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Heart disease
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Heart disease
What about fish consumption?
From Mr H. A. Tyrrell, MRPharmS
The recent continuing professional development article (PDF 75K) on
primary prevention of heart disease (PJ, 18 January, pp86–88) provided a useful overview
of the subject. However I was puzzled at the absence of comment regarding the value of including
fish in the diet. It is well established
that regular consumption of fish can significantly reduce cardiovascular disease and mortality,
probably due to the presence of omega-3 fatty acids and their effects in lowering triglycerides
and risk of thromboses and arrhythmias.
Both the British Heart Foundation and American Heart Association advocate the regular inclusion
of fish in the diet, although current United Kingdom advice from the Food Standards Agency is
to limit this to two servings per week (including one of oily fish) owing to concerns over possible
contamination of fish stock by industrial pollutants.
It would also be interesting to have the authors comments on the value or otherwise of incorporating
soy protein in the diet as a means of reducing cholesterol levels.
H. Tyrrell
Horsham, West Sussex
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HELEN WILLIAMS, Duncan McRobbie and Rhian Davies reply:
We thank your correspondent
for his interest in our article, which focused primarily on areas in which drug therapy
might be employed, alongside lifestyle change, to address cardiovascular risk. Coronary
heart disease is a multi-faceted disease and primary prevention should always start with
lifestyle adjustment, which would include a healthy diet.
The most recent summary of primary prevention strategies from the AHA advocates consumption
of a variety of fruit, vegetables, grains, low-fat or non-fat dairy products, fish, legumes,
poultry and lean meats and refers specifically to the role of unsaturated fatty acids from
fish, vegetables, legumes and nuts.1 Epidemiological studies and clinical trials have established
the role of omega-3 fatty acids in reducing the incidence of cardiovascular disease, although
the ideal intake has not yet been clearly established. As your correspondent pointed out
the current recommendations are to limit this to two servings of fatty fish per week.2 Soy protein is a rich source of omega-3 oils, and there are data to indicate that soy protein
may have a role in improving the lipid profile. Although this may support the inclusion
of soy protein within the diet, it does not match the reductions possible where statins
are appropriately employed.3
When considering the data to support the inclusion of individual foods within the diet,
advice should be tailored to the individual patient. It is well recognised that lifestyle
modification is difficult and the recommendations made must be realistic and achievable.4 |
References
1. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP et al. AHA Guidelines for
primary prevention of cardiovascular disease and stroke: 2002 update. Circulation 2002;106:388–91.
2. Kris-Etherton PM, Harris WH, Appel LJ for the Nutrition Committee. Fish consumption, fish
oil, omega-3-fatty acids and cardiovascular disease. Circulation 2002:106:2747– 57.
4. Erdman JW for the AHA Nutrition Committee. Soy protein and cardiovascular disease. Circulation
2000; 102:2555–9.
4. Kottke TE. What is the Optimal diet for heart health? BMJ USA 2001; 1:222–3. |
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