How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial

Dianne P Reidlinger, Julia Darzi, Wendy L Hall, Paul T Seed, Philip J Chowienczyk, Thomas A B Sanders, Cardiovascular disease risk REduction Study (CRESSIDA) investigators

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Abstract

Background: Controversy surrounds the effectiveness of dietary guidelines for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. Objective: The objective was to compare effects on vascular and lipid CVD risk factors of following the United Kingdom dietary guidelines with a traditional British diet (control). Design: With the use of a parallel-designed randomized controlled trial in 165 healthy nonsmoking men and women (aged 40-70 y), we measured ambulatory blood pressure (BP) on 5 occasions, vascular function, and CVD risk factors at baseline and during 12 wk after random assignment to treatment. The primary outcomes were differences between treatments in daytime ambulatory systolic BP, flow-mediated dilation, and total cholesterol/HDL cholesterol. Secondary outcomes were differences between treatment in carotid-to-femoral pulse wave velocity, high-sensitivity C-reactive protein, and a measure of insulin sensitivity (Revised Quantitative Insulin Sensitivity Check Index). Results: Data were available on 162 participants, and adherence to the dietary advice was confirmed from dietary records and biomarkers of compliance. In the dietary guidelines group (n = 80) compared with control (n = 82), daytime systolic BP was 4.2 mm Hg (95% CI: 1.7, 6.6 mm Hg; P<0.001) lower, the treatment effect on flow-mediated dilation [20.62% (95% CI: 21.48%, 0.24%)] was not significant, the total cholesterol:HDL cholesterol ratio was 0.13 (95% CI: 0, 0.26; P = 0.044) lower, pulse wave velocity was 0.29 m/s (95% CI: 0.07, 0.52 m/s; P = 0.011) lower, high-sensitivity Creactive protein was 36% (95% CI: 7%, 48%; P = 0.017) lower, the treatment effect on the Revised Quantitative Insulin Sensitivity Check Index [2% (95% CI:22%, 5%)] was not significant, and body weight was 1.9 kg (95% CI: 1.3<2.5 kg; P, 0.001) lower. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95% CI: 1.0, 3.9 mm Hg) of the fall in blood pressure. Conclusion: Selecting a diet consistent with current dietary guidelines lowers BP and lipids, which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women. This study is registered at www.isrctn.com as 92382106.

Original languageEnglish
Pages (from-to)922-930
Number of pages9
JournalAmerican Journal of Clinical Nutrition
Volume101
Issue number5
DOIs
Publication statusPublished - 1 Jan 2015
Externally publishedYes

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Nutrition Policy
Cardiovascular Diseases
Randomized Controlled Trials
Blood Pressure
Insulin Resistance
Pulse Wave Analysis
HDL Cholesterol
Dilatation
Sodium
Cholesterol
Diet
Lipids
Therapeutics
Diet Records
Thigh
Vascular Diseases
C-Reactive Protein
Compliance
Blood Vessels
Biomarkers

Cite this

Reidlinger, D. P., Darzi, J., Hall, W. L., Seed, P. T., Chowienczyk, P. J., Sanders, T. A. B., & Cardiovascular disease risk REduction Study (CRESSIDA) investigators (2015). How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial. American Journal of Clinical Nutrition, 101(5), 922-930. https://doi.org/10.3945/ajcn.114.097352
Reidlinger, Dianne P ; Darzi, Julia ; Hall, Wendy L ; Seed, Paul T ; Chowienczyk, Philip J ; Sanders, Thomas A B ; Cardiovascular disease risk REduction Study (CRESSIDA) investigators. / How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial. In: American Journal of Clinical Nutrition. 2015 ; Vol. 101, No. 5. pp. 922-930.
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abstract = "Background: Controversy surrounds the effectiveness of dietary guidelines for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. Objective: The objective was to compare effects on vascular and lipid CVD risk factors of following the United Kingdom dietary guidelines with a traditional British diet (control). Design: With the use of a parallel-designed randomized controlled trial in 165 healthy nonsmoking men and women (aged 40-70 y), we measured ambulatory blood pressure (BP) on 5 occasions, vascular function, and CVD risk factors at baseline and during 12 wk after random assignment to treatment. The primary outcomes were differences between treatments in daytime ambulatory systolic BP, flow-mediated dilation, and total cholesterol/HDL cholesterol. Secondary outcomes were differences between treatment in carotid-to-femoral pulse wave velocity, high-sensitivity C-reactive protein, and a measure of insulin sensitivity (Revised Quantitative Insulin Sensitivity Check Index). Results: Data were available on 162 participants, and adherence to the dietary advice was confirmed from dietary records and biomarkers of compliance. In the dietary guidelines group (n = 80) compared with control (n = 82), daytime systolic BP was 4.2 mm Hg (95{\%} CI: 1.7, 6.6 mm Hg; P<0.001) lower, the treatment effect on flow-mediated dilation [20.62{\%} (95{\%} CI: 21.48{\%}, 0.24{\%})] was not significant, the total cholesterol:HDL cholesterol ratio was 0.13 (95{\%} CI: 0, 0.26; P = 0.044) lower, pulse wave velocity was 0.29 m/s (95{\%} CI: 0.07, 0.52 m/s; P = 0.011) lower, high-sensitivity Creactive protein was 36{\%} (95{\%} CI: 7{\%}, 48{\%}; P = 0.017) lower, the treatment effect on the Revised Quantitative Insulin Sensitivity Check Index [2{\%} (95{\%} CI:22{\%}, 5{\%})] was not significant, and body weight was 1.9 kg (95{\%} CI: 1.3<2.5 kg; P, 0.001) lower. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95{\%} CI: 1.0, 3.9 mm Hg) of the fall in blood pressure. Conclusion: Selecting a diet consistent with current dietary guidelines lowers BP and lipids, which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women. This study is registered at www.isrctn.com as 92382106.",
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Reidlinger, DP, Darzi, J, Hall, WL, Seed, PT, Chowienczyk, PJ, Sanders, TAB & Cardiovascular disease risk REduction Study (CRESSIDA) investigators 2015, 'How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial' American Journal of Clinical Nutrition, vol. 101, no. 5, pp. 922-930. https://doi.org/10.3945/ajcn.114.097352

How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial. / Reidlinger, Dianne P; Darzi, Julia; Hall, Wendy L; Seed, Paul T; Chowienczyk, Philip J; Sanders, Thomas A B; Cardiovascular disease risk REduction Study (CRESSIDA) investigators.

In: American Journal of Clinical Nutrition, Vol. 101, No. 5, 01.01.2015, p. 922-930.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Hall, Wendy L

AU - Seed, Paul T

AU - Chowienczyk, Philip J

AU - Sanders, Thomas A B

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N2 - Background: Controversy surrounds the effectiveness of dietary guidelines for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. Objective: The objective was to compare effects on vascular and lipid CVD risk factors of following the United Kingdom dietary guidelines with a traditional British diet (control). Design: With the use of a parallel-designed randomized controlled trial in 165 healthy nonsmoking men and women (aged 40-70 y), we measured ambulatory blood pressure (BP) on 5 occasions, vascular function, and CVD risk factors at baseline and during 12 wk after random assignment to treatment. The primary outcomes were differences between treatments in daytime ambulatory systolic BP, flow-mediated dilation, and total cholesterol/HDL cholesterol. Secondary outcomes were differences between treatment in carotid-to-femoral pulse wave velocity, high-sensitivity C-reactive protein, and a measure of insulin sensitivity (Revised Quantitative Insulin Sensitivity Check Index). Results: Data were available on 162 participants, and adherence to the dietary advice was confirmed from dietary records and biomarkers of compliance. In the dietary guidelines group (n = 80) compared with control (n = 82), daytime systolic BP was 4.2 mm Hg (95% CI: 1.7, 6.6 mm Hg; P<0.001) lower, the treatment effect on flow-mediated dilation [20.62% (95% CI: 21.48%, 0.24%)] was not significant, the total cholesterol:HDL cholesterol ratio was 0.13 (95% CI: 0, 0.26; P = 0.044) lower, pulse wave velocity was 0.29 m/s (95% CI: 0.07, 0.52 m/s; P = 0.011) lower, high-sensitivity Creactive protein was 36% (95% CI: 7%, 48%; P = 0.017) lower, the treatment effect on the Revised Quantitative Insulin Sensitivity Check Index [2% (95% CI:22%, 5%)] was not significant, and body weight was 1.9 kg (95% CI: 1.3<2.5 kg; P, 0.001) lower. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95% CI: 1.0, 3.9 mm Hg) of the fall in blood pressure. Conclusion: Selecting a diet consistent with current dietary guidelines lowers BP and lipids, which would be expected to reduce the risk of CVD by one-third in healthy middle-aged and older men and women. This study is registered at www.isrctn.com as 92382106.

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