1

Preventive Cardiology:

Focus on trans fats

Source: CDC/NCHSSource: CDC/NCHSCourtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

NHANES NHANES

C-Reactive Protein and Cholesterol Levels C-Reactive Protein and Cholesterol Levels Highly Predictive of CHD Risk: Highly Predictive of CHD Risk:

Role for Inflammation?Role for Inflammation?

Ridker PM. Circulation. 2001;103:1813-1818.Ridker PM. Circulation. 2001;103:1813-1818.

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Quintile of TC:HDL-C

5 4 3 21

54321Quintile of hs-CRP

MenRelative

Risk

Women

Quintile of TC:HDL-C

5 4 3 2 1Quintile of hs-CRP

Quintile of hs-CRP5544332211

hs-CRP = high-sensitivity CRPhs-CRP = high-sensitivity CRP

Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Conventional Risk Factors for Conventional Risk Factors for Coronary Heart DiseaseCoronary Heart Disease

4 Risk Factors4 Risk Factors

CigaretteCigaretteSmokingSmoking

Hyper-Hyper-lipidemialipidemia

Hyper-Hyper-tensiontension DiabetesDiabetes

• 87% to 100% of patients who experienced a 87% to 100% of patients who experienced a fatal coronary event had an antecedent fatal coronary event had an antecedent exposure to exposure to 1 risk factor. 1 risk factor.**

• > 80% of patients with coronary disease had > 80% of patients with coronary disease had 1 of the 4 conventional risk factors.1 of the 4 conventional risk factors.****

* JAMA 2003;290:891 ** JAMA 2003;290:898* JAMA 2003;290:891 ** JAMA 2003;290:898Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Approximate Mortality Reduction Potential of Drug Vs Approximate Mortality Reduction Potential of Drug Vs Lifestyle Interventions in Patients with Coronary Disease*Lifestyle Interventions in Patients with Coronary Disease*

DrugDrug

LifestyleLifestyle

LowLow dosedose aspirinaspirin 18%18%StatinsStatins21%21%ßß Blockers

Blockers23%23%ACEACE Inhibitors

Inhibitors 26%26%

SmokingSmoking cessation

cessation35%35%

PhysicalPhysical activityactivity

25%25%ModerateModerate alcohol

alcohol20%20%

Combined lifestyle

Combined lifestyle changeschanges

45%45%

Iestra JA et al. Circ 2005;112:924Iestra JA et al. Circ 2005;112:924Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

The effects of lifestyle The effects of lifestyle

change and drug therapy on change and drug therapy on

cardiovascular risk reduction cardiovascular risk reduction

appear to be appear to be independent independent

and additiveand additive..

++

Hunninghake DB et al. NEJM 1993;32:1213Hunninghake DB et al. NEJM 1993;32:1213Barnard RJ et al. AJC 1997;79:1112Barnard RJ et al. AJC 1997;79:1112Sdringola S et al. JACC 2003;41:263Sdringola S et al. JACC 2003;41:263

Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

SITSITSPARINGLYSPARINGLY• watch TVwatch TV

• play computer gamesplay computer games

ENJOY LEISUREENJOY LEISUREACTIVITIESACTIVITIES

• golfgolf• bowlingbowling

• yardworkyardwork

STRETCH/STRETCH/STRENGTHENSTRENGTHEN

• curl-upscurl-ups• push-upspush-ups

• weight liftingweight lifting

2-3 Times/Wk2-3 Times/Wk

AEROBIC ACTIVITIESAEROBIC ACTIVITIES• long walkslong walks

• bikingbiking• swimmingswimming

3-5 Times/Wk3-5 Times/WkRECREATIONAL SPORTSRECREATIONAL SPORTS

• tennistennis• racquetballracquetball• basketballbasketball

• makemake extraextra stepssteps inin youryour dayday• walk the dogwalk the dog

• take the stairs instead of the elevatortake the stairs instead of the elevator• park your car farther away and walkpark your car farther away and walk

EVERYDAYEVERYDAY

The ActivityThe ActivityPyramidPyramid

PedometersPedometers

Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Cardioprotective Dietary Recommendations*Cardioprotective Dietary Recommendations*

Minimize the intake of beverages & Minimize the intake of beverages &

foods with added sugarsfoods with added sugars

Choose and prepare foods with little Choose and prepare foods with little

or no saltor no salt

Limit alcohol consumption (≤ 2 and 1 Limit alcohol consumption (≤ 2 and 1

drink/day for men and women, drink/day for men and women,

respectively), ideally with mealsrespectively), ideally with meals

*Lichtenstein A et al. Circ 2006;114:82*Lichtenstein A et al. Circ 2006;114:82Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Cardioprotective Dietary Recommendations*Cardioprotective Dietary Recommendations*

• Balance caloric intake & physical activity to achieve Balance caloric intake & physical activity to achieve and maintain a healthy body weightand maintain a healthy body weight

• Consume a diet rich in fruits and vegetables, as well Consume a diet rich in fruits and vegetables, as well as whole-grain, high-fiber foodsas whole-grain, high-fiber foods

• Eat fish, especially oily fish, ≥ 2 times/weekEat fish, especially oily fish, ≥ 2 times/week

• LimitLimit

– saturated fat (<7% of energy)saturated fat (<7% of energy)

– cholesterol to (< 300 mg/day), andcholesterol to (< 300 mg/day), and

– transtrans fatfat (<(< 1%1% ofof energy)energy)Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Trans fatty acids can adversely affect:Trans fatty acids can adversely affect:

LDL and HDL LDL and HDL cholesterol levelscholesterol levels

LP(a) and LP(a) and triglyceridestriglycerides

Vascular inflammation Vascular inflammation IL-6, TNF, CRPIL-6, TNF, CRP

Trans fatty acids increase:Trans fatty acids increase:

Coronary heart diseaseCoronary heart disease

DiabetesDiabetes Mozaffarian D. NEJM 2006Mozaffarian D. NEJM 2006Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Trans Fat Increases Risk of Coronary DiseaseTrans Fat Increases Risk of Coronary Disease

Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

Trans Fat Intake & Systemic InflammationTrans Fat Intake & Systemic Inflammation(Lopez-Garcia et al. J Nutr 2005)(Lopez-Garcia et al. J Nutr 2005)

1.6

1.7

1.8

1.9

2

Q1 Q2 Q3 Q4 Q5

IL-6(pg/ml)

1.3

1.4

1.5

1.6

1.7

1.8

1.9

CRP(mg/L)

Quintiles of Quintiles of TransTrans Fatty Acid Intake Fatty Acid Intake

Among 730 women, adjusted for age, BMI, smoking, physical activity, postmenopausal hormone Among 730 women, adjusted for age, BMI, smoking, physical activity, postmenopausal hormone therapy, and intakes of alcohol, saturated fat, polyunsaturated fat, and monounsaturated fat.therapy, and intakes of alcohol, saturated fat, polyunsaturated fat, and monounsaturated fat.

p trend 0.10p trend 0.10

p trend 0.009p trend 0.009

Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI