Diet, atherosclerosis and atherothrombotic events.
Epidemiologic studies and clinical trials have shown that diet and, in particular, the consumption of fats, influence the body's metabolism and can affect the development of atherosclerosis and resulting cardiovascular repercussions. A Western-type diet (high in saturated fats, simple sugars and salt, and low in fish, vegetables and fiber) has been associated with proinflammatory, pro-oxidative and prothrombotic tendencies and consequently higher cardiovascular risk. By contrast, a Mediterranean-type diet (with less meat and more fish, fiber, fruit, vegetables, olive oil and wine) appears to explain the lower tendency for cardiovascular disease (and cancer) in those who consume it. Between these two are population groups who prefer diets rich in polyunsaturated fatty acids. The lack of randomized and rigorously controlled population and clinical trials relating types of diet to primary or secondary cardiovascular events may explain some of the disagreements surrounding this subject. It would also explain the lack of results that shed light on diet-dependent mechanisms that may affect the development of atherosclerosis. In general, it is accepted that the morphologic and functional characteristics of vascular endothelium are influenced by the components absorbed from the diet. Prolonged exposure to certain harmful components in the diet may increase the risk of endothelial dysfunction, as shown by a decrease in antithrombotic, antioxidative, antiinflammatory and peripheral vasodilatory modulators, which represents the first step towards the onset of atherosclerosis. Among the main mechanisms involved in endothelial dysfunction are the proinflammatory and prooxidative effects of excess cholesterol, in contrast with the apparent benefit of monounsaturated fatty acids and the less consistent results obtained with polyunsaturated fatty acids.
Martins e Silva
J
J
Unidade de Biopatologia Vascular do Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal. jsilva@fm.ul.pt
Saldanha
Carlota
C
D050197:Atherosclerosis / Q000209:etiology* / Q000517:prevention & control*; D004032:Diet / Q000009:adverse effects*; D006801:Humans; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*