European Heart Journal Advance Access originally published online on May 22, 2006
European Heart Journal 2006 27(13):1629-1630; doi:10.1093/eurheartj/ehl036
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What to ‘eat and chew’ in acute myocardial infarction?: reply
Division of Metabolic Diseases
Policlinico Seconda Università di Napoli
Piazza L. Miraglia
80031 Napoli
Italia
Fax: +39 (0) 81 5665054
E-mail address: dario.giugliano{at}unina2.it
Division of Metabolic Diseases
Centre of Excellence for Cardiovascular Diseases
University of Naples SUN
Naples
Italy
We thank Dr Singh and his colleagues for putting in perspective an interesting topic: what should a patient with acute myocardial infarction (AMI) eat? Obviously, this question is charged with important practical implications. Starting from the premise that a patient with AMI or acute coronary syndrome is likely to be an ‘inflamed’ patient, it should be wise to prescribe a diet that is associated with reduced inflammatory markers. In other words, cooling down inflammation may be a sound dietetic strategy. Unfortunately, some foods currently given to these patients, such as refined starches or cakes, may cause a rapid rise in plasma glucose concentrations, which in turn may further deteriorate glucose homeostasis. Moreover, rapid glycaemic swings may activate the innate immune system, most likely by an excessive production of proinflammatory cytokines associated with a reduced production of anti-inflammatory cytokines.1 So, dietary patterns high in refined starches, sugar, and saturated and trans-fatty acids, and poor in natural antioxidants and fibre from fruits, vegetables, and whole grains should be avoided in patients with AMI or acute coronary syndrome. However, no trial has specifically addressed this topic.
We are sorry for not being aware of the Columbus paradigm, but we note that the phrase ‘endothelial dysfunction acutely triggered by the consumption of a high-fat meal rich in saturated fatty acids is reduced by the simultaneous consumption of a vegetable serving including pepper (100 g), tomatoes (100 g), and carrots (200 g)’ refers to our data.2 As cardiovascular diseases, various forms of cancer, and diabetes combine to make up nearly 70% of all deaths in the US,3 adoption of a healthy lifestyle is paramount to reducing chronic disease risk. So, the choice of healthy sources of carbohydrates, fat, and proteins associated with regular physical activity, and avoidance of smoking is critical to fighting the war against chronic disease.
Long-term dietary intervention studies are scanty. However, they demonstrate that a whole diet approach, such as the Mediterranean-style diet, reduced the risk of recurrent coronary events, and also improved endothelial function, inflammation, and insulin resistance in subjects with the metabolic syndrome.4 The importance of the whole-diet approach is best defined by the results of the Women Health Initiative5 showing that a dietary intervention low in fat and high in vegetables and fruits did not reduce the risk of cardiovascular events in postmenopausal women. However, the bulk of the dietary intervention was focused on substitution of fats with carbohydrates, in a quite similar exchange (–8.2% energy from fat vs. +8.1% energy from carbohydrates). Unfortunately, the reduced fat intake was stratified across all fat categories, including those with supposed or proven beneficial effects on cardiovascular health, such as monounsaturated and polyunsaturated fats. Following this line of reasoning, the healthy effect of increasing fruit and vegetables might have been dampened by reducing the intake of nuts.
A Western dietary pattern should be avoided in patients with acute coronary syndromes; however, the best recipe has to be defined.
References
- Esposito K and Giugliano D. (2006) Diet and inflammation: a link to metabolic and cardiovascular diseases. Eur Heart J 27:15–20.
[Abstract/Free Full Text] - Esposito K, Nappo F, Giugliano F, Giugliano G, Martella R, Giugliano D. (2003) Effect of dietary antioxidants on postprandial endothelial dysfunction induced by a high-fat meal in healthy subjects. Am J Clin Nutr 77:139–143.
[Abstract/Free Full Text] - Arias E, Anderson RN, Kung HC, Murphy SL, Kochanek KD. (2003) Deaths: final data for 2001. Natl Vital Stat Rep 52:1–115.[Medline]
- Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. (2004) Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 292:1440–1446.
[Abstract/Free Full Text] - Howard BV, Van Horn L, Manson JE, et al. (2006) Low-far dietary pattern and risk of cardiovascular disease. The Women's Health Initiative randomized controlled dietary modification trial. JAMA 295:655–666.
[Abstract/Free Full Text]
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