Dietary Prevention of Coronary Heart Disease

Active prevention of coronary heart disease (CHD) is usually started immediately after the first clinical manifestation of CHD. Secondary prevention focuses on risk reduction in patients with established CHD who are at high risk of recurrent cardiac events and death from cardiac causes. It is important to remember that the two main causes of death in these patients are sudden cardiac death (SCD) and heart failure (HF), often resulting from myocardial ischemia and subsequent necrosis. The main mechanism underlying recurrent cardiac events is myocardial ischemia resulting from atherosclerotic plaque rupture or ulceration. Plaque rupture is usually the consequence of intraplaque inflammation in relation with a high lipid content of the lesion, high concentration of leukocytes and lipid peroxidation products. Thus, in patients with established CHD, the three main aims of the preventive strategy are to prevent malignant ventricular arrhythmia and the development of severe ventricular dysfunction (and heart failure) and to minimize the risk of plaque inflammation and ulceration.