A Historical Perspective of the Understanding of the Link Between Diet and Coronary Heart Disease

Abstract

The development of the understanding of the underlying causes of coronary heart disease has undergone several stages. Ecological studies, such as the Seven Countries' Study, showed a possible relationship between mortality in coronary heart disease and intake of saturated fats. The investigated area with the lowest rates of cardiovascular disease was the island of Crete, Greece. A discussion soon started to evolve around the Mediterranean diet, which at the time consisted mainly of foods of vegetable origin, olive oil, and cereals of unrefined nature. Several clinical trials have been undertaken since then, including the Lyon Heart Diet Study, in which it was clearly shown that both mortality and morbidity in coronary heart disease were substantially lowered by Mediterranean food compared with controls. Dean Ornish proved that an extreme regimen actually could reduce already existing sclerotic plaques, while the Women's Health Initiative study showed that a more modest diet change did not cause the intended reduction in heart disease in middle-aged women. Another prospective study of a similar age group of women showed that a diet with a low glycemic load provided a good reduction in coronary heart disease. Multiple studies of different components of food have shown no positive result, pointing at the whole diet rather than its components of nutrients as being of importance. Today, the experts agree on the optimal diet to prevent not only heart disease but also cancer forms and other chronic disease such as type 2 diabetes mellitus. This diet consists of a lot of fruit and vegetables, lots of fish, less salt and sugar, more unrefined cereals, beans, and nuts. Going from a general notion of Mediterranean food to testing that food in clinical settings and testing nutrients as preventative agents, it can be concluded that a generally healthy lifestyle, including a healthy diet, appropriate amounts of physical activity, good sleep, and less stress, is the way to a heart-healthy life.