Accepted Manuscript

Dietary Prevention of Cardiovascular Diseases

John L. Sievenpiper, Carl J. Lavie

PII: S0033-0620(18)30085-9DOI: doi:10.1016/j.pcad.2018.05.001Reference: YPCAD 889

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Please cite this article as: John L. Sievenpiper, Carl J. Lavie , Dietary Prevention ofCardiovascular Diseases. The address for the corresponding author was captured asaffiliation for all authors. Please check if appropriate. Ypcad(2018), doi:10.1016/j.pcad.2018.05.001

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Dietary Prevention of Cardiovascular Diseases

John L. Sievenpiper, M.D., Ph.D.1

Carl J. Lavie, M.D.2

Department of Nutritional Sciences

Faculty of Medicine University of Toronto and the Division of Endocrinology and Metabolism

St. Michael's Hospital

Toronto, Ontario, Canada1

Department of Cardiovascular Diseases

John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of

Queensland School of Medicine

New Orleans, Louisiana2

Address correspondence to:

Dr. John L Sievenpiper MD, PhD, FRCPC

St. Michael's Hospital

6138-61 Queen Street East, Toronto,

ON, M5C 2T2, CANADA,

Tel: 416 867 3732, Fax: 416 867 7495

E-mail: john.sievenpiper@utoronto.ca

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Cardiovascular diseases (CVD) continues to be the leading cause of morbidity and mortality in

Canada, the United States and most of the Westernized World. In addition, the costs of

medications and medical procedures for the prevention and treatment of CVD continue to

increase at rapid pace, placing a major burden on the healthcare system and on society.

Therefore, simple, inexpensive treatments with vigorous non-pharmacologic therapy are

needed to promote better prevention and treatment of CVD. Certainly, articles in this journal,

Progress in Cardiovascular Diseases (PCVD), have emphasized non-pharmacologic strategies in

recent years, including dietary therapy (1-3), and particularly, physical activity and exercise

training to increase levels of cardiorespiratory fitness (4-15), with potential to produce very

marked reductions in CVD events and to reduce CVD- and all-cause mortality.

In this Issue of PCVD, dietary therapies for potential prevention of CVD and improvements in

the prognosis of CVD, including CVD death, are emphasized. World renowned experts in this

Issue discuss many aspects of dietary therapy, including the potential deleterious effects of

fructose to induce inflammation and increase levels of cortisol, potentially leading to dangerous

increases in visceral adiposity and cardiometabolic diseases. This topic certainly continues to

be an area of considerable debate and controversy with some investigators having questioned

the strength of much of the dietary evidence, including on sugars (16-18). Dr. Archer continues

his arguments about the weaknesses of the general dietary evidence that has been published

for decades, particularly the evidence regarding the potential toxicity of dietary sugars,

including fructose.

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Other manuscripts discuss the potential benefits of various dietary factors, including thiamine,

vegetables, nuts, and coffee, as well as the potential benefits of the Portfolio, DASH,

Vegetarian, and Mediterranean diets. There is some controversy on the effects of alcohol and

omega-3 polyunsaturated fatty acids, or fish oils, in the diet, which are reviewed. Regarding the

latter, some recent meta-analyses had not demonstrated the benefits of omega-3

polyunsaturated fatty acids, (19) while others have touted the benefits (20-22). The pros and

cons of omega-3 polyunsaturated fatty acids related to this debate, as well as the pros and cons

of alcohol consumption and dose response for alcohol’s benefits and toxicity, are discussed in

this Issue.

Most of the PCVD Issues deal with complicated issues regarding the diagnosis and treatment of

patients with, or at risk for, CVD. We hope that our readers will find this issue on the very

common and practical issues related to dietary therapy useful to provide guidance for their

own dietary choices and particularly for their dietary guidance to their patients. As with all of

our Issues, our goal is prevention and treatment of CVD across the globe.

Competing interests

JL Sievenpiper has received research support from the Canadian Institutes of Health Research

(CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC), Canadian

Nutrition Society (CNS), American Society for Nutrition (ASN), Calorie Control Council, INC

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International Nut and Dried Fruit Council Foundation, National Dried Fruit Trade Association,

The Tate and Lyle Nutritional Research Fund at the University of Toronto, and The Glycemic

Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund

established by the Alberta Pulse Growers). He has received in-kind research support from the

Almond Board of California, California Walnut Commission, American Peanut Council, Barilla,

Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Kellogg Canada, and WhiteWave

Foods. He has received travel support, speaker fees and/or honoraria from Diabetes Canada,

Canadian Nutrition Society (CNS), Mott’s LLP, Dairy Farmers of Canada, Sprim Brasil,

WhiteWave Foods, Rippe Lifestyle, mdBriefcase, Alberta Milk, FoodMinds LLC, Memac Ogilvy &

Mather LLC, PepsiCo, The Ginger Network LLC, International Sweeteners Association, Nestlé

Nutrition Institute, Pulse Canada, Canadian Society for Endocrinology and Metabolism (CSEM),

Barilla Centre for Food and Nutrition (BCFN) Foundation, and GI Foundation. He has ad hoc

consulting arrangements with Winston & Strawn LLP, Perkins Coie LLP, and Tate & Lyle. He is a

member of the European Fruit Juice Association Scientific Expert Panel. He is on the Clinical

Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study

of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Canadian Obesity Network. He

serves as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and

the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI)

North America. He is a member of the International Carbohydrate Quality Consortium (ICQC),

Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and

Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an

employee of Unilever Canada. C J Lavie has no disclosures on this topic.

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References

1) O’Keefe EL, DiNicolantonio JJ, Patil H, Helzberg JH, Lavie CJ. Lifestyle choices fuel

epidemics of diabetes and cardiovascular disease among Asian Indians. Prog Cardiovasc

Dis 2016;58:505-513.

2) DiNicolantonio JJ, Lucan SC, O’Keefe JH. The evidence for saturated fat and for sugar

related to coronary heart disease. Prog Cardiovasc Dis 2016;58 :464-472.

3) DiNicolantonio JJ, O’Keefe JH. Hypertension due to toxic white crystals in the diet:

should we blame salt or sugar? Prog Cardiovasc Dis 2016;59:219-225.

4) Arena R, Lavie CJ, Borghi-Silva A, et al. Exercise training in group 2 pulmonary

hypertension: which intensity and what modality. Prog Cardiovasc Dis 2016;59:87-94.

5) Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases

and prognosis – the obesity paradox updated. Prog Cardiovasc Dis 2016;58:537-547.

6) Lavie CJ, Sharma A, Alpert MA, et al. Update on obesity and obesity paradox in heart

failure. Prog Cardiovasc Dis 2016;58:393-400.

7) Wisloff U, Lavie CJ. Taking physical activity, exercise, and fitness to a higher level. Prog

Cardiovasc Dis 2017;60:1-2.

8) Katzmarzyk PT, Lee IM, Martin CK, Blair SN. Epidemiology of physical activity and

exercise training in the United States. Prog Cardiovasc Dis 2017;60:3-10.

9) Harber MP, Kaminsky LA, Arena R, et al. Impact of cardiorespiratory fitness on all-

cause and disease-specific mortality: advances since 2009. Prog Cardiovasc Dis

2017;60:11-20.

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10) Lee DC, Brellenthin AG, Thompson PD, Sui X, Lee IM, Lavie CJ. Running as a key lifestyle

medicine for longevity. Prog Cardiovasc Dis 2017;60:45-55.

11) Karlsen T, Aamot IL, Haykowsky M, Rognmo Ø. High intensity interval training for

maximizing health outcomes. Prog Cardiovasc Dis 2017;60:67-77.

12) Zisko N, Skjerve KN, Tari AR, et al. Personal Activity Intelligence (PAI), sedentary

behavior and cardiovascular risk factor clustering – the HUNT Study. Prog Cardiovasc

Dis 2017;60:89-95.

13) Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The Interaction of

cardiorespiratory fitness with obesity and the obesity paradox in cardiovascular disease.

Prog Cardiovasc Dis 2017;60:30-44.

14) Kachur S, Chongthammakun V, Lavie CJ, et al. Impact of cardiac rehabilitation and

exercise training programs in coronary heart disease. Prog Cardiovasc Dis 2017;60:103-

114.

15) Kondamudi N, Haykowsky M, Forman DE, Berry JD, Pandey A. Exercise training for

prevention and treatment of heart failure. Prog Cardiovasc Dis 2017;60:115-120.

16) Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines

Advisory Committee. Washington, DC: U.S. Department of Health and Human Services

and U.S. Department of Agriculture; 2015.

17) Archer E, Pavela G, Lavie CJ. The Inadmissibility of ‘What We Eat In America’ (WWEIA)

and NHANES Dietary Data in Nutrition and Obesity Research and the Scientific

Formulation of National Dietary Guidelines. Mayo Clin Proc 2015;90:911-926.

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18) Archer E, Pavela G, Lavie CJ. A discussion of the refutation of memory-based dietary

assessment methods (M-BMs): the rhetorical defense of pseudoscientific and

inadmissible evidence. Mayo Clin Proc 2015;90: 1736-1739.

19) Aung T, Halsey J, Kromhout D, et al; for Omega-3 Treatment Trialists’ Collaboration.

Associations of omega-3 fatty acid supplement use with cardiovascular disease risks:

meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol 2018;3:225-234.

20) Alexander D, Miller P, Van Elswyk M, Kuratko C, Bylsma L. A meta-analysis of

randomized trials and prospective cohort studies of eicosapentaenoic and

ocosahexaenoic long chain omega-3 fatty acids and coronary heart disease risk. Mayo

Clin Proc 2017;92:15-29.

21) O’Keefe JH, Jacob D, Lavie CJ. Omega-3 fatty acid therapy: the tide turns for a fish

story. Mayo Clin Proc 2017;92:1-3.

22) Maki KC, Palacios OM, Bell M, Toth PP. Use of supplemental long-chain omega-3 fatty

acids and risk for cardiac death: an updated meta-analysis and review of research gaps.

J Clin Lipidol 2017;11:1152-1160.

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