Strategies and difficulties in dietary intervention in myocardial infarction patients

Randomized controlled trials along with 'within group' studies of patients with symptomatic coronary artery disease suggest that dietary and other lifestyle changes can halt progression of coronary atherosclerosis, induce regression of pre-existing severe lesions, and reduce the severity or frequency of angina. Varying combinations have been tested, including restriction of dietary total, saturated and polyunsaturated fat using lean meat or vegetarian diets, fish oil supplements, smoking cessation, stress management, and exercise training. The relative importance of each of these remains unclear. In patients with recent myocardial infarction high fish diets appeared effective in reducing both ischaemic heart deaths and total death rates over two years, whereas modest changes in dietary saturated fats or fibre had no influence on outcome. These results suggest that a far more active dietary approach is needed for patients with symptomatic coronary disease. Further research is required into the possible complementary role of dietary measures and drug treatment for reversing the disease process and improving outcome, using new techniques for achieving behavioural change.