Arja Erkkilä

Kuopio University Publications D. Medical Sciences 233. 2001. 83 p. ISBN 951-781-813-0, ISSN 1235-0303.

ABSTRACT

Diet therapy forms a fundamental part of serum cholesterol lowering regimens in general, but especially in patients with coronary heart disease (CHD). However, little is known about dietary compliance in patients with CHD receiving usual care. This study examined diet, the role of diet and polymorphism of the apolipoprotein (apo) E gene in modifying serum lipid levels, and autoantibodies against oxidized low density lipoprotein (oxLDL) and cardiolipin in CHD patients.

The cross-sectional study was performed as a part of the Finnish contribution to the EUROASPIRE study (European Action on Secondary Prevention by Intervention to Reduce Events). Altogether 109 patients with coronary artery bypass graft (CABG), 106 patients with percutaneous transluminal coronary angioplasty (PTCA), 101 patients with acute myocardial infarction (AMI) and 99 patients with acute myocardial ischemia (AMIS) participated in the study.

A four-day food record, a short dietary questionnaire and the fatty acid profile of serum cholesteryl esters (CE), triglycerides (TG) and phospholipids (PL) were monitored to evaluate the diet. Autoantibodies against oxLDL and cardiolipin were analyzed by enzyme-linked immunosorbent assays. The concordance of diet with the recommended cholesterol lowering diet was moderate and did not differ among the patient groups. The mean fat intake accounted for 33% of the total energy intake (E%) and the saturated fat intake accounted for 13 E%. Only 25% of the patients achieved the recommended intake of saturated fat (<10 E%). The mean cholesterol intake was 219 mg/d and 83% of the patients achieved its recommended intake (<300 mg/d).

Patients who used lipid lowering drugs had a lower intake of fat and saturated fat. Patients who were obese or diabetic tended to have worse quality diets than the others. A low educational level in men was associated with a higher intake of fat and saturated fat, lower consumption of vegetables, fruits and berries, cheese and alcohol.

A high intake of fiber and cereal products, use of soft margarine on bread and a high proportion of linoleic acid in CE were associated with a low serum cholesterol concentration in patients who did not use lipid lowering drugs. Unexpectedly, the intakes of saturated, monounsaturated or polyunsaturated fat were not associated with serum cholesterol. The serum triglyceride concentration was positively associated with dietary sucrose intake in the apo e2 allele carriers, but not in patients with other genotypes. Male patients with AMI had higher autoantibodies against oxLDL than patients with CABG, PTCA or AMIS. Anticardiolipin antibodies did not differ among the patient groups. Antibodies against cardiolipin were inversely associated with dietary intakes of polyunsaturated fat and vitamin E in men.

In conclusion, the concordance of diet with the recommended cholesterol lowering diet was moderate in CHD patients, and this stresses the need for intensified dietary counseling in clinical practice. The concordance was better in patients who used lipid lowering drugs or had a higher educational level, but concordance was worse in obese and diabetic patients. High fiber intake and some indicators of high unsaturated fat intake were associated with lower serum cholesterol concentrations. The apo e2 allele might be associated with a larger serum triglyceride response to high dietary sucrose intake. There seems to be no major clinical value to measure autoantibodies against oxLDL and cardiolipin in CHD patients in clinical practice, even though the antibodies against oxLDL were independently associated with AMI in men.

National Library of Medicine Classification WG 300, QU 85. Medical subject headings: coronary disease; coronary artery bypass; angioplasty, transluminal, percutaneous coronary; myocardial infarction; myocardial ischemia; diet; dietary fats; dietary fiber; risk factors; educational status; fatty acids/blood; lipids/blood; cholesterol/blood; triglycerides/blood; apolipoproteins E/genetics; antibodies, anticardiolipin/blood; cross-sectional studies