Complementary Alternative Cardiovascular Medicine

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76 Alternative Cardiovascular Medicine amount of dietary cholesterol. The original equations developed by Keys et al. (5) and Hegsted et al. (6), reported by both in 1965, and more recently by Mensink and Katan (7), Hegsted et al. (8), and Clarke et al. (9), demonstrated that saturated fat was hypercholesterolemic, whereas PUFA lowered blood cholesterol levels. Saturated fat was twice as potent in raising blood cholesterol levels as PUFA was in lowering them. Specifically, the blood cholesterol predictive equations demonstrated that for each 1% increase in saturated fatty acids (SFAs), blood cholesterol increased 1.5 to 2.7 mg/dL. The investigators reported that MUFA had a neutral effect and that dietary cholesterol raised the blood cholesterol level but less so than saturated fat. A summary of the effect of SFA on LDL cholesterol is shown in Fig. 1. TRANS FATTY ACIDS Trans fatty acids are unsaturated fatty acids with one or more double bonds in the trans configuration. The resulting extended fatty acid chain is similar to saturated fat. Several epidemiologic studies have reported a positive relationship between trans fatty acid intake and both incidence of CHD and risk factors for CHD, notably lipids and lipoproteins (10–12). Numerous early controlled feeding studies reported that hydrogenated fats elicited a blood cholesterol response that was intermediate to that observed for unhydrogenated oils and saturated fats (reviewed in ref. 13). More recently, studies have been conducted to evaluate the plasma lipid and lipoprotein effects of trans fatty acids. These studies have consistently shown that trans fatty acids increase plasma total and LDL cholesterol relative to unsaturated fatty acids (14–16). Trans fatty acids elicit comparable cholesterol-raising effects vs SFA. In addition, trans fatty acids do not increase high-density lipoprotein (HDL) cholesterol as does SFA (17), resulting in a lower HDL cholesterol and a worsening of the LDL:HDL ratio which, in turn, increases CHD risk (see Fig. 2) (18). DIETARY CHOLESTEROL Numerous controlled clinical studies have shown a positive linear association between dietary cholesterol and LDL cholesterol. Consequently, because of an increase in LDL cholesterol, there is an increase in CHD risk. However, the LDL cholesterol-raising effect of dietary cholesterol is less than that of SFA. An increase of 100 mg/d of dietary cholesterol is predicted to result in a 0.5 to 1 mmol/L increase in total serum cholesterol, resulting in a 1% to 2% increase in CHD risk (see Fig. 3) (1).
Chapter 6 / Oils, Fats, and CVD 77 Fig. 1. Predicted changes in LDL cholesterol in response to increase in SAF (from 2% to 33% energy). Source: Institute of Medicine of the National Academies. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC, National Academies Press, 2002. Fig. 2. Effects of exchange of trans monounsaturated fatty acids for oleic acid on lipoprotein cholesterol levels. Source: Katan MB, Zock PL, Mensink RP. Trans fatty acids and their effects on lipoproteins in humans. Annu Rev Nutr 1995;15:473–493.
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Complementary and Alternative Cardi
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CONTEMPORARY CARDIOLOGY CHRISTOPHER
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© 2004 Humana Press Inc. 999 River
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vi Preface physician or other healt
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viii Contents 10 Massage Therapy an
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x Contributors ERIN L. OLIVO, PhD
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Chapter 1 / CAM and CVD 1 1 Complem
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Chapter 1 / CAM and CVD 3 patients
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Chapter 1 / CAM and CVD 5 The crite
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Chapter 1 / CAM and CVD 7 disease c
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Chapter 1 / CAM and CVD 9 analyses,
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Chapter 16 / A Guide for Physicians
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Index 279 INDEX A N-Acetylcysteine
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Index 281 taurine studies, 106 Conj
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Index 283 Homeopathic medicine, see
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Index 285 funding of studies, 148 g
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Contemporary Cardiology COMPLEMENTA
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Complementary Alternative Cardiovascular Medicine

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