Tuesday, April 23, 2013
12:45 PM–1:45 PM
Chairs
Presentations
David J.A. Jenkins, MD, PhD, DSc
Canada Research Chair in Nutrition and Metabolism, Department of Nutritional Sciences, University of Toronto, ON
Statins have made planning diet cardiovascular risk reduction studies difficult and have almost elimated interest in other competing cholesterol lowering drugs such as ezetamibe and high dose nicotinic acid. Meta analyses of randomized controlled statin trials suggest that statins in general reduce CHD risk by 20-30%. On the other hand it has been estimated from cohort studies that as much as 84% of CHD risk could be influenced by diet and lifestyle, suggesting that there may still be a very significant role for diet and lifestyle. In this respect diet and lifestyle have proved very effective in diabetes prevention and the DASH diet has been popular for the dietary management of hypertension. Furthermore nuts, soy protein foods, legumes in general, viscous fiber oats, barley and phyllsium cereals, and plant sterols all lower serum cholesterol. Although cohort studies have indicated benefits for CHD risk reduction for these foods and food components, no RCTs have demonstrated a protective effect for CHD. In the age of evidence based medicine the lack of RCT data with disease endpoints has reduced enthusiasm for use of diet as opposed to drugs. To address this situation, it is suggested that imaging techniques (ultrasound and MRI) should be considered to allow smaller participant numbers and early detection of the development of preclinical disease without relying on mortality. These techniques may enhance considerability the acceptance of dietary approaches in prevention and treatment of chronic disease including CHD and common diet related cancers.