There are some exciting new interactive, online tools for healthy eating that CDC has developed.
Recipe RE-MIX provides guidance about changing recipes to make them more healthy. So, patients can modify their favorite recipes by enter them in the interactive database (please visit) http://www.fruitsandveggiesmatter.gov/activities/analyze_my_plate.html. This tool will patients a variety of helpful tips for reducing the amount of total fat, saturated fat, sodium and sugar in the recipe. Also, in addition to lowering calories, the recipes incorporate fruits and vegetables as replacements for fats and sugars, thereby boosting the nutritional value of favorite foods.
I am very excited about another program developed by CDC, Analyze My Plate. Patients can evaluate their plate by clicking on the “Analyze My Plate” icon found on the CDC’s website above. This tool allows individuals to create healthy plates for breakfast, lunch, and dinner that incorporate foods from all food groups. Patients will have fun moving fruits and vegetables to a virtual plate, and see what the nutritional outcome is. This is an incredible tool for teaching principles of healthy meal planning. I think health professionals will have fun with this tool, as well.
Funding was received from the Foundation of the National Lipid Association to develop a computer-based interactive learning tool designed to aid patients in achieving target blood cholesterol levels through diet and physical activity. We are seeking practicing health professionals in lipid management who are willing to test the learning tool with their patients. The program will be provided on a CD that is compatible with both Windows and MAC operating systems. You will be asked to use the program and provide comprehensive feedback via a questionnaire within 8 weeks. There is no lower or upper limit on the number of patients who can test the learning tool in your practice. Once your assessment has been received, you will be permitted to keep the program free of charge and you will be compensated $150 for your help. We plan to summarize the results of the questionnaires that you complete and revise the tool as appropriate. Our goal is to make this tool available to NLA members. If you are interested in learning more about the project, please email Jennifer at jas58@psu.edu or call (1-866-778-3438), mention the Lipid Study, and leave your name and a contact number. This study is being conducted in the Department of Nutritional Sciences at Penn State University and has received IRB approval.
The 2010 Dietary Guidelines for Americans have been released recently. The main messages are that individuals should eat less, make smarter food choices, and be physically active. Specific recommendations for heart health include achieving and maintaining a healthy body weight, lowering saturated fat, trans fat, and dietary cholesterol, reducing intake of sodium and added sugars. These are all very important messages that clinicians should communicate to their patients.
A new feature of the 2010 Guidelines is inclusion of an Appendix that lists potential strategies for health professionals to use in implementing the 2010 Dietary Guidelines for key consumer behaviors (Appendix 2). For example, to help patients manage calorie intake, Appendix 2 presents key consumer behaviors to address, and potential strategies to help individuals modify their behavior to achieve a specific dietary guideline recommendation.
One topic that is addressed deals with calorie intake and the key consumer behaviors that can control calorie intake. Numerous potential strategies are presented that clinicians can communicate to their patients to help control calorie intake and, consequently, manage body weight.
The 2010 Dietary Guidelines target an overweight and obese population, which represents about 67% of the adult U.S. population. We are mindful that obesity that is associated with an increased risk of CHD. A new study published by Logue et al. in the February 14 issue of Heart reported that obesity is associated with fatal CHD Independent of traditional risk factors. The authors reported that men in the West of Scotland Prevention Study (WOSCOPS) with an increased BMI (30-39.9) may have increased risk of fatal CHD events beyond that mediated by classic risk factors.
Collectively, much remains to be done to decrease the prevalence of overweight and obesity. In addition to treating lipid risk factors and high blood pressure in patients, it is urgently important to aggressively intervene with patients who are not at a healthy body weight.
The American Diabetes Association has a very good resource for health care professionals to teach them skills needed to assist patients with behavior changes. The program "Facilitating Behavior Change: Key Strategies for Empowering Your Patients " is an easy-to-follow tutorial.
A new study reports the 25-year mortality follow-up of 838 patients randomized to partial ileal bypass surgery and diet instruction, or diet instruction alone (control) to evaluate surgical treatment for hyperlipidemia. In the study by Buchwald et al., 2010, patients in the treatment group experienced a 1.0 year overall higher life expectancy over 25 years of follow-up. In the cohort with an ejection fraction greater than or equal to 50%, overall life expectancy in the treatment group was 1.7 years greater. Although LDL-cholesterol levels were not reported in this study, the authors reported greater cholesterol lowering in the treatment group. Thus, their findings provide further support for long-term longevity associated with aggressive lipid lowering interventions.
In a study "Cardiovascular Risk Factor Trends and Potential for Reducing Coronary Heart Disease Mortality in the United States of America ", published by Capewell, Ford, Croft, Critchley, Greenlund, and Labarthe in the Bull World Health Organ (2010), the authors estimated that if Healthy People 2010 CVD risk factor targets were reached, there would be approximately 188,000 fewer CHD deaths (from 2000 to 2010). The CVD risk factors considered were total cholesterol, blood pressure, cigarette smoking, physical activity, BMI, and diabetes.
The table below shows that for every 38.6 mg/dL decrease in total cholesterol, there is reduction in estimated CHD mortality that ranges from 10% to 68% for men and women. The projected decrease is greater with increasing age, and individuals 55 and older would derive the greatest benefit.
Percentage risk reduction for CHD mortality for every 1-unit change in major CVD risk factors
|
|
|
| Age (yr) |
|
|
|
| 25-44 | 45-54 | 55-64 | 65-74 | 75-84 |
| Per 1 mmHg decease in SBP |
|
|
|
|
|
| Men | ↓3.5% | ↓3.4% | ↓3.1% | ↓2.7% | ↓2.1% |
| Women | ↓4.5% | ↓4.5% | ↓3.4% | ↓3.1% | ↓2.6% |
|
|
|
|
|
|
|
| Per 1 mmol/L decrease in TC | ↓10% | ↓35% | ↓55% | ↓67% | ↓68% |
|
|
|
|
|
|
|
| Per 1 kg/m2 increase in BMI | ↑4% | ↑3% | ↑2% | ↑1% | ↑1% |
The table was provided by Dr. Guixiang Zhao, CDC.
These findings again reinforce the importance of controlling LDL-cholesterol (which tracks with total cholesterol) through healthy lifestyle practices (diet and physical activity), as well as drug therapy when indicated.
In a study "Cardiovascular Risk Factor Trends and Potential for Reducing Coronary Heart Disease Mortality in the United States of America ", published by Capewell, Ford, Croft, Critchley, Greenlund, and Labarthe in the Bull World Health Organ (2010), the authors estimated that if Healthy People 2010 CVD risk factor targets were reached, there would be approximately 188,000 fewer CHD deaths (from 2000 to 2010). The CVD risk factors considered were total cholesterol, blood pressure, cigarette smoking, physical activity, BMI, and diabetes.
The table below shows that for every 38.6 mg/dL decrease in total cholesterol, there is reduction in estimated CHD mortality that ranges from 10% to 68% for men and women. The projected decrease is greater with increasing age, and individuals 55 and older would derive the greatest benefit.
Percentage risk reduction for CHD mortality for every 1-unit change in major CVD risk factors
|
|
|
| Age (yr) |
|
|
|
| 25-44 | 45-54 | 55-64 | 65-74 | 75-84 |
| Per 1 mmHg decease in SBP |
|
|
|
|
|
| Men | ↓3.5% | ↓3.4% | ↓3.1% | ↓2.7% | ↓2.1% |
| Women | ↓4.5% | ↓4.5% | ↓3.4% | ↓3.1% | ↓2.6% |
|
|
|
|
|
|
|
| Per 1 mmol/L decrease in TC | ↓10% | ↓35% | ↓55% | ↓67% | ↓68% |
|
|
|
|
|
|
|
| Per 1 kg/m2 increase in BMI | ↑4% | ↑3% | ↑2% | ↑1% | ↑1% |
The table was provided by Dr. Guixiang Zhao, CDC.
These findings again reinforce the importance of controlling LDL-cholesterol (which tracks with total cholesterol) through healthy lifestyle practices (diet and physical activity), as well as drug therapy when indicated.
Non-optimal Lipids Commonly Present in Young Adults and Coronary Calcium Later in Life: The Cardia (Coronary Artery Risk Development in Young Adults) Study. Pletcher, MJ et al. Annals of Internal Medicine 2010;153:137-146.
This study reported that non-optimal levels of LDL and HDL cholesterol during young adulthood (ages 18 to 30 years) was independently associated with coronary atherosclerosis two decades later. This study was conducted to determine whether non-optimal lipid levels during young adulthood could cause atherosclerotic changes in middle age. The study evaluated 3,258 participants in the CARDIA study. LDL & HDL cholesterol, triglycerides, and coronary calcium levels were quantified. 87 percent of the participants had non-optimal levels of LDL cholesterol, HDL cholesterol, or triglycerides during young adulthood. Coronary calcium prevalence after 20 years was 8 percent in participants who maintained optimal LDL levels and 44 percent in participants with higher LDL levels. Both LDL and HDL cholesterol levels were independently associated with coronary calcium. The results of this study reinforce the importance of achieving optimal LDL cholesterol levels early in life as a means to reduce atherosclerosis as early as middle age.
