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2019 reserved. rights All Inc. November/December Health, Kluwer The Lyon Heart Study showed a Diet The Lyon It’s important to follow the trail of evi- fish, whole grains and cereals, and moder- fish, whole grains and cereals, The dairy. wine and ate amounts of red gaps that exist within the Mediterranean outcomes on heart positive diet regarding limited to the recommendations health are the of wine and dairy in moderation and inclusion of whole grains and cereals. over a nearly 72% decrease remarkable events 5-year period in major cardiovascular for those who consumed a Mediterranean- groups. with control type diet compared trial validated This randomized controlled in the sec- that diet plays a significant role and numerous of CVD, ondary prevention confirmed studies have also prospective a these findings. The Lifestyle Heart Trial, that included study randomized controlled reduction a low-fat vegetarian diet, stress showed a and physical activity, measures, in CVD. regression dence, especially when it comes to CVD. The a evidence overwhelmingly points toward Wolters 2019 © Copyright matters The heart-healthy benefits of the Medi- heart

terranean diet continue to be the most widely examined. Several prospective cohort studies have evaluated the impact of of CVD primary and secondary prevention and confirmed that specific dietary patterns the found in the are The Medi- cornerstone of CVD prevention. terranean diet consists of olive oil, legumes, and vegetables, nuts, lean meats and fruits Overview Since the 1960s when the Seven Countries that certain Mediterranean study revealed CVD populations experienced decreased mortality due to their unique dietary patterns, several eating plans to sup- Some of port heart health have emerged. American the popular ones are the more Association (AHA) plan, DASH Heart diet, Mediterranean diet, Ornish diet, and Americans. the US Dietary Guidelines for Managing (CVD) disease (CVD) Managing cardiovascular often involves a combination of pharma- ap- cologic therapy and a solid dietary diet.” It’s known as the “cardiac proach for critical that the foods we recommend planned as our patients be as carefully be- receive they the pharmacologic care cause diet is an important part of cardiac often are Although there health. journals and in scientific controversies evidence- are there among the lay press, recom- recognized based and broadly mendations that you can consider when caring for patients with CVD, whether re- inpatient or outpatient. This article diet views the top evidence-based cardiac interven- and discusses recommendations and tions for nurses who assess, educate, for patients with CVD. care The cardiac diet explained diet The cardiac By Julie Nyhus, FNP-BC www.NursingMadeIncrediblyEasy.com UDRA11 / SHUTTERSTOCK / UDRA11

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refined grains; trans and saturated fats; sodi- key points um; and red meats, including processed Encourage meats such as bacon, salami, ham, hot dogs, • Fresh, frozen, or canned fruits and veg- and sausages. etables (unsalted) • Olive, canola, or peanut oil when cooking Implications for nursing practice • Raw or unsalted nuts and seeds, unsweet- History taking and the physical exam are ened nut butters essential evaluation tools that allow you • Fish, poultry, and small amounts of lean, red to determine the optimal dietary approach meat that are grilled, baked, or boiled (avoid for your patient. Correlate your patient’s fried) health history and head-to-toe assessment • Legumes and beans, such as great northern, with the cardiac diet but remember that pinto, black, garbanzo, and kidney beans • Low-fat dairy products, such as milk, cheese, cardiac knowledge isn’t limited to anat- yogurt, and cottage cheese omy and physiology—it encompasses the • Whole grains in moderation, such as oat- patient’s medications, risk factors, stress, , dried beans, barley, and brown rice exercise, and management skills. Primary Discourage areas of focus for cardiac assessment are • Sugars, such as table sugar, high-fructose serum lipids and glucose, body mass in- corn syrup, honey, candy, soda, sweetened dex (BMI), and BP. These should be rou- beverages such as fruit drinks or lemon ade, tinely assessed in patients with CVD and cane sugar, and agave taken into consideration when the cardiac • Artificial sweeteners diet is prescribed. • High-carbohydrate diets Knowledge of lab values such as total cho- • Low-carbohydrate diets lesterol, low-density lipoprotein cholesterol, • Red meat high-density lipoprotein cholesterol, and tri- • Sodium glyceride levels allows you to focus on lipid- • Refined grains • Fried foods lowering dietary options, such as healthy fats • Trans saturated fats found in fatty meats, found in fish and olive oil. Information about poultry skin, butter, whole milk dairy prod- serum glucose levels enables you to recom- ucts, tropical oils (such as palm, palm kernel, mend fewer refined and fried foods, along and coconut), and egg yolks with daily exercise to decrease insulin resis- • Processed foods such as packaged or fast tance. Direct patients with elevated lipid or foods glucose levels to the AHA website to discover • Processed meats, such as bacon, lunch that most fruits and vegetables are low in cal- meat, salami, ham, hot dogs, and sausages ories, fat, sodium, and cholesterol and are good sources of fiber, , and minerals. plant-based diet. Indeed, in its 2019 guide- Obtaining routine BP measurements lines on the primary prevention of CVD, the guides you to recommend significant American College of Cardiology and the lifestyle changes, such as smoking cessa- AHA confirmed beneficial dietary patterns tion or weight loss. Tracking BMI ensures that include plant-based diets or diets high that you focus on one of the most crucial in fruits and vegetables, nuts, whole grains, dietary recommendations for cardiac lean animal protein such as fish, and vegeta- patients: avoiding foods that contain par- ble fiber have been shown to lower all-cause tially hydrogenated vegetable oils, thereby mortality compared with a standard diet. In decreasing the amount of trans fat. This addition, longstanding dietary patterns intervention will assist with weight loss known to increase cardiovascular mortality while also impacting cardiovascular health. include sugar; artificial sweeteners; high- Encourage patients to replace the danger- carbohydrate diets; low-carbohydrate diets; ous fats found in beef, pork, lamb, poultry

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Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. with skin, lard, cream, butter, cheese, and full-fat dairy products with monounsatu- on the web rated and polyunsaturated fats. Healthy For you fats can be found in olive oil, fatty fish, and CDC: unsalted nuts. www.cdc.gov/heartdisease/healthy_living.htm Tools such as nurse-generated pam- Mayo Clinic: www.mayoclinic.org/diseases- phlets that outline dietary guidelines conditions/heart-disease/in-depth/heart- specific to patients with elevated BMI or healthy-diet/art-20046702 BP can assist in implementing changes. For your patients Patients with elevated BMI may ben- American Heart Association: www.heart. efit from understanding the difference org/en/healthy-living/healthy-eating/eat- between complex and simple carbohy- smart/nutrition-basics/aha-diet-and-lifestyle- recommendations drates, learning how to read food labels, or discovering that the cardiac diet isn’t CDC: www.cdc.gov/dhdsp considered “dieting” but is a lifestyle change aimed at decreasing the progres- provider to be assessed for any potential sion of CVD. dietary safety issues or undiagnosed med- Understand how overwhelming it can ical conditions. be for patients to cope with CVD, let alone change their diet at the same time. Encour- Follow the evidence age patients with CVD to make gradual Because CVD remains the leading cause dietary changes. For example, swapping of death in the US, with over 635,000 out processed foods for fresh or frozen deaths annually, the cardiac diet is a vegetables. Teach patients to replace sug- common adjunct to pharmacologic inter- ary snacks with fresh fruit, switch butter or ventions. As nurses, we’re a respected margarine for olive oil, and dine on and trusted source regarding lifestyle legumes on meatless Mondays. modifications and should be knowledge-

As nurses, we’re a respected and trusted source regarding lifestyle modifi cations such as diets that will improve health outcomes for our patients.

Point patients toward evidence-based able about diets that will improve health resources such as the AHA website, which outcomes for our patients. Familiarize provides patient-friendly information on yourself with the evidence surrounding specific diet and lifestyle recommenda- the cardiac diet and supporting resources. tions. Patients who face additional health Linking your patient’s health history challenges such as diabetes or other and physical exam with specific dietary chronic diseases may be best served by changes is one way you can make an im- discussing their specific nutritional needs pact. You can also provide informational with a registered nutritionist. handouts presenting evidence-based sup- In addition, before initiating any major port for a heart-. dietary changes, such as the Mediter- The cardiac diet is more than a list of ranean diet or the DASH diet, patients foods that support heart health—it’s a should consult with their healthcare dietary pattern emphasizing vegetables, www.NursingMadeIncrediblyEasy.com November/December 2019 Nursing made Incredibly Easy! 7

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fruits, whole grains, lean meat, and fish and Cholesterol Education Program/American Heart Association step I dietary pattern on cardiovascular avoiding foods that negatively impact car- disease. Circulation. 2001;103(13):1823-1825. diovascular health, such as sugar, artificial Medline Plus. Heart disease and diet. https://medlineplus. sweeteners, high- or low-carbohydrate gov/ency/article/002436.htm. diets, and refined or processed foods. National Heart, Lung, and Blood Institute. DASH eating plan. www.nhlbi.nih.gov/health-topics/dash-eating-plan. Encourage your patients with CVD to eat Ornish D, Scherwitz LW, Billings JH, et al. Intensive with the goal of preventing further heart lifestyle changes for reversal of coronary heart disease. disease and optimizing their future health. ■ JAMA. 1998;280(23):2001-2007. Rees K, Takeda A, Martin N, et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular REFERENCES disease. Cochrane Database Syst Rev. 2019;3:CD009825. American Heart Association. Diet and lifestyle recommen- Temple NJ, Guercio V, Tavani A. The Mediterranean diet dations. www.heart.org/en/healthy-living/healthy- and cardiovascular disease: gaps in the evidence and eating/eat-smart/nutrition-basics/aha-diet-and-lifestyle- research challenges. Cardiol Rev. 2019;27(3):127-130. recommendations. Tsioufis C. The Mediterranean and the DASH dietary Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA patterns: insights into their role in cardiovascular disease guideline on the primary prevention of cardiovascular disease: prevention. Hellenic J Cardiol. 2018;59(2):134-135. executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical Julie Nyhus is a health writer and cardiothoracic clinic RN at OSF practice guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414. Saint Francis Medical Center in Peoria, Ill. Health.gov. Dietary guidelines for Americans 2015-2020, eighth edition. https://health.gov/dietaryguidelines/2015/ The author has disclosed no financial relationships related to this guidelines. article. Kris-Etherton P, Eckel RH, Howard BV, St Jeor S, Bazzarre TL. Benefits of a Mediterranean-style, National DOI-10.1097/01.NME.0000585092.35054.d2

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