Shaper A G
Department of Clinical Epidemiology & General Practice, Royal Free Hospital School of Medicine, London, U.K.
Eur Heart J. 1987 Aug;8 Suppl E:31-8. doi: 10.1093/eurheartj/8.suppl_e.31.
The customary diet of a population is the essential factor determining susceptibility to atherosclerosis and coronary heart disease (CHD), and it does so through its effects on lipoproteins, blood pressure and the coagulation system. The simplest and possibly strongest measure of this dietary effect is the serum total cholesterol concentration in the population. Within populations on high-risk diets [high saturated fat intakes and low ratio of polyunsaturated to saturated fatty acids (P/S ratio)], hypertension and cigarette smoking are potent secondary factors. Adipose tissue fatty acid studies support this concept of a dietary basis to CHD; low levels of linoleic acid and high P/S ratios are associated with a higher risk of CHD. Marine long-chain polyunsaturated fats may play a protective role in the CHD story. Monounsaturated fats are as effective in lowering serum total cholesterol as low fat-high carbohydrate diets. Coagulation factors of possible importance to CHD risks can be affected by dietary fat intake. Dietary fats affect blood pressure levels and may initiate hypertension. Coffee and alcohol consumption do not appear to effect the risk of CHD, although coffee may raise the blood cholesterol and alcohol raise the blood pressure. Diet is probably the central environmental factor in the development of CHD.
人群的日常饮食是决定动脉粥样硬化和冠心病（CHD）易感性的关键因素，它通过对脂蛋白、血压和凝血系统的影响来发挥作用。衡量这种饮食影响的最简单且可能最有力的指标是人群中的血清总胆固醇浓度。在高风险饮食人群中（高饱和脂肪摄入量以及低多不饱和脂肪酸与饱和脂肪酸比例（P/S比）），高血压和吸烟是重要的次要因素。脂肪组织脂肪酸研究支持冠心病饮食基础这一概念；亚油酸水平低和P/S比高与冠心病风险较高相关。海洋长链多不饱和脂肪可能在冠心病发病过程中起到保护作用。单不饱和脂肪在降低血清总胆固醇方面与低脂高碳水化合物饮食同样有效。对冠心病风险可能具有重要意义的凝血因子会受到膳食脂肪摄入的影响。膳食脂肪会影响血压水平并可能引发高血压。咖啡和酒精的摄入似乎不会影响冠心病风险，尽管咖啡可能会升高血液胆固醇，酒精会升高血压。饮食可能是冠心病发展过程中的核心环境因素。
