Preventive Cardiology: Focus on trans fats

1. Preventive Cardiology:Focus on trans fats 1

2. Source: CDC/NCHS Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

3. Men Women Relative Risk 5 5 5 5 4 4 4 4 3 3 3 3 2 2 2 2 1 Quintile of hs-CRP 1 1 Quintile of TC:HDL-C Quintile of hs-CRP 1 Quintile of TC:HDL-C NHANES C-Reactive Protein and Cholesterol Levels Highly Predictive of CHD Risk: Role for Inflammation? hs-CRP = high-sensitivity CRP Ridker PM. Circulation. 2001;103:1813-1818. Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

4. 4 Risk Factors Diabetes Hyper- lipidemia Hyper- tension Cigarette Smoking • 87% to 100% of patients who experienced a fatal coronary event had an antecedent exposure to  1 risk factor.* • > 80% of patients with coronary disease had  1 of the 4 conventional risk factors.** Conventional Risk Factors for Coronary Heart Disease Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI * JAMA 2003;290:891 ** JAMA 2003;290:898

5. Approximate Mortality Reduction Potential of Drug Vs Lifestyle Interventions in Patients with Coronary Disease* Lowdoseaspirin18% Statins21% ßBlockers23% ACEInhibitors26% Smokingcessation35% Physicalactivity25% Moderatealcohol20% Combined lifestyle changes45% Drug Lifestyle Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI Iestra JA et al. Circ 2005;112:924

6. The effects of lifestyle change and drug therapy on cardiovascular risk reduction appear to be independent and additive. + Hunninghake DB et al. NEJM 1993;32:1213 Barnard RJ et al. AJC 1997;79:1112 Sdringola S et al. JACC 2003;41:263 Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

7. Pedometers • SIT • SPARINGLY • watch TV • play computer games The Activity Pyramid 2-3 Times/Wk • ENJOY LEISURE • ACTIVITIES • golf • bowling • yardwork • STRETCH/ • STRENGTHEN • curl-ups • push-ups • weight lifting 3-5 Times/Wk • AEROBIC ACTIVITIES • long walks • biking • swimming • RECREATIONAL SPORTS • tennis • racquetball • basketball EVERYDAY • makeextrastepsinyourday • walk the dog • take the stairs instead of the elevator • park your car farther away and walk Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

8. Cardioprotective Dietary Recommendations* Minimize the intake of beverages & foods with added sugars Choose and prepare foods with little or no salt Limit alcohol consumption (≤ 2 and 1 drink/day for men and women, respectively), ideally with meals *Lichtenstein A et al. Circ 2006;114:82 Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

9. Cardioprotective Dietary Recommendations* • Balance caloric intake & physical activity to achieve and maintain a healthy body weight • Consume a diet rich in fruits and vegetables, as well as whole-grain, high-fiber foods • Eat fish, especially oily fish, ≥ 2 times/week • Limit • saturated fat (<7% of energy) • cholesterol to (< 300 mg/day), and • transfat(<1%ofenergy) Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

10. Trans fatty acids can adversely affect: LDL and HDL cholesterol levels LP(a) and triglycerides Vascular inflammation IL-6, TNF, CRP Trans fatty acids increase: Coronary heart disease Diabetes Mozaffarian D. NEJM 2006 Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

11. Trans Fat Increases Risk of Coronary Disease Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI

12. Trans Fat Intake & Systemic Inflammation(Lopez-Garcia et al. J Nutr 2005) p trend 0.10 p trend 0.009 Quintiles of Trans Fatty Acid Intake Among 730 women, adjusted for age, BMI, smoking, physical activity, postmenopausal hormone therapy, and intakes of alcohol, saturated fat, polyunsaturated fat, and monounsaturated fat. Courtesy of Barry Franklin, PhD, William Beaumont Hospital, Royal Oak, MI