[Nutrition in prevention of coronary heart disease]

Clinical as well as basic research in the field of atherogenesis indicates that the progression of this disease process can be slowed down or even reversed. It is well established that nutrition plays an important role in the prevention and treatment of the classical atherogenic risk factors such as obesity, diabetes mellitus and hyperlipidemia. In addition, some nutrients such as the polyunsaturated n-3-fatty-acids or antioxidative vitamins can intervene directly by influencing one or more steps of the atherogenetic and/or thrombogenetic process. A comprehensive understanding of the pathogenesis of this disease as well as of the mechanisms of nutrient action are essential to the planning of successful nutritional prevention strategies. Because most nutrients influence mainly the slow and long-standing development of the atherosclerotic lesion, their inclusion in primary nutritional prevention should be started at an early age. Few nutrients such as the n-3 fatty acids, which also reduce the thrombogenetic risk factors, have demonstrated some success in the secondary prevention of CHD. Given the complexity with which nutrients intervene in the atherosclerotic process and their interactions with each other, nutritional prevention strategies should be based on well-grounded dietary modifications rather than supplementation with individual nutrients.