lady working there had suffered a heart attack that required surgery. Whilst driving back
home, I was thinking of the major risk factors for a coronary heart disease to develop. I recalled what
she had said previously about herself. She is 65 years of age, living alone with dozens of chickens. She
loves her pork roast (particularly the crackling), and her cakes and biscuits. Would you think her diet
and lifestyle alone have caused the heart attack?
According to the National Heart Foundation of Australia and the Cardiac Society of Australia and New
Zealand, there are actually three major risk factors for Coronary Heart Disease that cannot be modified
by diet alone or any other means. These are:
1. Increasing age
2. Male gender
3. Family history of premature heart disease
Ageing is one of the significant risk factors in developing CHD. The risk increases as we age, particularly
for men with an average age of 45 years or older. The occurrence of CHD in women is 10 to 15 years later.
The reasoning for this gender difference is still unknown but the most likely explanation according to
researchers is that men experienced an earlier onset of risk factors such as elevated LDL cholesterol and
blood pressure. In addition, the histories of family members who have CHS are taken as independent risk
factors. The more immediate family members affected by CHD, the more they are at risk at developing the
So what are the major risk factors that we can modify?
1. High blood LDL (Low Density Lipoproteins) cholesterol
LDL is commonly known as the bad cholesterol. High level of LDL is associated with high amount of
saturated fats in the body.
2. Low blood HDL (High Density Lipoproteins) cholesterol
HDL is often referred to as the good cholesterol. Low levels of HDL correlates directly with heart disease.
3. High Blood Pressure or hypertension injures the artery walls and accelerates plaque formation.
It is a major independent risk factor for all forms of cardiovascular disease and it substantially increases
the risk of death from CHD. For many people with diabetes, the risk of CHD is similar to that of people with
According to Kochen & Kochen authors of Nutrition, Diet and Hypertension, most people with hypertension
are obese. Obesity raises blood pressure in part by altering kidney function, promoting insulin resistance
which damages blood vessels, and increasing blood volume and cardiac output without an appropriate
reduction in peripheral resistance.
6. Physical inactivity
Dr. James Levine, director of the Mayo Clinic Arizona State University Obesity Solutions Initiative coined the
mantra ‘Sitting is the new smoking’. He and other researchers have found evidence that prolonged sitting
increases the risk of developing various types of diseases such as heart disease, cancer and Type 2 diabetes.
7. Cigarette Smoking
Is a powerful risk factor for CHD and other forms of cardiovascular disease. Smoking damages the heart
directly by increasing blood pressure and the cardiac workload.
How to reduce the risk of coronary heart disease?
A major diet and lifestyle change is necessary in the reduction of CHD risk. The treatment of CHD focuses on
lowering LDL cholesterol commonly known as the bad cholesterol. The Third Report of the National
Cholesterol Education program suggests that lowering LDL cholesterol significantly reduces the incidence
A person with high level of LDL more often consumes an atherogenic diet: foods that are high in saturated
fats, trans fat and cholesterol. To lower the risk, diets that are rich in fruits, vegetables and whole grains
are recommended for daily consumption.
Bread, cereals and pasta
· Choose wholegrain breads and cereals
· Minimize the intake of bakery products that contain trans fatty acids or hydrogenated oil.
· Prepare pasta in tomato sauce instead of a cream or cheese sauce.
Fruits and vegetables
· Consume fresh fruits and vegetables frequently- five servings of vegetables and two servings of fruit every day.
· Enjoy the natural flavour of steamed vegetables (without butter) for dinner and fruits for dessert.
· When choosing canned fruit products select the ones that are canned in juice due to their higher nutrient
density that those canned in syrup.
· Consumption of high-sodium foods such as pickles and olives should be restricted.
· French fries or chips from fast food restaurants should be avoided because they are often loaded with trans fats.
· Buy frozen vegetables without sauce.
Lunch and Dinner
· Select lean cuts of beef such as sirloin, top and bottom round and eye fillet and lean cuts of pork such as
tenderloin and loin chops. Trim all visible fat to avoid excess calories and fat.
· Select extra lean minced meat and drain well after cooking. Substitute minced meat with skinless lean minced
chicken to keep your fat intake low.
· To help reduce meat intake include more vegetarian or legume dishes to boost fibre in the diet.
· Although eggs are high in cholesterol, they can be included in the diet since trans fat and saturated fat mostly
influence the blood cholesterol levels. A serving of two eggs in two to three meals a week is sufficient.
· Restrict processed meats and deli meats such as salami, ham, corned beef, frankfurts and other luncheon meats.
· Limit high sodium foods of salty or smoked fish such as anchovies, caviar, salted or dried cod, herring, sardines
and smoked salmon.
· Consider low- fat meat sources including game such as venison, goat and wild boar.
· Select tuna, sardines and other canned meats packed in water; rinse oil-packed items with hot water to remove
much of the fat.
· Eat a meatless meal or two daily.
· Grill, roast, broil, bake, stir-fry or stew meats; don’t fry. When possible, place food on a rack so that fat can drain.
· Substitute whole milk with low fat milk.
· For cooking, use evaporated milk instead of heavy cream.
· Use fat-free yoghurt or sour cream to make dips and salad dressings.
· Restrict foods high in saturated fat or sodium, such as cheese, processed cheeses, ice cream and many other
· Use fat-free and low-fat cheeses such as part-skim ricotta and low-fat mozzarella instead of regular cheeses.
Fats and Oils
· Use butter or margarine sparingly. Substitute butter with polyunsaturated margarines or those with added
plant sterols or stanols to lower LDL cholesterol levels.
· Use monounsaturated and polyunsaturated fats to replace saturated fat. Include monounsaturated fats such
as olive oil and canola oil in recipes and salad dressings.
· Use avocado or hummus as alternative for margarines and spreads two to three times a week.
· Limit use of lard and meat fat.
Spices and Seasoning
· Select flavourings and sauces that is low in sodium such as salt-reduced stock, soy sauce, barbeque and
· Improve the flavour of foods without adding sodium by using spices and herbs such as more garlic, ginger,
basil, curry, or chilli powder, cumin, pepper, lemon, mint, oregano, rosemary and thyme.
Snacks and desserts
· Select low sodium and low saturated fat choices such as unsalted pretzels and nuts, plain popcorn and
unsalted chips and crackers.
· Nuts (unsalted) and seeds are good source of polyunsaturated fat that may help lower blood cholesterol.
· Snack on raw vegetables or fruits instead of high fat items like potato chips.
· Choose canned or dried fruits and some raw vegetables to boost fruit and vegetable intake.
· Select low-fat or fat-free frozen desserts such as frozen yoghurt, sherbet or ice milk instead of ice cream.
· Choose water as main drink.
· Restrict intake of sugary drinks such as soft drinks, sports drinks, fruit juice drinks and cordials.
· Drink coffee and tea in moderation.
· If alcohol is consumed, limit it to two standard drinks daily.
· Physical activity: Participate in at least 30 minutes of moderate intensity endurance activity on most days
of the week such as brisk walking, water aerobics, and bicycling. The eventual goal should be an expenditure
of at least 2000 kilojoules weekly.
· Smoking cessation: Minimise exposure to any form of tobacco or tobacco smoke.
Adapted from Healthy Eating Guidelines, National Heart Foundation and Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in
Adults (Adult Treatment Panel III), NIH publication no. 02-5215
(Bethesda, Md.: National Heart, Lung, and Blood Institute, 2002) pp. V-8 and II-4.
AHA Scientific Statement: Diet and lifestyle recommendations revisions 2006, Circulation 114 pp.82-96.
De Caterina R, Zampolli A, Del Turco S, Madonna R, Massaro M. 2006, Nutritional mechanisms that
influence cardiovascular disease, retrieved from National Center for Biotechnology Information,
U.S National Library of Medicine, PubMed,
Gerstacker, Diana 2014, Sitting is the new smoking – 7 ways a sedentary lifestyle is killing you,
The Active Times, Spanfeller Media Group, New York,
K. Rahmouni, Correia ML, Haynes WG, Mark AL 2005, Obesity-associated hypertension:
New insights into mechanisms, retrieved from National Center for Biotechnology Information, U.S National
Library of Medicine, PubMed,
National Center for Chronic Disease Prevention and Health Promotion 2015, Division of Nutrition,
Physical Activity and Obesity, Georgia, USA,
National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand 2007,
Reducing Risk in Heart Disease, Heart Foundation, Canberra, Australia.
National Heart Foundation of Australia 2009, Healthy eating and drinking,
T.A. Kotchen and J.M Kotchen, ‘Nutrition,diet, and hypertension’,
in M.E. Shils and co-editors, Modern Nutrition in Health and Disease 2006, 10th edn,
Lippincott Williams & Wilkins, Philadelphia.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III),
NIH publication no. 02-5215 (Bethesda, Md.: National Heart, Lung, and Blood Institute, 2002)
pp. V-8 and II-4.
Whitney, Eleonor, Rolfes, Sharon, Crowe, Tim, CameronSmith, David, Walsh, Adam, 2014,
Understanding Nutrition Australia and New Zealand Edition,
2nd edition, Cengage Learning Australia, Australia.