Practice Update - ESC Congress 2017

these foods ranging from 400 to 800 g per day, but this is unaffordable for many people in low- to middle-income coun- tries," Dr. Mente said. Dr. Mente and colleagues assessed asso- ciations between fruit, vegetable, and legume consumption at baseline and risk of cardiovascular disease and mortality after a median of 7.4 years of follow-up. Looking at the total of 5796 deaths, 1649 cardiovascular deaths, and 4784 major cardiovascular events, and adjusting for demographic, lifestyle, health, and die- tary factors, the study showed greater fruit, vegetable, and legume intake was associated with lower total and noncar- diovascular mortality. Of particular importance, an intake of 3 to 4 servings per day (equivalent to 375– 500 g per day) was just as beneficial on total mortality as higher amounts (haz- ard ratio 0.78; 95% confidence interval 0.69–0.88). Looking at dietary components sepa- rately, benefits were attributable to fruit and legumes, with vegetable intake not significantly associated with improved outcomes. Specifically, compared with fewer than three servings of fruit per week, more than three daily was associated with an 18% reduced risk in noncardiovascular mortality (hazard ratio 0.82: 95% confidence interval 0.70–0.97; P = .0008), and 19% reduction in total mortality (hazard ratio 0.81; 95% confidence interval 0.72–0.93; P < .0001). Regarding legumes, higher consumption was associated with significant reduction in both noncardiovascular mortality and total mortality risk. Finally, comparing vegetable preparation, the study showed a trend toward lower risk of cardiovascular disease and death with raw vs cooked vegetable intake “but raw vegetables are rarely eaten in South Asia, Africa, and Southeast Asia,” said Dr. Mente. "Since dietary guidelines do not differentiate between the benefits of raw vs cooked vegetables, our results indicated that recommendations should emphasize raw over cooked vegetables.” Dr. Mente concluded that the findings “were robust, globally applicable, and pro- vided evidence to inform nutrition policies. Many people worldwide don’t consume an optimal amount of fruit, vegetables, and legumes. The PURE data added to substantial evidence from many studies and extended them globally."

" In fact, individuals with high carbohydrate intake, above 60% of energy, may benefit from a reduction in carbohydrate intake and an increase in the consumption of fats.

Mahshid Dehghan, PhD

cardiovascular events. Instead, ApoB/ ApoA1 provides the best overall indication of effect of saturated fat on cardiovascular risk. “Focusing on a single lipid marker such as LDL cholesterol alone does not capture the net clinical impact of nutrients on car- diovascular risk,” Dr. Dehghan said. “For decades, dietary guidelines have focused on reducing total fat and sat- urated fatty acid intake based on the presumption that replacing saturated fatty acids with carbohydrate and unsaturated fats will lower LDL cholesterol and should therefore reduce cardiovascular events," she added. She noted that much of the evidence supporting this approach has been from studies of Western populations character- ized by nutritional excess.

Dr. Dehghan concluded, “PURE provided a unique opportunity to study the impact of diet on total mortality and cardiovas- cular disease in diverse settings, some in which overnutrition is common and others where undernutrition is of greater concern.” Results of PURE also showed that even relatively moderate intake of fruit, vege- tables, and legumes, such as beans and lentils, may lower risk of cardiovascular disease and death. “To our knowledge, this was the first study to report on the associations of fruit, vegetable, and legume intake with cardiovascular disease risk in countries at varying economic levels and from different regions. Previous research, and many dietary guidelines in North America and Europe, recommended daily intake of

PracticeUpdate Editorial Team

ESC Congress 2017 • PRACTICEUPDATE CONFERENCE SERIES 13