Controlling coronary risk through nutrition

The epidemic of coronary artery disease (CAD), the main cause of deaths in 'western' countries, could have been avoided through appropriate lifestyles of eating and activities. The dramatic decline in CAD in some countries is more difficult to attribute to changes that is the rapid rise in eastern European countries (high dietary saturated fat plus smoking). While CAD rates in Asian/Pacific countries are relatively low, subgroups, mainly through affluence, show high rates. Inappropriate eating patterns are superimposed on genetic factors (commonly diabetes in Asia) and on other lifestyle factors (smoking). Eventually the combination of dyslipidemia ('high triglyceride-low high density lipoprotein' in Asia Pacific rim), plus smoking plus hypertension (part salt related) may trigger a CAD epidemic. The challenge is better public health management including balancing the nature of the food supply with the nutritional needs for preventing CAD through national food and nutrition policies. Critical are the sources of fats (often key economic commodities), the amount of salt, preventing obesity especially of the central type, and provision of plant foods with a better understood mix of fatty acids, antioxidants and specific starches and nonstarch polysaccharides. The anti-atherogenic effects of specific antioxidants and of n-3 fatty acids in fish probably explain the lower than expected CAD rates in several countries. Although many of the risk factors are common, important regional differences demand national strategies, while providing wider perspectives on the multifactorial nature of the disease and the value of certain traditional diets.