January 31, 2008
Heart Disease Patients Do Not Improve Their Diets

Looking death in the face is not a big enough motivator to get people to adopt good diets.

WORCESTER, Mass.—More than 13 million Americans have survived a heart attack or have been diagnosed with coronary heart disease (CHD), the number one cause of death in the United States. In addition to medications, lifestyle changes, such as a healthy diet and exercise, are known to reduce the risk for subsequent cardiac events. Despite this evidence, a high proportion of heart attack survivors do not follow their doctor’s advice to adhere to a healthy diet, according to researchers at the University of Massachusetts Medical School (UMMS).

Humanity evolved in calorie-limited conditions and hence we crave sugar and fat. The threat of death is not strong enough to overcome deeply wired instincts.

Not enough fruits, vegetables, fiber. Not as good as several prominent weight loss diets.

Of a maximum 80 points—which indicates the healthiest diet—the average AHEI score was 30.8, with individual scores ranging between 5.1 and 69.8. The mean AHEI score was poorer than scores reported for samples of healthy individuals from the Health Professional’s Follow-up Study and the Nurses’ Health Study. In a previous study by Ma and colleagues, the AHEI of several popular weight loss plans was calculated; the highest scoring diet was the Ornish Diet (AHEI = 64.6) and lowest scoring diet was the Atkins diet (AHEI= 42.3). The fact that one year after a coronary event patients with known CHD still have lower AHEI scores than these popular diets may be indicative of the complex issues of effecting and sustaining behavioral change and the confusion patients may face in navigating through dietary recommendations. When examining AHEI components, only 12.4 percent of the participants met the optimal daily consumption of vegetables and 7.8 percent for fruit. Only 8 percent of the patients met the cereal fiber recommendation, and 5.2 percent of the participants limited their trans-fat intake to 0.5 percent of total calories or less. In addition, nearly 11 percent of calories were from saturated fat (less than 7 percent is recommended), while total fiber was only 16.8 grams per day (25 grams or more per day is recommended).

Well, diet research is all very interesting and I like to read and write about it. But we really need either gene therapy that will fix our damaged hearts or gene therapy that will reprogram our taste buds.

Update: The AHEI referred to above is the Alternative Healthy Eating Index developed at Harvard as a more accurate measure of diets that lower heart disease risks.

Using data from 38,615 men in the Health Professionals Follow-up Study and 67,271 women in the Nurses' Health Study, Willett; Marjorie McCullough of the American Cancer Society; and HSPH and HMS colleagues tested whether two alternative measures of diet quality worked better to predict disease risk. The Alternative Healthy Eating Index (AHEI) weighs quality of food choices (for example, ratio of white to red meat), while the Recommended Food Score (RFS) tallies healthy foods eaten. They examined the relationship between these measures and the incidence of cardiovascular disease, cancer, and non-traumatic death over 12 years in women and eight years in men.

The researchers found that men in the highest, healthiest quintile of AHEI scores had a 20 percent lower risk for these events compared with men in the lowest quintile. For women, risk was reduced 11 percent. The RFS was associated with a small reduction of risk in men but not in women. These risk reductions primarily reflected the association of dietary scores with cardiovascular disease; neither score predicted cancer risk.

You can read more about AHEI. It has nothing surprising. Eat less refined foods, more vegetables, white meat over red meat, and other advice that is already fairly widely disseminated.

Share |      Randall Parker, 2008 January 31 09:12 PM  Aging Cardiovascular Studies

averros said at February 1, 2008 11:40 AM:

I'm not sure what use that OHEI score is - the Ornish diet is very high on carbohydrates, which means that it can trigger type-2 diabetes.

The problem with most dietary "science" is that it is emphatically NOT science. Different practitioners come with radically different approaches, and do not do any validation in a statistically meaningful way. No wonder the patients ignore their advice - they have seen dozens of fads, and none of these faddish diets actually did anything to help them to maintain lower weight.

So far the only useful dietary advice I've seen is to stop eating heavily processed prepackaged junk.

matthew said at February 1, 2008 2:14 PM:

No its just the opposite for the majority of survivors. They believe their survival is miraculous so why would diet really matter? Ever day is a gift for them even though there is no god.

Rob said at February 2, 2008 9:08 AM:

Randall, there someone wrote a book on the area. It's called change or die, and it discusses why people can or can't change.

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