J. of Cardiovasc. Trans. Res. (2009) 2:328–334 DOI 10.1007/s12265-009-9116-7
Nutrition as a Vehicle for Cardiovascular Translational Research Delfin Rodriguez-Leyva & Richelle S. McCullough & Grant N. Pierce
Received: 1 April 2009 / Accepted: 26 May 2009 / Published online: 12 June 2009 # Springer Science + Business Media, LLC 2009
Abstract It is becoming increasingly evident that poor nutrition plays an important role in inducing cardiovascular disease. Just as importantly, data now support the contention that appropriate nutritional interventions may have just as important an effect in preventing or delaying the appearance of cardiovascular disease. If this is indeed true, then it is critical that these advances in our knowledge of the effects of nutritional interventions be translated into effective strategies to combat cardiovascular disease. It is argued in this paper, with a few specific examples, that the translation of nutritional interventions can provide powerful approaches to alleviating the clinical challenges currently facing us today in the cardiovascular field. Furthermore, the value-added economic advantages of translating nutritional strategies on a wide scale into the public become another intriguing argument to further support investigations in this growing field.
R. S. McCullough : G. N. Pierce Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada R. S. McCullough : G. N. Pierce Department of Physiology, Faculty of Medicine University of Manitoba, Winnipeg, Manitoba, Canada D. Rodriguez-Leyva Cardiovascular Research Division, V.I. Lenin University Hospital, Holguin, Cuba G. N. Pierce (*) St. Boniface General Hospital Research Centre, 351 Tache Ave, Winnipeg, Manitoba, Canada R2H 2A6 e-mail:
[email protected]
Keywords Nutrition . Heart Disease . Cardiovascular Disease . Food . Knowledge Translation . Prevention . Atherosclerosis
The Rationale for a Research Strategy to Prevent Heart Disease Heart disease has become a true pandemic. It is the leading cause of death worldwide [1]. Globally, deaths from cardiovascular diseases are predicted to rise from 17.1 million in 2004 to 23.4 million in 2030 [1]. The United States is not the only country that suffers from heart disease. Many other countries in the world experience even higher rates of heart disease and death due to cardiovascular complications when expressed on a per capita basis [2]. Our losses due to heart disease are not only in terms of human resources. The US health care system spent over $200B in only 1 year (2007) on the direct and indirect costs of coronary heart disease (CHD) and stroke [3]. This cost for cardiovascular health care has stretched the capacity of every government in the world to the breaking point in order to support these expenditures. To make matters worse, it is almost inevitable that these expenses will continue to escalate. The cost of human resources (physicians, nurses, associated health care personnel, support staff of all kinds), sophisticated equipment and the indirect costs of doing business (legal expenses, infrastructure, indirect expenses) is fully expected to rise almost unabated into the foreseeable future. The vast majority of this annual $200B expense is directed to aspects of clinical care after the disease is present [3]. This is never questioned because the patient is many times in dire need of immediate, life saving attention. However, is this financial attention too late? It
J. of Cardiovasc. Trans. Res. (2009) 2:328–334
may be far more prudent to address the problem of CHD prior to the establishment of significant clinical symptoms because: (a) the lesions may be more easily reversed at the start of disease progression, (b) if successful, an earlier intervention will have a greater impact upon the quality of life of the patient, (c) even delaying the appearance of CHD will have obvious cost savings as well as quality-of-life implications, and, (d) the clinical symptoms of the CHD are not likely to be as serious and life threatening. The potential benefits to health endpoints, quality of life, and the reduction in health care costs are strong arguments, therefore, that can be advanced to support the advancement of a preventive approach to the problem of CHD as a viable, complimentary strategy to addressing the clinical problem of CHD.
The Causes of Cardiovascular Disease The field of medical research, at least in the basic science arena, has been led for decades by the general assumption that it is essential for us to know in as much detail as possible the mechanism(s) responsible for a disease if we are to treat or develop new therapeutic strategies to combat a disease [4]. It is a logical course of action that has resulted in the identification of a number of key pathways and mechanisms that are involved in CHD. This knowledge has been translated to a large degree through the pharmaceutical industry into a great variety of effective therapeutic options that are used currently in the hospital with great success in the treatment of CHD. However, in view of the discussion above concerning the need for preventive strategies to address CHD, is there an alternative approach that could yield even greater advances in our therapeutic approach to CHD? The landmark study of Yusuf and colleagues [5] showed that over 90% of heart disease is caused by factors that are largely within our control. Behavioral modification of three factors in particular: diet (for example the consumption of fruits and vegetables), smoking, and exercise represent the majority of the causes of heart disease, as identified by their study. If this postulate is true (or even if it is largely exaggerated), it brings into question the value of further research investigating aspects of the remaining
