Nutrition counseling reduces risk of repeat cardiovascular events, research finds

04 Jun 2024 --- According to a recent study by a University of Michigan Health Frankel Cardiovascular Center research team, fewer than a quarter of people — one in four — who have had major heart events get dietary counseling afterward despite the significant benefits of diets.

The scientists tracked around 150,000 patients between 2015 and 2020 with reported severe heart conditions, including heart attack and heart failure. Diet is the leading contributor to premature death from heart disease in the US, the study notes.

“When patients receive this education, we have seen tremendous results. Some have cut cholesterol levels in half within weeks,” says Dr. Eric Brandt, director of preventive cardiology at the Frankel Cardiovascular Center and first author of the study.

“However, physicians are often limited by the time required to manage other aspects of a patient’s condition. Additionally, most cardiologists do not receive sufficient education to provide dietary advice themselves.” 

In other industry news, the European Society of Cardiology, in collaboration with the University of Oxford, presented staggering figures about the cost of cardiovascular diseases on European health care expenses, estimated at €282 billion (US$305 billion) from data collected and processed in 2021. The cost of general health care and long-term care alone amounts to €155 billion (US$168 billion).

Medical nutrition therapy
The study’s results were published in the Journal of the Academy of Nutrition and Dietetics. They show that clinicians documented dietary counseling in only 23% of cases within 90 days of hospitalization.  

The counseling was given as part of a supervised cardiac rehabilitation program or medical nutrition therapy, an approach involving detailed nutritional assessments and targeted interventions led by registered dietitian nutritionists.  

“Nutrition counseling may reduce the risk a person has for cardiovascular episodes and disease, yet our research shows that the vast majority of patients, who are all at risk after significant heart events, are not receiving this essential education,” says Dr. Brahmajee Nallamothu, professor of internal medicine-cardiology at University of Michigan Medical School and senior author of the study.Nutrition counseling has a significant impact on the risk of cardiovascular episodes, according to new research.

The majority of the dietary counseling took place in the cardiac rehabilitation program, which is considered underused as a maximum of only 30% of eligible patients participated. When the rehabilitation figure is removed, clinicians offer only around 5% dietary counseling. 

The current study’s researchers cite a lack of time for counseling or clinicians’ lack of expertise in this area as possible reasons for the low rate. In addition, women, adults over 65 and patients with chronic kidney disease were all less likely to receive counseling from their providers.  

Insurance coverage obstacle
The research was supported by the Blue Cross Blue Shield of Michigan Foundation and funded by the National Institutes of Health and the Blue Cross Blue Shield of Michigan Foundation. 

Participants covered by traditional Medicare were less likely to receive dietary counseling than patients with private insurance but more likely than those with Medicaid. Currently, medical nutrition therapy is only covered for Medicare patients living with diabetes and end-stage kidney disease. 

According to researchers, nearly half of US adults have poor diet quality, yet many struggle to afford healthy foods. In 2022, the American Heart Association released a statement supporting efforts to “increase equitable access to nutritious, affordable food” in health care delivery. 

Brandt notes: “Lifestyle is the cornerstone for preventing cardiovascular disease. Without providing counseling on changing behaviors to choose the foods that our patients should eat, many are left without the tools to manage nutrition. I hope to see the landscape change to one where eating healthier is more well-supported and achievable.”

Meanwhile, researchers from various academic institutions in the US, China, Denmark and the UK conducted a large long-term cohort study on the regular use of fish oil supplements on the trajectory of cardiovascular disease. The study found that regular use could increase the risk of first-time heart disease and stroke but slow the progression of existing poor cardiovascular disease.

By Inga de Jong