Managing Dyslipidaemic Patients – Improving Adherence with Lifestyle Intervention

A satellite symposium report
European Cardiology, 2011;7(4):246-250
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Abstract

On 27 June 2011, during the European Atherosclerosis Society (EAS) Congress 2011, Danone hosted an educational symposium entitled ‘Nutritional Behaviour and Reduction of Cardiovascular Risk: From Basic Science to Clinical Practice’. The symposium was co-chaired by Professor M John Chapman, EAS President and Director of the Dyslipidaemia and Atherosclerosis Research Unit at the French National Institute of Health and Medical Research (INSERM), Pitié-Salpêtrière Hospital, Paris, and Professor John Deanfield, British Heart Foundation Vandervell Professor of Cardiology, University College Hospital, London, UK. The focus of the four presentations and discussions was whether the incorporation of functional foods in the diet of dyslipidaemic patients might improve adherence to lifestyle changes, and the implications of such an approach.

Speakers: Philippe Besnard, Professor and Head of the Nutrition Physiology and Toxicology Research Unit, INSERM, University of Bourgogne, Dijon; Eric Bruckert, Medical Doctor, Professor of Endocrinology and Director of the Endocrinology-Metabolism and Prevention of Cardiovascular Disease Department, Pitié-Salpêtrière Hospital, Paris; John Deanfield, Professor of Cardiology and Head of Cardiovascular Prevention, University College London; Lluis Masana, Professor of Medicine and Head of the Vascular Medicine and Metabolism Unit, Institut d'Investigació Sanitària Pere Virgili, Rovira i Virgili University, University Hospital San Joan, Reus.
Support: The publication of this educational symposium report was sponsored by Danone.
Keywords
Phytosterol, lifestyle, hypercholesterolaemia, cardiovascular risk, lipid sensing
Received: August 05, 2011 | Accepted August 18, 2011 | Citation European Cardiology, 2011;7(4):246-250
Focus on Lifestyle to Reduce Cardiovascular Risk

Pharmacotherapeutic intervention, in particular targeting elevated cholesterol, has undoubtedly been successful in reducing the mortality and morbidity of patients with cardiovascular disease.1 However, these gains have now been largely overtaken by escalating rates of obesity and cardiometabolic disease, driven by the adoption of energy-dense diets and a sedentary lifestyle. The INTERHEART study, a global case-control study, previously showed that a Western high-fat diet, a driver for the development of hypercholesterolaemia, is associated with increased coronary risk.2 As seen in China, an increasingly Westernised diet and associated increase in total cholesterol have contributed to marked increases in coronary heart disease mortality (by 50 % in men and by 27 % in women) despite improved access to better treatment.3

Clearly, improved lifestyle is a key component of modern preventive cardiology, as recognised by the recently published European Atherosclerosis Society (EAS)/European Society of Cardiology (ESC) joint guidelines for management of dyslipidaemia.4 These new guidelines also place emphasis on nutritional approaches, either alone or complementary to pharmacotherapy, in managing hypercholesterolaemia to reduce cardiovascular risk. As highlighted by Eric Bruckert, Director of the Endocrinology-Metabolism and Prevention of Cardiovascular Disease Department at the Pitié-Salpêtrière Hospital in Paris, in his presentation, adherence to a healthy diet from an early age has been shown to translate to a reduction in the risk of coronary heart disease and diabetes.5 However, the biggest challenge in implementing lifestyle advice is sustaining change in the long term.

Are there Practical Tools that can Help in Adherence to Dietary Changes?

Bruckert reviewed data showing that preventive programmes for managing cardiovascular risk factors that include both education and a self-monitoring component, such as measuring blood glucose or blood pressure, were beneficial in helping patients sustain improvements in lifestyle.6,7 Furthermore, the use of a pedometer8 not only increased physical activity but also improved other cardiovascular risk factors, suggesting that simple practical tools might help in promoting a lifestyle change.

References:
  1. Unal B, Critchley JA, Capewell S, Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000, Circulation, 2004;109:1101–7.
  2. Iqbal R, Anand S, Ounpuu S, et al., INTERHEART Study Investigators, Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study, Circulation, 2008;118:1929–37.
  3. Critchley J, Liu J, Zhao D, et al., Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999, Circulation, 2004;110:1236–44.
  4. Reiner Z, Catapano A, de Backer G, et al., ESC/EAS guidelines for the management of dyslipidaemias: the Task Force on the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS), Eur Heart J, 2011;32:1769–818.
  5. Tirosh A, Shai I, Afek A, et al., Adolescent BMI trajectory and risk of diabetes versus coronary disease, N Eng J Med, 2011;364:1315–25.
  6. Wood DA, Kotseva K, Connolly S, et al., EUROACTION Study Group, Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial, Lancet, 2008;371:1999–2012.
  7. Yamaoka K, Tango T, Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials, Diabetes Care, 2005;28:2780–6.
  8. Bravata DM, Smith-Spangler C, Sundaram V, et al., Using pedometers to increase physical activity and improve health: a systematic review, JAMA, 2007;298:2296–304.
  9. Cade J, Thompson R, Burley V, Warm D, Development, validation and utilisation of food-frequency questionnaires – a review, Public Health Nutr, 2002;5:567–87.
  10. Béliard S, Coudert M, Valéro R, et al., Validation of a simple self-administered food frequency questionnaire to evaluate nutritional lifestyles in hypercholesterolemic patients (submitted).
  11. Graham I, Atar D, Borch-Johnsen K, et al., European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts), Eur Heart J, 2007;28:2375–414.
  12. Lichtenstein AH, Appel LJ, Brands M, et al., Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee, Circulation, 2006;114:82–96.
  13. Masana L, Descamps O, Bosi E, et al., Lifestyle behaviour and cardiovascular risk in hypercholesterolemia: impact of consumption of phytosterol-supplemented yogurt, Presented at: 79th EAS Congress, Gothenburg, 26–29 June 2011, Abstract 1380.
  14. Jones PH, Davidson MH, Stein EA, et al., STELLAR Study Group, Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin and pravastatin across doses (STELLAR Trial), Am J Cardiol, 2003;92:152–60.
  15. Tuzcu EM, Kapadia SR, Tutar E, et al., High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound, Circulation, 2001;103:2705–10.
  16. Folsom AR, Yatsuya H, Nettleton JA, et al., ARIC Study Investigators, Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence, J Am Coll Cardiol, 2011;57:1690–6.
  17. Kastorini CM, Milionis HJ, Esposito K, et al., The effect of Mediterranean diet on metabolic syndrome and its components, J Am Coll Cardiol, 2011; 57:1299–313.
  18. Mattes RD, Oral detection of short-, medium-, and long-chain free fatty acids in humans, Chem Senses, 2009;34:145–50.
  19. Fukuwatari T, Shibata K, Iguchi K, et al., Role of gustation in the recognition of oleate and triolein in anosmic rats, Physiol Behav, 2003;78:579–83.
  20. Laugerette F, Passilly-Degrace P, Patris B, et al., CD36 involvement in orosensory detection of dietary lipids, spontaneous fat preference, and digestive secretions, J Clin Invest, 2005;115:3177–84.
  21. Simons PJ, Kummer JA, Luiken JJ, Boon L, Apical CD36 immunolocalization in human and porcine taste buds from circumvallate and foliate papillae, Acta Histochem, 2010; [Epub ahead of print].
  22. Mela DJ, Sacchetti DA, Sensory preferences for fats: relationships with diet and body composition, Am J Clin Nutr, 1991;53:908–15.
  23. Stewart JE, Feinle-Bisset C, Golding M, et al., Oral sensitivity to fatty acids, food consumption and BMI in human subjects, Br J Nutr, 2010;104:145–52.

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