Nutrition should be main focus in premature CVD prevention, says expert

03 Sep 2019 --- Premature heart disease risk is linked to lifestyle, such as diet, and not genetic predisposition, according to research presented at the European Society of Cardiology (ESC) Congress 2019. Lifestyle factors such as physical inactivity, smoking, high blood pressure, diabetes and high cholesterol were highlighted by the researchers. The findings show that healthy behaviors should be a top priority for reducing heart disease even in those with a family history of early-onset CVD.

“Genetics are an important contributor to premature heart disease but should not be used as an excuse to say it is inevitable,” notes study author Dr. João A. Sousa of Funchal Hospital, Portugal. “In our clinical practice, we often hear young patients with premature heart disease ‘seek shelter’ and explanations in their genetics/family history. However, when we look at the data in our study, these young patients were often smokers, physically inactive, with high cholesterol levels and high blood pressure – all of which can be amended.”

When it comes to prevention, nutrition should be a main focus, Dr. Sousa tells NutritionInsight. This is because it has a direct impact on blood pressure, cholesterol levels, diabetes and weight. “It has been proven in the past that a diet rich in vegetables (rich in potassium and calcium) and poor in sodium – such as the DASH diet – may offer a lot of benefits. Salt intake is a transversal problem to cardiovascular disease as a whole. But the problem goes way beyond the salt, as we are watching an increase in the intake of saturated fatty acids and low fruit, vegetables and fiber intake,” he adds.

People with a family history of premature heart disease should adopt healthy lifestyles, the new study says.The link between lifestyle and heart disease has been well documented in previous research. In January, a collaborative German-American study found that nearly half of premature CVD deaths in Europe could be prevented by better nutrition. The researchers evaluated data provided by the Global Burden of Disease Study (GBD) which were collected between 1990 and 2016. They analyzed the prevalence of cardiovascular diseases, such as heart attacks and strokes, in the 51 countries that the World Health Organization (WHO) has designated as the “European region.”

Healthier lifestyles can prevent CAD
The new research involved 1,075 patients under the age of 50, of whom roughly half had coronary artery disease (CAD). Specific conditions included stable angina, heart attack and unstable angina. The average age was 45 and 87 percent were men. Risk factor levels and genetics in patients were compared to a control group of 520 healthy volunteers (average age 44 and 86 percent of whom were men). Patients and controls were recruited from the Genes in Madeira and Coronary Disease (GENEMACOR) database.

The researchers assessed five modifiable risk factors: physical inactivity, smoking, high blood pressure, diabetes and high cholesterol. Nearly three-quarters (73 percent) of patients had at least three of these risk factors compared to 31 percent of controls. In both groups, the likelihood of developing CAD increased exponentially with each additional risk factor. The probability of CAD was three, seven and 24 times higher with one, two and three or more risk factors, respectively.

All participants underwent genome sequencing. These data were used to develop a genetic risk score containing 33 variants thought to contribute to CAD or risk factors such as high blood pressure. The average score was higher in patients than controls. The score was also an independent predictor for premature CAD. However, the contribution of genetics to risk of CAD declined as the number of modifiable factors rose.

Dr. Sousa also notes that the findings demonstrate that genetics contribute to CAD. However, in patients with two or more modifiable cardiovascular risk factors, genetics play a less decisive role in the development of CAD.

“Our study provides strong evidence that people with a family history of premature heart disease should adopt healthy lifestyles, since their poor behaviors may be a greater contributor to heart disease than their genetics. That means to quit smoking, exercise regularly, eat a healthy diet, and get blood pressure and cholesterol levels checked,” he notes.

“Our unit has been studying for years the interaction between genes and cardiovascular disease. Going forward, our focus remains to raise awareness of the role of genes in cardiovascular disease. In the future, we may see genome sequencing applied to patients on a daily routine and have a higher impact on our daily clinical practice than the one we are watching today. I think we just now started scratching the surface regarding this very sensitive topic and further research will be needed to clarify the clinical impact genome sequencing may have,” Dr. Sousa concludes.

By Kristiana Lalou

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