Thread by @DBelardoMD

This weekend at #ACC22 it was such an honor to present on nutrition & share our new paper "Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An ASPC Clinical Practice Statement" sciencedirect.com/science/articl…

It was an honor to lead a clinical practice statement with world renowned cardiologists @DrMarthaGulati @ErinMichos @rblument1 @kcferdmd @DrOstfeld @RonBlankstein @pnatarajanmd @KoushikReddyMD and world expert nutrition scientists @KevinH_PhD @deirdre_tobias @KCKlatt & Dr Sriram

If you told me I would have this opportunity when I was a cardiology fellow, just 2 yrs ago, I would have said "that's impossible." But thanks to @DrMarthaGulati & every author on this important paper, my knowledge of nutrition science & cardiovascular disease continues to grow.

Some important takeaways from our paper:
Hyperlipidemia:
✔️Dietary modifications to reduce LDL-C and apoB
▪️Replacing saturated fat with polyunsaturated and monounsaturated fat
▪️Reducing dietary cholesterol intake
▪️Increasing intake of fiber rich foods

Hypertension:
▪️Eating a low sodium DASH dietary pattern
▪️Decreasing sodium intake by approximately 1000 mg per day
▪️Increasing intake of dietary potassium from fruits, vegetables, nuts, seeds, beans
▪️Increasing intake of fiber rich foods

Type 2 DM:
Preventing weight gain & obesity is pivotal for prevention
Multiple different dietary patterns can lower T2D risk, including low carbohydrate, Mediterranean, Diabetes Prevention Program, low fat, or plant-based diets.
Overall dietary pattern > macronutrient ratio

Obesity:
Complex, multidisciplinary approach needed in prevention.
Reducing intake of calorically dense ultra-processed foods, refined grains, processed meats, unprocessed red meats, and sugar-sweetened beverages

Supplements:
Vitamin supplementation is not routinely recommended for prevention of ASCVD
Botanical/herbal supplements: formulations not standardized, vary substantially in bioactives across batches & products, can interact w/ meds & can contribute to liver injury, arrhythmia

Multivitamins:
A large body of RCT and prospective cohort evidence demonstrates that multivitamin-multimineral supplementation does not confer CVD benefits in the general population

Calcium:
Calcium supplements, particularly in higher doses and when taken without vitamin D, have also been associated with increased risk of vascular events in some (but not all) studies, whereas no such risk has been seen with calcium intake from food sources.

Phytosterols/stanols; viscous fibers:
Have a significant body of evidence to support risk factor lowering (e.g. LDL-C lowering); however, their utilization in clinical practice remains limited, likely due to unclear net benefits, cost and practicality of continued, long-term use

Social Determinants of Health affecting ASCVD outcomes:
▪️inadequate housing
▪️exposure to adversity (e.g. violence, safety concerns)
▪️suboptimal health literacy
▪️food insecurity (lack of access to sufficient, affordable and nutritious food

Screen all patients for food insecurity:
The Hunger Vital Sign

Refer to food assistance programs and other community food resources:
SNAP, food pantries, home-delivered meals

Social Determinants of Health should be addressed with all patients

Provide culturally relevant nutrition resources for ASCVD prevention

We also included an amazing pediatric cardiologist in our clinical practice statement, Dr. Renee Rodriguez, and we included a section on children and ASCVD prevention

Primary prevention of ASCVD should begin as early as possible!
ASCVD prevention in pediatric populations requires compassionate, effective, and individualized approaches to address modifiable risk factors

We also discuss special considerations in nutrition in older adults:
consider & accommodate:
Protein-energy malnutrition
Micronutrient deficiencies
Changes in oral/dental health
Changes in neurological function
Consider fortified and/or medical foods & supplements when approp.

Registered Dietitians: The heroes of prevention
RDs effectively improve diet quality, facilitate intentional weight loss, improve glucose, HbA1c, lipids & blood pressure
MNT results in greater improvements in cardiovascular disease risk factors & referral should be encouraged

Registered Dietitians:
Insurance and Medicare coverage of dietetic consultations remains variable and often with a limited scope
Medicare Part B coverage: type 2 diabetes and renal disease
We as physicians need to advocate for improved coverage of RD's!

Last, but certainly not least: various dietary patterns can improve cardiometabolic health: low carb, low fat, mediterranean, plant based, etc.
We should meet patients where they are at, and help them modify their preferred dietary pattern to be beneficial for ASCVD prevention