changes to diet are effective in protecting people from cardiovascular disease?

Since dietary support and advice by health professionals and self-help materials are effective at reducing cardiovascular risk, at least in the short term, what actual changes to diet are effective in protecting people from cardiovascular disease? Again considering systematic reviews of randomised controlled trials as the best level of evidence, we are lucky that quite a few have been published in the area of diet and cardiovascular disease. The most important studies show that dietary intervention actually makes a difference to health or mortality. To date, the most effective dietary intervention for people who already have cardio- vascular disease is omega-3-rich fish oil. Evidence for this comes from a high-quality systematic review of randomised controlled trials. Advice to increase intakes of long chain omega-3 fats for people with some cardiovascular disease (compared with no such advice) appears to reduce the risk of fatal myocardial infarction .The effects of these cardioprotective doses of omega-3 fats appear consistent whether the advice is dietary (eating more oily fish, usually 2 to 3 large portions weekly) or supplemental (taking the equivalent of 0.5 to 1.0 g of a mixture of eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) fatty acids daily). A further systematic review examined the effects of omega-3 fats in diabetics. Unfortunately, no studies or large subgroups of published studies assess the effects of omega-3 fats on disease endpoints in diabetics. There is no evidence of detrimental effects of cardioprotective doses of omega-3 fats on glycemic control or LDL cholesterol levels (higher levels of supplementation have been used to reduce trig- lyceride levels; the smaller cardioprotective doses mentioned above may well save lives of diabetics but do not alter triglycerides significantly). More evidence would be useful to clarify this issue. Although no studies compare the effect of reducing saturated fats to that of increasing omega-3 fats, an indirect comparison suggests that the effect of reducing saturated fats is smaller than the effect of increasing omega-3 fats, takes longer to be seen, but may increase in importance over periods longer than 2 years. Other systematic reviews suggest no evidence of protective effects of dietary supplements of antioxidant vitamins and no evidence of effects of garlic capsules on peripheral arterial occlusive disease. Evidence for a Mediterranean diet high in omega-3 fats, fruits, and vegetables and low in saturated fats and processed foods comes from only one trial in men who had recovered from myocardial infarctions. While the effects of increasing fruits and vegetables and reducing processed foods appear promising, it is not clear how much of the protective effect seen in this study was due to the rapeseed (canola) margarine supplied to the intervention group (high in omega-3 fats), how much was due to reductions in saturated fats, and how much (if any) was due to fruits and vegetables.

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