The role of nutrition in the prevention of arteriosclerotic cardiovascular disease

In Germany, arteriosclerotic cardiovascular disease is responsible for about 50 % of all deaths. Because of the severe morbidity and high mortality primary prevention appears mandatory. The low rates of cardiovascular disease in many countries and the striking rise of risk when the inhabitants migrate to western industrial societies demonstrate that environmental factors like nutrition and lifestyle play the predominent role over genetic determinants. As a preventive measure fat modification promises success. The extent of atherosclerosis and cardiovascular disease is related to the intake of fat and cholesterol. In particular, the amount of saturated fat in the diet correlates stronger with the incidence of cardiovascular disease than total fat intake. In contrast, the consumption of unsaturated fatty acids appears to be beneficial, since it is inversely correlated with the plasma cholesterol concentration and the risk of myocardial infarction. Yet, effects other than those on plasma lipids maybe operative. In this respect linolenic acid has attracted much attention because of a decrease of cardiovascular events apparently due to only grams of intake of this fatty acid. In variance, trans-unsaturated fatty acids resemble more saturated fatty acids in that they increase LDL-cholesterol and decrease HDL. Basically a diet rich in fruit and vegetables, but low in total fat with preference of unsaturated fatty acids instead of fatty saturated and trans fatty acids appears to be favorable.