Dietary management of cardiovascular diseases

Since cholesterol was discovered in atherosclerotic plaques and was able, when given in diet, to induce the same type of lesions in animals, the aim of previous dietary changes was to reduce serum cholesterol as much as possible. For this purpose, the intake of saturated fats was decreased and replaced by linoleic acid, the main fatty acid lowering cholesterol. Nevertheless, this type of diet in primary or secondary prevention did not succeed in reducing satisfactorily cardiovascular and total mortality unless the intake of fish (DART and Hjermann trials) i.e. of n-3 fatty acids, was increased. On the other hand, the diet with the greatest life expectancy in the western world is that of Crete, largely vegetarian with a high intake of alpha-linolenic acid. Such a diet, compared to the usual prudent diet in 600 patients after a first myocardial infarction, reduced within a few months all cause mortality and cardiovascular events by more than 70%. Thus a highly palatable diet adapted from Crete seems to be much more efficient to prevent recurrences and death after a first myocardial infarction than the hypocholesterolemic diet presently advised.