降低動脈粥樣硬化性心血管疾病風險的十個營養策略

Top 10 dietary strategies for atherosclerotic cardiovascular risk reduction

不良的飲食型態造成超重/肥胖、血脂異常、高血壓、糖尿病前期、糖尿病及代謝症候群等因素，增加了心血管疾病的發生率。建議透過十大營養策略來促進健康飲食模式，以降低動脈粥樣硬化性心血管疾病風險。此十大策略包含：1)將營養篩檢納入問診流程中以評估飲食狀況，並確定是否需轉介給營養師。2)適時將患者轉介給營養師進行醫學營養治療。3)對於超重/肥胖、第2型糖尿病和高血壓的營養和飲食建議。4)改善低密度脂蛋白膽固醇以及降低心血管疾病風險。5)採用有益心臟健康的飲食模式。6)降低三酸甘油酯以預防乳糜微粒血症。7)選擇對心血管有利的脂肪酸來源。8)避免攝取過多膽固醇。9)補充黏性纖維、植物固醇與益生菌。10)執行運動處方。通過這些營養策略以控制體重、改善血壓血脂、延緩罹患第二型糖尿病等，被認為是降低心血管疾病發生風險的有效方式。

Poor dietary quality has surpassed all other mortality risk factors, accounting for 11 million deaths and half of Cardiovascular disease (CVD) deaths globally. Implementation of current nutrition recommendations from the American Heart Association (AHA), American College of Cardiology (ACC) and the National Lipid Association (NLA) can markedly benefit the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). These include: 1) incorporate nutrition screening into medical visits; 2) refer patients to a registered dietitian nutritionist (RDN) for medical nutrition therapy, when appropriate, for prevention of ASCVD; 3) follow ACC/AHA Nutrition and Diet Recommendations for ASCVD prevention and management of overweight/obesity, type 2 diabetes and hypertension; 4) include NLA nutrition goals for optimizing low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) and reducing ASCVD risk; 5) utilize evidence-based heart-healthy eating patterns for improving cardiometabolic risk factors, dyslipidemia and ASCVD risk; 6) implement ACC/AHA/NLA nutrition and lifestyle recommendations for optimizing triglyceride levels; 7) understand the impact of saturated fats, trans fats, omega-3 and omega-6 polyunsaturated fats and monounsaturated fats on ASCVD risk; 8) limit excessive intake of dietary cholesterol for those with dyslipidemia, diabetes and at risk for heart failure; 9) include dietary adjuncts such as viscous fiber, plant sterols/stanols and probiotics; and 10) implement AHA/ACC and NLA physical activity recommendations for the optimization of lipids and prevention of ASCVD. Implementation of dietary strategies that promote healthier dietary patterns has been shown to improve blood pressure (BP), delay the onset of Type 2 Diabetes (T2DM), and improve the lipid profile, which is critical for reduce ASCVD risk.