Maximal Therapy for CVD

More than 40 years ago, a 12-year study by Dr. Morrison was performed on a group of older Americans who had had at least one prior heart attack. It was the first such study to show that a very-low-fat, near-vegetarian diet dramatically reduced deaths, especially from cardiovascular disease (CVD).

In the 1970s, Nathan Pritikin reversed his own coronary artery disease with a very-low-fat, near-vegetarian diet. He started the Pritikin Longevity Center to educate others about the diet he believed could reverse clogged arteries and prevent most deaths from CVD. Since the 1980s, the Pritikin Research Foundation has sponsored dozens of studies, demonstrating a dramatic improvement in blood lipids and numerous other risk factors associated with CVD.

In the 1990s, Dr. Dean Ornish showed that a very-low-fat, near-vegetarian diet, coupled with exercise and other lifestyle modifications, not only dramatically improved CVD risk factors, but also reversed clogged arteries in most patients.

Cholesterol-lowering medications, i.e., statins, have been shown to improve blood lipids. These drugs usually reduce CVD events such as heart attacks or strokes by 20 to 50% in most studies. However, when statins are taken by patients following a moderate diet, few experience regression.

While a very-low-fat, near-vegetarian diet and lipid-lowering medications have both been demonstrated individually to be far more beneficial in treating and preventing CVD mortality than simply following a moderate American Heart Association-style diet, there has been little data showing the impact of combining a very-low-fat, near-vegetarian diet with cholesterol-lowering medications.

A new study examined the impact of an aggressive, very-low-fat diet with drugs on several hundred patients who had undergone measurements of blood flow to their hearts.

For the next 5 years, patients self-selected to follow one of three different treatment plans:

1) Moderate – Most patients in the moderate treatment group elected to follow a moderate American Heart Association diet and take cholesterol-lowering drugs, but a few followed a strict lowfat diet and declined cholesterol-lowering medications.

2) Poor – Patients in the poor treatment group either

a) Were not on a prescribed diet or medication or

b) Followed a healthier diet or took medication but were actively smoking cigarettes.

3) Maximal – Patients in the maximal treatment group received intensive dietary instruction on how to follow a very-low-fat (10%), near-vegetarian diet and they also took cholesterol-lowering drugs.

The figure above shows the results of this study. The very-low-fat, near-vegetarian diet, coupled with lipid-lowering drugs dramatically reduced the risk of a nonfatal heart attack or death by four to five times. Maximal treatment with diet and drugs also reduced the number of patients who underwent heart surgery about fourfold. The authors of this study conclude, “Intense lifestyle and pharmacological lipid treatment reduce size/severity of myocardial perfusion abnormalities and cardiac events compared with usual-care, cholesterol-lowering drugs.”1

Bottom Line:

The results of this study clearly confirm that the use of a very-low-fat, near-vegetarian diet is a safe and effective component for aggressively treating patients who have advanced cardiovascular disease and wish to prevent the need for bypass surgery and angioplasty and also avoid having a heart attack and dying. The very-low-fat, near-vegetarian diet used in this study consisted largely of whole grains, fruits, vegetables, nonfat dairy products, a little seafood, skinless white meat poultry and egg whites. The addition of flax, soy products and fatty fish are beneficial for the heart and should be included to assure an adequate intake of omega-3 fatty acids. It should be noted that there are no comparable studies demonstrating the effectiveness of the increasingly popular Mediterranean-style diet either with or without medication for reversing atherosclerosis and improving blood flow to the heart. This more aggressive dietary approach, when coupled with cholesterol-lowering medication, dramatically reduced the need for heart surgeries and also prevented most heart attacks and deaths. The results of this study strongly suggest that this aggressive approach is not only more clinically effective but may also be much more cost effective than more conventional treatment strategies.

For more information visit www.foodandhealth.com, click on CPE courses and read Bypassing the Evidence.

By James J. Kenney, PhD, RD, FACN.

References

1. J Am Coll Cardiol 2003;41:263-72

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