To the Editor,
We read the article “Effects of Brazilian Cardioprotective Diet Program on risk factors in
patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial” by
Bernardete Weber et al. with a great interest (11. Weber B, Galante A, Bersch-Ferreira A, Torreglosa C, Carvalho V, Victor E, et al.
Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart
disease: a Brazilian Cardioprotective Diet randomized pilot trial. Clinics. 2012;67(12):1407-14,
http://dx.doi.org/10.6061/clinics/2012(12)10.
http://dx.doi.org/10.6061/clinics/2012(1...
). The
authors evaluated the ability of the Brazilian Cardioprotective Diet Program to reduce blood
pressure, fasting glucose levels, and body mass indices (BMIs) among patients with established
atherothrombotic disease. They concluded that patients participating in the Brazilian
Cardioprotective Diet Program showed greater decreases in these factors than patients who received
the dietary therapy proposed by the Brazilian guidelines for cardiovascular disease (CVD). We thank
the authors for their study, which was well designed and thoroughly documented.
Cardiovascular disease is the most important cause of mortality and morbidity in developed countries worldwide. Secondary prevention is important to combat the further progression of atherosclerotic disease and to reduce mortality from coronary artery disease. Although there is an established association between regular physical activity and cardiac risk factors in the secondary prevention of coronary artery disease (22. Demirkol S, Cakar M, Balta S, Unlu M, Ay SA, Karaman M. To maintain a proper follow-up of the patients with coronary artery disease is as nearly important as medications. Int J Cardiol. 2012;pii: S0167-5273(12)01589-6.), the authors did not mention the relationships between physical activity and reductions in blood pressure, fasting glucose levels, and BMI. We think that the results of the study would be stronger if the authors addressed the issue of physical activity in their patient cohort.
Cardiovascular risk modifications can also be affected by atherosclerotic risk factors, such as
alcohol consumption, hypothyroidism, impaired glucose tolerance (33. Solimene MC. Coronary heart disease in women: a challenge for the 21st century.
Clinics. 2010;65(1):99-106, http://dx.doi.org/10.1590/S1807-59322010000100015.
http://dx.doi.org/10.1590/S1807-59322010...
), and the elevated inflammatory status associated with inflammatory diseases, cardiac
syndrome X, and infection (44. Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, et al. Evaluation of
the mean platelet volume in patients with cardiac syndrome X. Clinics.
2012;67(9):1019-22.). These risk modifications can
also be affected by eating disorders, excess salt intake, major depression, and gastrointestinal
disease (55. Torres MRSG, Ferreira T da S, Nogueira L de P, Do Nascimento DCS, Sanjuliani AF.
Dietary counseling on long-term weight loss in overweight hypertensive patients. Clinics.
2011;66(10):1779-85.). Several of these possible contributing factors
were not mentioned in the present study. It would be better if the authors provided data concerning
these factors.
Finally, cardiovascular risk factors may be influenced by weight loss medications, aspirin, a history of drug addiction (66. Torres MRSG, Ferreira T da S, Nogueira L de P, Do Nascimento DCS, Sanjuliani AF. Dietary counseling on long-term weight loss in overweight hypertensive patients. Clinics. 2011;66(10):1779-85.), and some antihypertensive therapies, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers. It would be better if the authors performed a subgroup analysis, dividing the three patient groups on the basis of the administration of antihypertensive therapy. We believe that these data would provide a more complete basis for future research concerning the clinical effects of diet on cardiovascular risk factors.
REFERENCES
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1Weber B, Galante A, Bersch-Ferreira A, Torreglosa C, Carvalho V, Victor E, et al. Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial. Clinics. 2012;67(12):1407-14, http://dx.doi.org/10.6061/clinics/2012(12)10.
» http://dx.doi.org/10.6061/clinics/2012(12)10 -
2Demirkol S, Cakar M, Balta S, Unlu M, Ay SA, Karaman M. To maintain a proper follow-up of the patients with coronary artery disease is as nearly important as medications. Int J Cardiol. 2012;pii: S0167-5273(12)01589-6.
-
3Solimene MC. Coronary heart disease in women: a challenge for the 21st century. Clinics. 2010;65(1):99-106, http://dx.doi.org/10.1590/S1807-59322010000100015.
» http://dx.doi.org/10.1590/S1807-59322010000100015 -
4Demirkol S, Balta S, Unlu M, Yuksel UC, Celik T, Arslan Z, et al. Evaluation of the mean platelet volume in patients with cardiac syndrome X. Clinics. 2012;67(9):1019-22.
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5Torres MRSG, Ferreira T da S, Nogueira L de P, Do Nascimento DCS, Sanjuliani AF. Dietary counseling on long-term weight loss in overweight hypertensive patients. Clinics. 2011;66(10):1779-85.
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6Torres MRSG, Ferreira T da S, Nogueira L de P, Do Nascimento DCS, Sanjuliani AF. Dietary counseling on long-term weight loss in overweight hypertensive patients. Clinics. 2011;66(10):1779-85.
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No potential conflict of interest was reported.
Publication Dates
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Publication in this collection
Apr 2013