Dietary Prevention of Coronary Heart Disease

Abstract

Active prevention of coronary heart disease (CHD) should be started early in life and focus on prevention of arterial disease. Secondary prevention however should primarily focus on the risk of death and myocardial protection. The two main causes of death in these patients are sudden cardiac death (SCD) and heart failure (HF), often resulting from myocardial ischemia and subsequent necrosis. In that context, it is crucial to understand that our populations are chronically and severely deficient in some major nutrients in particular ω-3 polyunsaturated fatty acids (n-3 PUFA). Actually, consumption of n-3 PUFA is inversely correlated with the risk of SCD, the first cause of death in CHD patients. On the other hand, the main mechanism underlying recurrent cardiac events is myocardial ischemia resulting from atherosclerotic plaque rupture or ulceration. Plaque rupture is usually the consequence of intraplaque inflammation in relation with a high lipid content of the lesion, high concentration of leukocytes and lipid peroxidation products. Thus, in patients with established CHD, the three main aims of the preventive strategy are to prevent malignant ventricular arrhythmias and SCD (1), the development of severe ventricular dysfunction and heart failure (2), and to minimize the risk of plaque inflammation and ulceration ( 3|3}). For that purpose, the adoption of a Mediterranean diet rich in ω-3 fatty acids seems to be the most effective strategy.