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Nutritional mechanisms that influence cardiovascular disease^1,2,3,4

¹ From the Institute of Cardiology, University Cardiology Division, and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy (RDC and RM), and the Laboratory for Thrombosis and Vascular Research, CNR Institute of Clinical Physiology, Pisa (RDC, AZ, and SDT), and Lecce (MM), Italy

ABSTRACT

Current evidence suggests that most significant risk factors for heart disease have been identified. Although age, sex, and genetics are important unmodifiable risk factors, most new cases of acute myocardial infarctions today can be predicted by the presence and level of 9 risk (or cardioprotective) factors that can easily be assessed and, most importantly, modified. These risk factors are the same in almost every geographic region and in every racial/ethnic group worldwide and are consistent in men and women. Eight of these 9 risk factors are influenced by diet, and most act by promoting atherogenesis, which is the most important background condition for cardiovascular disease. Dietary interventions mostly affect atherogenesis by modulating, at the cellular level, proinflammatory processes that initiate and perpetuate endothelial dysfunction, plaque formation, and, eventually, plaque rupture. For example, there is now enough evidence, both epidemiologic and clinical, of the beneficial effects of n–3 fatty acids. Either as part of a normal low-fat diet or as supplements, these fatty acids are now recommended to prevent cardiovascular disease. This review will summarize the mechanisms by which diet may influence atherogenesis through the early inception, progression, and clinical emergence of atherosclerosis, with a special focus on n–3 fatty acids.

Key Words: Atherosclerosis • diabetes • endothelial dysfunction • insulin resistance • obesity • omega-3 fatty acids • n–3 fatty acids • oleate • docosahexaenoic acid • eicosapentaenoic acid • arachidonic acid • 5-lipoxygenase polymorphisms • leukotrienes

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