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Coronary angiogram Monitors blockage and flow of blood through the coronary arteries. Uses X-rays to detect dye injected via cardiac catheterization. Get Email Updates. To receive email updates about this page, enter your email address: Email Address.

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CDC is not responsible for Section compliance accessibility on other federal or private website. Cancel Continue. Measures your heart rate while you walk on a treadmill. Checks the inside of your arteries for blockage by inserting a thin, flexible tube through an artery in the groin, arm, or neck to reach the heart. Monitors blockage and flow of blood through the coronary arteries.

A wealth of epidemiologic studies have evaluated associations between dietary exposures and CHD. In some cases, RCTs have not been conducted, and RCTs that have been conducted have generally not been adequately powered or have evaluated surrogate end points rather than clinical outcomes. Despite this lack of information, evidence-based recommendations derived from cohort studies have been advocated. We found strong evidence that trans —fatty acids are associated with CHD risk, but weak evidence implicating saturated and polyunsaturated fatty acids and total fat intake.

Relatively few cohort studies have shown that a higher intake of polyunsaturated fatty acids or a lower intake of saturated fatty acids is related to a reduced risk of CHD. However, these data were interpreted by some to mean that all fats are associated with increased CHD risk, and subsequent dietary guidelines advocated low-fat diets. For polyunsaturated fatty acid intake, most of the RCTs have not been adequately powered and did not find a significant reduction in CHD outcomes.

On the other hand, mechanistic studies have demonstrated that diets low in total fat are associated with increased triglyceride and lower high-density lipoprotein cholesterol levels, whereas diets enriched with unsaturated fatty acids such as olive oil have positive effects on serum lipids.

Our results support an association between foods with higher glycemic index values and CHD outcomes.

Nutrition, Metabolism & Cardiovascular Diseases

Metabolic studies have shown that higher glycemic index scores are associated with coronary risk factors, such as higher fasting triglycerides and lower high-density lipoprotein cholesterol levels. Nevertheless, the glycemic index represents 1 functional property of food that can help guide dietary choices and may effectively organize a healthy dietary pattern, if used carefully.

This functional index may be supplemented with information about glycemic load, which reflects weighted carbohydrate intake and may provide further information about food choices based on appropriate serving size. Metabolic studies have shown that these factors exert beneficial effects on surrogate measures of CHD such as levels of serum triglycerides and thrombotic factors, markers of endothelial dysfunction, and prevention of cardiac arrhythmias. A previous systematic review reported a stronger protective effect for fish intake in populations at higher risk of CHD than initially healthy populations, 41 which we also observed.

However, a meta-analysis by Bucher et al 42 suggested that an equal benefit from dietary and supplemental sources existed. The discrepant findings of cohort studies vs RCTs often draw the attention of investigators. In our analysis, differentiating between dietary and supplemental intake and implementation of the Bradford Hill guidelines helped to demonstrate that discrepant results involving the 2 designs are minimal. In particular, our findings of modest or weak evidence of a causal link between CHD and intake of polyunsaturated fatty acids and total fat and vitamin E and ascorbic acid supplements are compatible with the results from RCTs.

Similarly, the strong evidence of causation involving a Mediterranean dietary pattern is compatible with the evidence from the Lyon Diet Heart Study trial. These findings lend support to the usefulness of the Bradford Hill guidelines in gauging the evidence of causation and emphasize the importance of examining the evidence from observational studies, given some of the limitations of RCTs eg, subject compliance, disease latency, and duration of exposure. We observed strong evidence of a causal link between CHD and dietary patterns. Population-based cohort studies have demonstrated the protective effect of a quality diet against CHD and all-cause mortality, 45 - 49 and these benefits are additive with other lifestyle activities aimed at improving health.

Given the advantages of evaluating dietary patterns vs single nutrient components, we recommend that future RCTs test various dietary patterns in sufficiently large populations and determine the effects of these patterns on multiple important health outcomes, including cardiovascular disease and cancer.

Our study has a number of strengths because we undertook several measures to minimize bias, including restricting our review to studies with the strongest causal inference eg, cohort studies and RCTs , conducting an independent assessment of study eligibility by 2 of the authors, using predefined criteria to evaluate the evidence of causation, and performing stratification analyses for a number of extraneous variables.

In addition, we examined high-quality or larger studies with sufficient outcome events, evaluated the potential for heterogeneity of effects across cohort studies, and assessed publication bias. We may be criticized for creating arbitrary definitions of strong, moderate, and weak evidence, although these classifications have face validity and similar scoring systems have been used to assess the evidence of causation from observational studies.

Third, the heterogeneity of cohort studies may have influenced our results. However, our scatterplots of RR values against the difference in mean and median intake between quantile extremes showed no relationship for each dietary predictor, suggesting that differences in mean intake across studies do not explain the variation in RR values. Last, the evidence of causation may depend on the prevention strategy primary vs secondary or dietary assessment tool used in studies or may vary across populations.

However, our subanalysis showed that, in general, the summary estimates are consistent across the strata of potential effect modifiers. Our implementation of the Bradford Hill criteria identified strong evidence that a causal association exists between CHD and intake of vegetables, nuts, monounsaturated fatty acids, foods with a high glycemic index, trans —fatty acids, and overall diet quality or dietary patterns. Although investigations of dietary components may help to shed light on mechanisms behind the benefits of dietary patterns, it is unlikely that modifying the intake of a few nutrients or foods would substantially influence coronary outcomes.

Our findings support the strategy of investigating dietary patterns in cohort studies and RCTs for common and complex chronic diseases such as CHD. Correspondence: Sonia S. Author Contributions: Dr Mente had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design : Mente and Anand.

Case Report ARTICLE

Acquisition of data : Mente and de Koning. Analysis and interpretation of data : Mente, Shannon, and Anand. Drafting of the manuscript : Mente and Anand. Critical revision of the manuscript for important intellectual content : Mente, de Koning, Shannon, and Anand. Statistical analysis : Mente, Shannon, and Anand.

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Obtained funding : de Koning. Administrative, technical, and material support : Anand. Study supervision : Anand. Role of the Sponsor: No external funding was obtained for the design and conduct of the study; for the collection, management, analysis, or interpretation of the data; or for the preparation, review, or approval of the manuscript. All Rights Reserved. View Large Download. Table 1. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. Randomised trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction.

Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease.

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Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. Philadelphia, PA Lippincott-Raven;. Email an article.

Nutrition and Diet in the Causation, Prevention, and Management of Heart (R21)

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Lifestyle disease - Wikipedia

Fact checked by Carolyn Robertson. Eating more vegetables and less meat contributes to a healthy heart, new research suggests. These 5 tropical plants may 'provide anticancer benefits'. Related coverage. Latest news Eating more nuts may help prevent weight gain.

Excess weight and body fat cause cardiovascular disease

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