February 11, 2008 - Having a heart attack is apparently not sufficient reason for most people to change to a heart-healthy diet, a new study finds.
"We found that diet quality is poor after a coronary heart disease event," said study author Yunsheng Ma, M.D., an assistant professor of medicine at the University of Massachusetts Medical School, in Worcester.
But he warned that patients' failure to eat healthier puts them at risk for another cardiac event.
"Coronary heart disease [CHD] is the number one cause of mortality in Americans," the study noted. An estimated 13 million Americans have survived a heart attack or have coronary heart disease symptoms, the researchers added.
The findings are published in the February issue of the Journal of the American Dietetic Association.
In the study, Dr. Ma's team surveyed 555 patients averaging 61 years of age, 60 percent of whom were men. All of the participants were diagnosed with coronary heart disease and had already experienced a heart attack, angina or arrhythmia. The researchers queried the patients on their diets one year after they had undergone coronary angiography linked to some kind of coronary event.
According to the researchers, only 12.4 percent of the patients met the recommended consumption of vegetables. Similarly, only about 8 percent met daily fruit intake recommendations and just 8 percent were getting a heart-healthy amount of cereal fiber. Little more than 5 percent were limiting their intake of dangerous trans fats to recommended levels, the team said.
Compounding this, the researchers found that worst diets were associated with smoking and obesity. Poor diets were also closely correlated with lower levels of education.
Research has confirmed that fruit and vegetable consumption is associated with a lowered risk of heart disease, the researchers noted. The American Heart Association currently recommends "an overall healthy diet" that is rich in fruits and vegetables, high-fiber foods and limited amounts of saturated fat and trans fats, with an eye to maintaining a healthy weight.
The study concluded that "it may be helpful for physicians and health-care providers to refer CHD patients to behavioral interventions that include both diet and physical activity components, such as cardiac rehabilitation." Rehab by itself might not be enough, the study adds, urging consultation with registered dieticians to learn about how to make the necessary changes in diet.
Dr. Ma said that currently about 80 percent of patients do not go to rehabilitation after a coronary heart disease event such as angina, arrhythmia or heart attack. But even if patients do enter rehabilitation, many of these programs do not include dietary modifications, he added.
Alice Lichtenstein, M.D., Tufts University, helped craft the American Heart Association's dietary recommendations. She questioned whether the new study produced truly conclusive results, noting that the study subjects may have under-reported their consumption of unhealthy foods. That's because the participants' mean calorie intake was a relatively healthy 1,775 calories but their average body-mass index was 30, which is in the obese range, Dr. Lichtenstein noted.
She said that instead of trying to calculate the exact amount of fat or saturated fat in their diet, it may be easier for people to simply concentrate in the types of healthy foods they should be eating -- items such as fruits, vegetables, grains, beans and fish. Americans have a wide range of such foods to choose from, so "it is easier now to consume a diet consistent with a heart-healthy pattern than it's ever been before," Dr. Lichtenstein said.
SOURCES: Alice Lichtenstein, D.Sc., Gershoff Professor, Friedman School of Nutrition, Tufts University, Boston; Yunsheng Ma, M.D., Ph.D., assistant professor, medicine, University of Massachusetts Medical School, Worcester, Mass.; February 2008 Journal of the American Dietetic Assocation
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