2016 European guidelines for cardiovascular disease prevention in clinical practice: the new guidelines represent an evidence-based consensus of the 6th European Joint Task Force involving European Society of Cardiology and nine other societies. The guidelines for cardiovascular disease prevention are not only related to physical activity and smoking habits but also to healthy diet. Dietary habits clearly influence the risk of CVD and other chronic diseases.
In the guidelines it is clearly mentioned that “for prevention of CVD, the types of fatty acids consumed are more important than the total fat content”. The risk of coronary artery disease is reduced by 2–3% when 1% of energy intake from saturated fatty acids is replaced by polyunsaturated fatty acids. Saturated fatty acid intake should be reduced to a maximum of 10% of energy intake by replacing it with polyunsaturated fatty acids. Polyunsaturated fatty acids lower LDL cholesterol levels when they replace saturated fatty acids.
The trans fatty acids have been shown to be harmful due to their unfavourable impact on both total cholesterol (increase) and HDL-cholesterol (decrease). Studies have shown that on average, a 2% increase in energy intake from trans fatty acids increases coronary artery disease risk by 23%. It is recommended to derive <1% of total energy intake from trans fatty acids, the less the better.
The impact of dietary cholesterol on serum cholesterol levels is weak compared with that of the fatty acid composition of the diet. However when guidelines are followed to lower saturated fat intake, this usually also leads to a reduction in dietary cholesterol intake. It is recommended to limit the cholesterol intake to <300 mg/day.
Plant-based eating patterns tend to be low in total fat and saturated fat, include a good level of unsaturated fats leading to better overall fat quality, and are high in fibre – all in line with global dietary recommendations. Eating smaller amounts of animal-derived foods, which are the main sources of saturated fat in many of the Western diets, and replacing these with legumes, nuts, oils and seeds can improve the quality of the diet and help achieve current dietary recommendations.
These new guidelines are in line with recent findings of a meta-analysis (Lou D et al) comprising more than 12000 patients, investigating the association between soy consumption and the risk of stroke or coronary heart disease (CHD). A significantly inverse association between soy intake and the risk of stroke (46% lower risk) and coronary heart disease (34% lower risk) was observed in case-control studies. Soy foods are typically low in saturated fat and contain unsaturated fatty acids and rich in soy protein, all in line with the dietary recommendations.
Piepoli MF, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016;23:NP1-NP96.
Lou D, et al . Soy Consumption with Risk of Coronary Heart Disease and Stroke: A Meta-Analysis of Observational Studies. Neuroepidemiology 2016;46:242-52.