Hamer Mark, Steptoe Andrew
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
Br J Nutr. 2006 May;95(5):849-59. doi: 10.1079/bjn20061741.
Epidemiological evidence suggests that the diet influences CHD risk, although the protective effects of dietary intervention for patients in diseased states has gained less attention. Secondary care prevention strategies for patients often involves drug therapy that is expensive and can result in undesirable side effects. Therefore, it is potentially beneficial to utilise other strategies, such as diet, in the management of CHD. A systematic review was conducted to examine the effects of specific nutrients on progression of atherosclerosis, vascular function, haemostasis and inflammation in CHD patients. Results show substantial evidence for the efficacy of n-3 oils in reducing cardiovascular mortality and one mechanism may be related to the stabilisation of vulnerable atherosclerotic plaques, although the effects on progression of atherosclerosis, haemostatic activity and vascular inflammation remain equivocal. Promising data also exist for the efficacy of flavonoid-rich foods for improving endothelial function, although strong clinical endpoint evidence is lacking. The variation in the efficacy of certain nutrients in CHD patients may be explained by genetics, existing risk factors, psychosocial factors and methodological issues, although these are often not adequately taken into consideration. We conclude that there is a need to undertake more appropriately designed trials in specific clinical populations, controlling for additional lifestyle and risk factors, examining potential interactions with medications, and also establishing methods to increase compliance to dietary recommendations before specific nutrients can be widely prescribed for secondary prevention. Future research should also utilise techniques that provide a direct measure of atherosclerosis.
流行病学证据表明饮食会影响冠心病风险，尽管饮食干预对患病状态患者的保护作用较少受到关注。针对患者的二级预防策略通常涉及药物治疗，这种治疗费用高昂且可能导致不良副作用。因此，在冠心病管理中利用其他策略（如饮食）可能有益。进行了一项系统综述，以研究特定营养素对冠心病患者动脉粥样硬化进展、血管功能、止血和炎症的影响。结果显示有大量证据表明n-3油在降低心血管死亡率方面有效，一种机制可能与易损动脉粥样硬化斑块的稳定有关，尽管其对动脉粥样硬化进展、止血活性和血管炎症的影响仍不明确。富含类黄酮的食物在改善内皮功能方面的有效性也有有前景的数据，尽管缺乏有力的临床终点证据。冠心病患者中某些营养素疗效的差异可能由遗传因素、现有风险因素、心理社会因素和方法学问题来解释，尽管这些因素常常未得到充分考虑。我们得出结论，在特定临床人群中需要进行设计更合理的试验，控制其他生活方式和风险因素，研究与药物的潜在相互作用，并建立提高对饮食建议依从性的方法，然后才能广泛开特定营养素用于二级预防。未来的研究还应利用能直接测量动脉粥样硬化的技术。
