Рекомендации по коррекции питания в лечении атеросклероза

Коррекция питания является основой российских и зарубежных рекомендаций по лечению атеросклероза, стабильных и нестабильных форм ишемической болезни сердца. Благодаря правильно подобранному сбалансированному рациону возможно достижение целевых показателей липидного профиля. Поэтому назначение диеты является обязательным и самым первым компонентом в лечении любых форм атеросклероза. Анализ научной литературы с использованием библиографических баз NCBI, WoS, Scopus и РИНЦ показал, что наиболее приемлемы в профилактике и лечении атеросклероза вегетарианская и веганская диеты, достоверно снижающие риск развития и прогрессирования атеросклероза, осложнений и смертности. Это связано с тем, что растительные волокна препятствуют всасыванию холестерина и способствуют нормализации микрофлоры кишечника. Содержащиеся в овощах, фруктах, ягодах, чае и зерновых полифенолы препятствуют агрегации тромбоцитов и воспалительным процессам, способствуют улучшению состояния эндотелия и соотношения липопротеинов крови. Антиатерогенными свойствами обладают соевый белок, витамин D, омега-3-жирные кислоты и многие другие описанные в обзоре компоненты. Для всеядных людей необходимо ограничение атерогенных продуктов, богатых холестерином, железом, сахаром, кальцием и фосфатами. Важное значение имеет способ приготовления, поскольку при жарке как растительных, так и животных продуктов образуются атерогенные вещества, способствующие воспалительным процессам в стенках артерий и дислипидемии.

1. Visseren F.L. J., Mach F., Smulders Y.M. et al. ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart. J. 2021; 42(34): 3227-3337. doi: 10.1093/eurheartj/ehab484

2. Кухарчук В.В., Ежов М.В., Сергиенко И.В. и др. Клинические рекомендации Евразийской ассоциации кардиологов (ЕАК)/ Национального общества по изучению атеросклероза (НОА) по диагностике и коррекции нарушений липидного обмена с целью профилактики и лечения атеросклероза (2020). Евразийский кардиологический журнал. 2020; (2): 6-29. doi: 10.38109/2225-1685-2020-2-6-29.

3. Heffron S.P., Rockman C.B., Adelman M.A., et al. Greater Frequency of Fruit and Vegetable Consumption Is Associated with Lower Prevalence of Peripheral Artery Disease. Arterioscler. Thromb. Vasc. Biol. 2017; 37: 1234–1240. doi: 10.1161/ATVBAHA.116.308474.

4. Dybvik J.S., Svendsen M., Aune D. Vegetarian and vegan diets and the risk of cardiovascular disease, ischemic heart disease and stroke: a systematic review and meta-analysis of prospective cohort studies. Eur. J. Nutr. 2023; 62(1): 51-69. doi: 10.1007/s00394-022-02942-8.

5. Koch C.A., Kjeldsen E.W., Frikke-Schmidt R. Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials. Eur. Heart. J. 2023; 44(28): 2609-2622. doi: 10.1093/eurheartj/ehad211.

6. Esselstyn C.B. Jr., Gendy G., Doyle J. et al. A way to reverse CAD? J. Fam. Pract. 2014; 63(7): 356-364b.

7. US Burden of Disease Collaborators; Mokdad A.H., Ballestros K. et al. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018; 319(14): 1444-1472. doi: 10.1001/jama.2018.0158.

8. Saz-Lara A., Battino M., Del Saz Lara A. et al. Differences in carotid to femoral pulse wave velocity and carotid intima media thickness between vegetarian and omnivorous diets in healthy subjects: a systematic review and meta-analysis. Food Funct. 2024; 15(3): 1135-1143. doi: 10.1039/d3fo05061k.

9. Lampsas S., Xenou M., Oikonomou E. et al. Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment. Molecules. 2023; 28(3): 969. doi: 10.3390/molecules28030969.

10. Мустафин Р.Н., Галиева Э.А. Роль микроРНК и ретроэлементов в патогенезе атеросклероза. Архивъ внутренней медицины. 2024; 14(2): 85-95. doi: 10.20514/2226-6704-2024-14-2-85-95

11. Fan H., Zhou J., Huang Y. et al. A Proinflammatory Diet Is Associated with Higher Risk of Peripheral Artery Disease. Nutrients. 2022; 14(17): 3490. doi: 10.3390/nu14173490.

12. Mathur R., Ahmid Z., Ashor A.W. et al. Effects of dietary-based weight loss interventions on biomarkers of endothelial function: a systematic review and meta-analysis. Eur. J. Clin. Nutr. 2023; 77(10): 927-940. doi: 10.1038/s41430-023-01307-6.

13. Ros E., Martínez-González M.A., Estruch R. et al. Mediterranean diet and cardiovascular health: Teachings of the PREDIMED study. Adv. Nutr. 2014; 5(3): 330S-6S. doi: 10.3945/an.113.005389.

14. Willcox B.J., Willcox D.C., Todoriki H. et al. Caloric restriction, the traditional Okinawan diet, and healthy aging: the diet of the world’s longest-lived people and its potential impact on morbidity and life span. Ann. N.Y. Acad. Sci. 2007; 1114: 434-55. doi: 10.1196/annals.1396.037.

15. Рудченко И.В., Тыренко В.В., Качнов В.А. Питание — один из важных факторов профилактики и лечения сердечно-сосудистых заболеваний, обусловленных атеросклерозом. Кардиоваскулярная терапия и профилактика. 2020; 19(3): 2301. doi: 10.15829/1728-8800-2020-2301.

16. Seidelmann S.B., Claggett B., Cheng S., et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public. Health. 2018; 3(9): e419-e428. doi: 10.1016/S2468-2667(18)30135-X.

17. Riccardi G., Giosuè A., Calabrese I., Vaccaro O. Dietary recommendations for prevention of atherosclerosis. Cardiovasc. Res. 2022; 118(5): 1188-1204. doi: 10.1093/cvr/cvab173.

18. Ежов М.В., Кухарчу В.В., Сергиенко И.В. и др. Нарушения липидного обмена. Клинические рекомендации 2023. Российский кардиологический журнал. 2023; 28(5): 5471. doi: 10.15829/1560-4071-2023-5471.

19. Shah B., Newman J.D., Woolf K. et al. Anti-Inflammatory Effects of a Vegan Diet Versus the American Heart Association-Recommended Diet in Coronary Artery Disease Trial. J.Am. Heart Assoc. 2018; 7(23): e011367. doi: 10.1161/JAHA.118.011367.

20. Grootveld M., Percival B.C., Leenders J., Wilson P.B. Potential Adverse Public Health Effects Afforded by the Ingestion of Dietary Lipid Oxidation Product Toxins: Significance of Fried Food Sources. Nutrients. 2020; 12(4): 974. doi: 10.3390/nu12040974.

21. Juvvi P., Kumar R., Semwal A.D. Recent studies on alternative technologies for deep-fat frying. J. Food Sci. Technol. 2024; 61(8): 1417- 1427. doi: 10.1007/s13197-023-05911-z.

22. Тюрюмин Я.Л., Шантуров В.А., Тюрюмина Е.Э. Физиология обмена холестерина (обзор). Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской Академии медицинских наук. 2012; 2(84): 153-158.

23. Soliman G.A. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients. 2019; 11(5): 1155. doi: 10.3390/nu11051155.

24. Arnesen E.K., Thorisdottir B., Bärebring L. et al. Nuts and seeds consumption and risk of cardiovascular disease, type 2 diabetes and their risk factors: a systematic review and meta-analysis. Food Nutr. Res. 2023; 67. doi: 10.29219/fnr.v67.8961.

25. Wang Y., Harding S.V., Thandapilly S.J. et al. Barley β-glucan reduces blood cholesterol levels via interrupting bile acid metabolism. Br.J. Nutr. 2017; 118(10): 822-829. doi: 10.1017/S0007114517002835.

26. Gulati S., Misra A., Pandey R.M. Effects of 3 g of soluble fiber from oats on lipid levels of Asian Indians — a randomized controlled, parallel arm study. Lipids Health Dis. 2017; 16(1): 71. doi: 10.1186/s12944-017-0460-3.

27. Cicero A.F. G., Fogacci F., Stoian A.P., Toth P.P. Red Yeast Rice for the Improvement of Lipid Profiles in Mild-to-Moderate Hypercholesterolemia: A Narrative Review. Nutrients. 2023; 15(10): 2288. doi: 10.3390/nu15102288.

28. Cheng H.M., Koutsidis G., Lodge J.K., et al. Tomato and lycopene supplementation and cardiovascular risk factors: A systematic review and meta-analysis. Atherosclerosis. 2017; 257: 100-108. doi: 10.1016/j.atherosclerosis.2017.01.009.

29. Potì F., Santi D., Spaggiari G. et al. Polyphenol Health Effects on Cardiovascular and Neurodegenerative Disorders: A Review and MetaAnalysis. Int. J. Mol. Sci. 2019; 20(2): 351. doi: 10.3390/ijms20020351.

30. Behl T., Bungau S., Kumar K. et al. Pleotropic Effects of Polyphenols in Cardiovascular System. Biomed. Pharmacother. 2020; 130: 110714. doi: 10.1016/j.biopha.2020.110714.

31. Nakayama H., Tsuge N., Sawada H., Higashi Y. Chronic intake of onion extract containing quercetin improved postprandial endothelial dysfunction in healthy men. J.Am. Coll. Nutr. 2013; 32(3): 160-4. doi: 10.1080/07315724.2013.797858.

32. Gao X., Yanan J., Santhanam R.K. et al. Garlic flavonoids alleviate H2 O2 induced oxidative damage in L02 cells and induced apoptosis in HepG2 cells by Bcl-2/Caspase pathway. J. Food Sci. 2021; 86(2): 366- 375. doi: 10.1111/1750-3841.15599.

33. Lindstedt S., Wlosinska M., Nilsson A.C. et al. Successful improved peripheral tissue perfusion was seen in patients with atherosclerosis after 12 months of treatment with aged garlic extract. Int. Wound J. 2021; 18(5): 681-691. doi: 10.1111/iwj.13570.

34. Wlosinska M., Nilsson A.C., Hlebowicz J. et al. The effect of aged garlic extract on the atherosclerotic process — a randomized doubleblind placebo-controlled trial. BMC Complement. Med. Ther. 2020; 20(1): 132. doi: 10.1186/s12906-020-02932-5.

35. Damay V.A., Ivan I. Resveratrol as an Anti-inflammatory Agent in Coronary Artery Disease: A Systematic Review, Meta-Analysis and Meta-Regression. Chin. J. Integr. Med. 2024 Jul 3. doi: 10.1007/s11655-024-3665-0.

36. Ebrahimi F., Ghazimoradi M.M., Fatima G., Bahramsoltani R. Citrus flavonoids and adhesion molecules: Potential role in the management of atherosclerosis. Heliyon. 2023; 9(11): e21849. doi: 10.1016/j.heliyon.2023.e21849.

37. Wang F., Zhao C., Yang M. et al. Four Citrus Flavanones Exert Atherosclerosis Alleviation Effects in ApoE-/- Mice via Different Metabolic and Signaling Pathways. J. Agric. Food Chem. 2021; 69(17): 5226- 5237. doi: 10.1021/acs.jafc.1c01463.

38. Mulvihill E.E., Burke A.C., Huff M.W. Citrus Flavonoids as Regulators of Lipoprotein Metabolism and Atherosclerosis. Annu. Rev. Nutr. 2016; 36: 275-99. doi: 10.1146/annurev-nutr-071715-050718.

39. Lin K., Chen H., Chen X. et al. Efficacy of Curcumin on Aortic Atherosclerosis: A Systematic Review and Meta-Analysis in Mouse Studies and Insights into Possible Mechanisms. Oxid. Med Cell. Longev. 2020; 2020: 1520747. doi: 10.1155/2020/1520747.

40. Helli B., Gerami H., Kavianpour M. et al. Curcumin Nanomicelle Improves Lipid Profile, Stress Oxidative Factors and Inflammatory Markers in Patients Undergoing Coronary Elective Angioplasty; A Randomized Clinical Trial. Endocr Metab Immune Disord Drug Targets. 2021; 21(11): 2090-2098. doi: 10.2174/1871530321666210104145231.

41. Kelava L., Nemeth D., Hegyi P. et al. Dietary supplementation of transient receptor potential vanilloid-1 channel agonists reduces serum total cholesterol level: a meta-analysis of controlled human trials. Crit. Rev. Food Sci. Nutr. 2022; 62(25): 7025-7035. doi: 10.1080/10408398.2021.1910138.

42. Harland J.I., Haffner T.A. Systematic review, meta-analysis and regression of randomised controlled trials reporting an association between an intake of circa 25 g soya protein per day and blood cholesterol. Atherosclerosis. 2008; 200(1): 13-27. doi: 10.1016/j.atherosclerosis.2008.04.

43. Ramsden C.E., Zamora D., Majchrzak-Hong S. et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ. 2016; 353: i1246. doi: 10.1136/bmj.i1246.

44. Mehmood A., Usman M., Patil P. et al. A review on management of cardiovascular diseases by olive polyphenols. Food Sci. Nutr. 2020; 8(9): 4639-4655. doi: 10.1002/fsn3.1668.

45. Luo S., Hou H., Wang Y. et al. Effects of omega-3, omega-6, and total dietary polyunsaturated fatty acid supplementation in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis. Food Funct. 2024; 15(3): 1208-1222. doi: 10.1039/d3fo02522e.

46. Sekikawa A., Cui C., Sugiyama D. et al. Effect of High-Dose Marine Omega-3 Fatty Acids on Atherosclerosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients. 2019; 11(11): 2599. doi: 10.3390/nu11112599.

47. Alhassan A., Young J., Lean M.E. J., Lara J. Consumption of fish and vascular risk factors: A systematic review and meta-analysis of intervention studies. Atherosclerosis. 2017; 266: 87-94. doi: 10.1016/j.atherosclerosis.2017.09.028.

48. Gao L.G., Cao J., Mao Q.X. et al. Influence of omega-3 polyunsaturated fatty acid-supplementation on platelet aggregation in humans: a meta-analysis of randomized controlled trials. Atherosclerosis. 2013; 226(2): 328-34. doi: 10.1016/j.atherosclerosis.2012.10.056.

49. Naqvi A.Z., Davis R.B., Mukamal K.J. Nutrient intake and peripheral artery disease in adults: Key considerations in cross-sectional studies. Clin. Nutr. 2014; 33: 443–447. doi: 10.1016/j.clnu.2013.06.011.

50. Bleys J., Miller E.R. 3rd, Pastor-Barriuso R. et al. Vitamin-mineral supplementation and the progression of atherosclerosis: a meta-analysis of randomized controlled trials. Am.J. Clin. Nutr. 2006; 84(4): 880-887.

51. Liu Y., Tian T., Zhang H. et al. The effect of homocysteine-lowering therapy with folic acid on flow-mediated vasodilation in patients with coronary artery disease: a meta-analysis of randomized controlled trials. Atherosclerosis. 2014; 235(1): 31-5. doi: 10.1016/j.atherosclerosis.2014.03.032.

52. Bruckert E., Labreuche J., Amarenco P. Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis. Atherosclerosis. 2010; 210(2): 353-61. doi: 10.1016/j.atherosclerosis.2009.12.023.

53. Kumar S., Nanduri R., Bhagyaraj E. et al. Vitamin D3-VDR-PTPN6 axis mediated autophagy contributes to the inhibition of macrophage foam cell formation. Autophagy. 2021; 17(9): 2273-2289. doi: 10.1080/15548627.2020.1822088.

54. Yin K., You Y., Swier V. et al. Vitamin D Protects Against Atherosclerosis via Regulation of Cholesterol Efflux and Macrophage Polarization in Hypercholesterolemic Swine. Arterioscler. Thromb. Vasc. Biol. 2015; 35(11): 2432-42. doi: 10.1161/ATVBAHA.115.306132.

55. Uberti F., Lattuada D., Morsanuto V. et al. Vitamin D protects human endothelial cells from oxidative stress through the autophagic and survival pathways. J. Clin. Endocrinol. Metab. 2014; 99(4): 1367-74. doi: 10.1210/jc.2013-2103.

56. Oh J., Riek A.E., Darwech I. et al. Deletion of macrophage Vitamin D receptor promotes insulin resistance and monocyte cholesterol transport to accelerate atherosclerosis in mice. Cell Rep. 2015; 10(11): 1872-86. doi: 10.1016/j.celrep.2015.02.043.

57. Lupoli R., Vaccaro A., Ambrosino P. et al. Impact of Vitamin D deficiency on subclinical carotid atherosclerosis: a pooled analysis of cohort studies. J. Clin. Endocrinol. Metab. 2017; 102(7): 2146-2153. doi: 10.1210/jc.2017-00342.

58. Choi Y.K., Song S.W., Shin B.R. et al. Serum vitamin D level is negatively associated with carotid atherosclerosis in Korean adults. Int. J. Food Sci. Nutr. 2017; 68(1): 90-96. doi: 10.1080/09637486.2016.1216526.

59. Stricker H., Tosi Bianda F., Guidicelli-Nicolosi S. et al. Effect of a single, oral, high-dose vitamin D supplementation on endothelial function in patients with peripheral arterial disease: a randomised controlled pilot study. Eur. J. Vasc. Endovasc. Surg. 2012; 44(3): 307-12. doi: 10.1016/j.ejvs.2012.06.023.

60. Pincombe N.L., Pearson M.J., Smart N.A. et al. Effect of vitamin D supplementation on endothelial function — An updated systematic review with meta-analysis and meta-regression. Nutr. Metab. Cardiovasc. Dis. 2019; 29(12): 1261-1272. doi: 10.1016/j.numecd.2019.08.005.

61. Säidifard N., Tangestani H., Djafarian K. et al. Serum Vitamin D Level and Carotid Intima-Media Thickness: A Systematic Review and MetaAnalysis of Observational Studies and Randomized Control Trials. Horm. Metab. Res. 2020; 52(5): 305-315. doi: 10.1055/a-1153-0657.

62. Zhou A., Selvanayagam J.B., Hyppönen E. Non-linear Mendelian randomization analyses support a role for vitamin D deficiency in cardiovascular disease risk. Eur. Heart. J. 2022; 43(18): 1731-1739. doi: 10.1093/eurheartj/ehab809.

63. Jonsson A.L., Bäckhed F. Role of gut microbiota in atherosclerosis. Nat. Rev. Cardiol. 2017; 14(2): 79-87. doi: 10.1038/nrcardio.2016.183.

64. Vourakis M., Mayer G., Rousseau G. The Role of Gut Microbiota on Cholesterol Metabolism in Atherosclerosis. Int. J. Mol. Sci. 2021; 22(15): 8074. doi: 10.3390/ijms22158074.

65. Grzelak-Błaszczyk K., Milala J., Kosmala M. et al. Onion quercetin monoglycosides alter microbial activity and increase antioxidant capacity. J. Nutr. Biochem. 2018; 56: 81-88. doi: 10.1016/j.jnutbio.2018.02.002.

66. Khalili L., Centner A.M., Salazar G. Effects of Berries, Phytochemicals, and Probiotics on Atherosclerosis through Gut Microbiota Modification: A Meta-Analysis of Animal Studies. Int. J. Mol. Sci. 2023; 24(4): 3084. doi: 10.3390/ijms24043084.

67. Groen A.K., Bloks V.W., Verkade H., Kuipers F. Cross-talk between liver and intestine in control of cholesterol and energy homeostasis. Mol. Aspects Med. 2014; 37: 77-88. doi: 10.1016/j.mam.2014.02.001.

68. Bergeron N., Chiu S., Williams P.T. et al. Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial. Am.J. Clin. Nutr. 2019; 110(1): 24-33. doi: 10.1093/ajcn/nqz035.

69. Shivappa N., Steck S.E., Hurley T.G., et al. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014; 17: 1689–1696. doi: 10.1017/S1368980013002115.

70. Samani N.J., Boultby R., Butler R. et al. Telomere shortening in atherosclerosis. Lancet. 2001; 358(9280): 472-3. doi: 10.1016/S0140-6736(01)05633-1.

71. Nettleton J.A., Diez-Roux A., Jenny N.S. et al. Dietary patterns, food groups, and telomere length in the Multi-Ethnic Study of Atherosclerosis (MESA). Am.J. Clin. Nutr. 2008; 88(5): 1405-12.

72. Torrijo-Belanche C., Moreno-Franco B., Muñoz-Cabrejas A. et al. High Serum Phosphate Is Associated with Cardiovascular Mortality and Subclinical Coronary Atherosclerosis: Systematic Review and MetaAnalysis. Nutrients. 2024; 16(11): 1599. doi: 10.3390/nu16111599.

73. Molina R.E., Bohrer B.M., Mejia S.M. V. Phosphate alternatives for meat processing and challenges for the industry: A critical review. Food. Res. Int. 2023; 166: 112624. doi: 10.1016/j.foodres.2023.112624.

74. Vinchi F., Porto G., Simmelbauer A. et al. Atherosclerosis is aggravated by iron overload and ameliorated by dietary and pharmacological iron restriction. Eur. Heart J. 2020; 41(28): 2681-2695. doi: 10.1093/eurheartj/ehz112.

75. Naruszewicz M., Zapolska-Downar D., Kośmider A. et al. Chronic intake of potato chips in humans increases the production of reactive oxygen radicals by leukocytes and increases plasma C-reactive protein: a pilot study. Am.J. Clin. Nutr. 2009; 89(3): 773-7. doi: 10.3945/ajcn.2008.26647.

76. Qavi A.H., Zhou G., Ward R.E. et al. Association of potato consumption with calcified atherosclerotic plaques in the coronary arteries: The NHLBI Family Heart Study. Nutr. Metab. Cardiovasc. Dis. 2023; 33(12): 2413-2418. doi: 10.1016/j.numecd.2023.07.027.

77. Mérida D.M., Acosta-Reyes J., Bayán-Bravo A. et al. Phthalate exposure and subclinical carotid atherosclerosis: A systematic review and meta-analysis. Environ. Pollut. 2024; 350: 124044. doi: 10.1016/j.envpol.2024.124044.

78. Morelli M.B., Santulli G., Gambardella J. Calcium supplements: Good for the bone, bad for the heart? A systematic updated appraisal. Atherosclerosis. 2020; 296: 68-73. doi: 10.1016/j.atherosclerosis.2020.01.008.

79. Huang C., Huang J., Tian Y. et al. Sugar sweetened beverages consumption and risk of coronary heart disease: a meta-analysis of prospective studies. Atherosclerosis. 2014; 234(1): 11-6. doi: 10.1016/j.atherosclerosis.2014.01.037.