The effect of diet intake on vascular function and therapeutic effect of cardiovascular medicine in patients with cardiovascular disease

Cardiovascular diseases (CVDs) remain to be the leading causes of morbidity and mortality in Hong Kong and worldwide. Among different modifiable risk factors, dietary pattern is on the major determinant for CVD and overall mortality. Other than pharmacological therapies for cardiovascular risk factors, such as hypertension, hyperlipidemia and diabetes, maintaining a healthy diet is a more sustainable method in general population to prevent CVDs. Current lifestyle intervention in the West countries focus on high intake of fruit and vegetables with more than 400g per day and limited saturated fats with less than 10% of energy, there is very limited data on impact of dietary pattern on CVDs in Chinese. Prior studies among Chinese in Hong Kong have shown that only half of the local population fell within these recommended ranges for fat, saturated fatty acid and cholesterol intakes. Several different dietary patterns have been recommended for CVDs prevention based on: i) food groups, such as Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet; ii) macronutrients: the low-carbohydrate diet, low glycemic index diet, very-low- fat diet and iii) nutrition or vitamin supplement. However, the effect of different dietary patterns based on modulations of food group, macronutrients and particular micronutrients on vascular structure and function in Chinese subjects is unclear. In the first part of this thesis, the relationships between different dietary pattern and surrogate markers of subclinical atherosclerosis and vascular function in different high risk populations for CVDs were investigated. In Chapter 3, we compared the assessment of dietary pattern in Chinese using different tool, including Food Frequency Questionnaire (FFQ); Dietary Record; and Dietitian assessment. In this study, we demonstrated that suitable dietary assessments tools should be chosen for the assessment of different dietary pattern, according to characteristics of assessments. In Chapter 4, the relationship between the fruit intake and subclinical atherosclerosis as measured by carotid intimal thickness (IMT) was investigated in patient with type II diabetes mellitus (DM). Our results showed that high fruit intake was associated with lower burden of carotid atherosclerosis, independent of level of vitamin intake in patients with type II DM. In Chapter 5, we compared the impact of high carbohydrate diet on arterial stiffness between control subjects without CVDs and patients with high risk for CVDs. Our findings showed that high carbohydrate diet mainly affected patients with established CVDs, and their increased arterial stiffness was associated with an elevation of blood pressure. In Chapter 6, we determined the effect of dietary vitamin intake on oxidative stress in patients with high risk of CVDs. In those high risk patients for CVDs, we demonstrated that increased dietary intake of vitamin A, beta-carotene and alpha tocopherol were associated with decreased oxidative stress, but these relationships were not observed in those control subjects without CVDs. It is likely attributed to the higher systemic oxidative stress levels in patients with high risk of CVDs. On the other hand, food intake may also affect the clinical efficacy of cardiovascular therapies. In particularly, it has been well established that herbal intake which is commonly used by Chinese can affect the anticoagulant effect of warfarin on patients with non-valvular atrial fibrillation (AF). Thus, in this second part of the thesis, we investigated the effect of concomitant herbal intake on anticoagulation control in patients with non-valvular AF treated with warfarin. Our results showed that patients with AF treated with warfarin had limited knowledge on potential interaction between herbal substances in foods and warfarin, in which increased herbal substances intake significantly reduced the percentage time of anticoagulant effect within the therapeutic range. Moreover, a single section of education on knowledge of herbal ingredients did not improve their percentage time of therapeutic range for these patients. In conclusion, these findings suggest that dietary pattern in Chinese might have significant impact of vascular function in patients with type II DM and high risk for CVDs. Moreover, the herbal substances in the diet among Chinese could have significant impact of the therapeutic effects in some of the cardiovascular medications, such as warfarin. Future clinical studies will be needed to confirm these potential beneficial effects of particular diet intake on vascular function in patients with high risks of CVDs as well as potential interaction between herbal substances in Chinese diet and cardiovascular medications.published_or_final_versionMedicineDoctoralDoctor of Philosoph