omega-3 PUFAs on mortality Marchioli R et al. Circulation 105 (2002):1897 40% in all deaths, 30% in cardiovascular deaths

15. Mediterranean diet Adherence to a Mediterranean-type diet – 30% the risk of dying from heart disease in the general population 1. – 37% the risk of cardiovascular events after myocardial infarction 2. – 18% the risk of dying among European elderly with previous myocardial infarction 3. 1 Trichopoulou et al, New England Journal of Medicine, 348 (2003):2599 2 De Lorgeril et al, Journal of the American College of Cardiology. 28 (1996):1103 3 Trichopoulou et al, European Journal of Epidemiology. 22 (2007):871

16. European Journal of Cardiovascular Prevention and Rehabilitation, 14 (2007) Suppl2, E1

17. Salt in breakfast cereals Current recommendations: <5 g/day Mancia et al, European Heart Journal 28 (2007): 1462

18. Salt in vegetable soups Current recommendations: <5 g/day Mancia et al, European Heart Journal 28 (2007): 1462

19. Conclusion Heart disease represents a health and economical issue in Europe Dietary prevention works at the population and individual level… …but has to be implemented!

20. Thank you!