This 55-year-old man developed exertional chest pain. He had a positive stress exercise test and a coronary angiogram that revealed 2-vessel nonobstructive coronary disease. His risk profile indicates he is a nonsmoker with treated hypertension, and a low HDL–C. His father had an MI at age 67. His mother had type 2 diabetes diagnosed at age 60. He is on a low dose aspirin, long-acting beta blocker, a high-intensity statin, and an ACE inhibitor. His BP 135/86, pulse 58, weight 183 lbs and BMI 26.3. His LDL–C is 95 mg/dL, his HDL–C 39 mg/d and triglycerides are 145 mg/dL. His fasting glucose is 109 mg/dL. He wants to know what dietary change recommendations you would make. His cardiologist has given him physical activity recommendations.
Which of the following statements is the most correct answer?
Show Answer
The correct answer is: b. He should consume a dietary pattern that emphasizes vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils and nuts; and limits intake of sweets, sugar-sweetened beverages and red meats.
Lifestyle modification, both diet and physical activity, is an important adjunct to pharmacotherapy in improving ASCVD risk factors and should be coupled with efforts to achieve and maintain a healthy body weight. This recommendation is based largely on studies of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern (DASH and DASH-Sodium) and Mediterranean–type dietary patterns and is consistent with that described by the AHA Diet and Lifestyle Recommendations and 2010 Dietary Guidelines for Americans.
References
Eckel RH, Jakicic JM, Ard, JD, Hubbard VS, de Jesus JM, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Houston Miller N, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TW, Yanovski SZ. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology American/Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013. (In press)
Appel LJ, Moore TJ, Obarzanek E et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. The New England journal of medicine 1997;336:1117-24.
Sacks FM, Svetkey LP, Vollmer WM et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. The New England journal of medicine 2001;344:3-10.
Estruch R, Martinez-Gonzalez MA, Corella D et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Annals of internal medicine 2006;145:1-11.
American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114:82-96.
2010 Dietary Guidelines for Americans. http://health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf. 2010.
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