[Diet and secondary prevention of coronary heart disease--are our recommendations good enough?].
BACKGROUND
Dietary treatment plays an important role in prevention of coronary heart disease. In Norway as in other European countries, patients with established coronary heart disease are advised to follow a cholesterol-lowering diet. However, epidemiological observations have suggested that Mediterranean and other diets may have cardioprotective characteristics beyond their effects on serum total and LDL cholesterol levels.


METHODS
We describe the results of randomised, controlled clinical trials that have investigated the effect of diet on secondary prevention of coronary heart disease.


RESULTS
Diets characterised by high contents of oleic acid (18: 1n-9), alpha-linolenic acid (18: 3n-3) and fish or fish oil and near-vegetarian diets have reduced cardiovascular morbidity and mortality in patients with coronary heart disease.


CONCLUSIONS
Several characteristics of the Mediterranean diet seem to have additional anti-atherothrombogenic effects beyond those observed with the usually recommended cholesterol-lowering diet. We ask whether Norwegian dietary recommendations for secondary prevention, should emphasise more strongly the type of fat used and fruit and vegetable intake, in line with the principles of the Mediterranean diet. Such dietary advice should be incorporated into the medical treatment given to all patients with coronary heart disease, regardless of their lipid profile.
Johnson
L K
LK
Hjerterehabiliteringen Medisinsk avdeling Sentralsykehuset i Vestfold 3116 Tønsberg. lkjohn@frisurf.no
Hjermann
I
I
Tonstad
S
S
D003327:Coronary Disease / Q000178:diet therapy / Q000401:mortality / Q000517:prevention & control*; D004036:Diet, Atherogenic; D018752:Diet, Fat-Restricted; D004041:Dietary Fats / Q000008:administration & dosage; D004045:Dietary Services; D005247:Feeding Behavior; D005395:Fish Oils / Q000008:administration & dosage; D006801:Humans; D008055:Lipids / Q000097:blood; D009829:Oleic Acids / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D014675:Vegetables; D017962:alpha-Linolenic Acid / Q000008:administration & dosage
D004041:Dietary Fats; D005395:Fish Oils; D008055:Lipids; D009829:Oleic Acids; D017962:alpha-Linolenic Acid