Ernährung in der Prävention und Therapie der koronaren Herzkrankheit

Diet and lifestyle have an important impact on the development of cardiovascular risk factors, the manifestation of coronary heart disease, and the prognosis after a cardiovascular event. Even in the presence of strong genetic predisposition patients benefit from a healthy lifestyle with respect to coronary heart disease. Much of the effectiveness of lifestyle interventions is supposedly due to their broad influence on all major risk factors as there are overweight, central obesity, lipid disorders, hypertension, and diabetes mellitus type 2, but also due to independent mechanisms. A Mediterranean diet has been repeatedly shown to reduce cardiovascular events by exchange of several nutrients among others preferring olive oil or nuts, even without measurable impact on conventional risk factors. A diet rich in fruit, vegetables and low-fat milk products and limited in salt and calories if appropriate is considered evidence-based for reducing elevated blood pressure and prevention of coronary heart disease. In terms of insulin resistance and prevention of type 2 diabetes the multimodal interventions of the diabetes prevention studies have set the gold standard. Strictly avoiding nutrients rich in those fatty acids (lauristic, myristic, palmitic acid) that increase cholesterol synthesis and reduce hepatic LDL-uptake have proven effective for lowering LDL-cholesterol. Even in clinically overt coronary heart disease, diet, physical activity, and stress management can induce regression of coronary stenoses and reduce angina pectoris. Diet and lifestyle may be employed as a sole preventative measure, but also combined with medication. Recommendations need not only consider the individual risk profile, but also the personal preferences to ensure adequate adherence.