Ernährung in der Prävention und Therapie der koronaren Herzkrankheit

Ernährung und Lebensstil spielen für die Entstehung kardiovaskulärer Risikofaktoren, die Manifestation und Prognose der koronaren Herzkrankheit (KHK) eine entscheidende Rolle. Von einem gesunden Ernährungs- und Lebensstil profitieren Patienten selbst bei einem stark erhöhten genetischen Risiko für KHK. Diese Übersicht fasst die von Erfahrungen in Populationen mit niedriger Inzidenz und von Interventionsstudien ableitbaren Ratschläge zusammen.

Abstract

Diet and lifestyle have an important impact on the development of cardiovascular risk factors, the manifestation of coronary heart disease, and the prognosis after a cardiovascular event. Even in the presence of strong genetic predisposition patients benefit from a healthy lifestyle with respect to coronary heart disease. Much of the effectiveness of lifestyle interventions is supposedly due to their broad influence on all major risk factors as there are overweight, central obesity, lipid disorders, hypertension, and diabetes mellitus type 2, but also due to independent mechanisms. A Mediterranean diet has been repeatedly shown to reduce cardiovascular events by exchange of several nutrients among others preferring olive oil or nuts, even without measurable impact on conventional risk factors. A diet rich in fruit, vegetables and low-fat milk products and limited in salt and calories if appropriate is considered evidence-based for reducing elevated blood pressure and prevention of coronary heart disease. In terms of insulin resistance and prevention of type 2 diabetes the multimodal interventions of the diabetes prevention studies have set the gold standard. Strictly avoiding nutrients rich in those fatty acids (lauristic, myristic, palmitic acid) that increase cholesterol synthesis and reduce hepatic LDL-uptake have proven effective for lowering LDL-cholesterol. Even in clinically overt coronary heart disease, diet, physical activity, and stress management can induce regression of coronary stenoses and reduce angina pectoris. Diet and lifestyle may be employed as a sole preventative measure, but also combined with medication. Recommendations need not only consider the individual risk profile, but also the personal preferences to ensure adequate adherence.

Kernaussagen

• Ernährung und Lebensstil spielen im Hinblick auf die Entstehung kardiovaskulärer Risikofaktoren und die Manifestation und Prognose der koronaren Herzkrankheit eine herausragende Rolle.

• Ernährungs- und Lebensstilinterventionen sollten in der Primär-, Sekundär- und Tertiärprävention allein und in Verbindung mit medikamentösen Therapien eingesetzt werden.

• Es sollte darauf hingewiesen werden, dass eine strikte Ernährungs- und Lebensstilintervention die Möglichkeit einer kurativen Therapie verspricht und Interventionen entbehrlich werden können.

• Gemeinsame Basis aller evidenzbasierten Diäten ist die Reduktion von rotem und verarbeitetem Fleisch, fettreichen Milchprodukten und gezuckerten Getränken. Stattdessen sind Vollkornprodukte, rohes und gekochtes Gemüse, Hülsenfrüchte, Obst, Fisch und pflanzliche Öle zu bevorzugen.

• Die hohe Wirksamkeit der Lebensstilintervention beruht auf der gleichzeitigen Beeinflussung aller zentralen Risikofaktoren und darüber hinaus eigenständigen Effekten.

• Ernährungsempfehlungen sind in multimodalen Programmen, kombiniert mit körperlicher Aktivität und Stressreduktion, aufgrund der additiven Effekte und wechselseitigen Beeinflussung erfolgversprechend.

• Realistische Zielsetzungen und eine stufenweise Umsetzung der Ziele verbessert die Adhärenz. In der Beratung ist deshalb nicht nur das Risikoprofil des Patienten zu beachten, sondern auch die individuellen Wünsche und Bedürfnisse sowie die Möglichkeiten zur Verhaltensänderung zu berücksichtigen.

Schlüsselwörter

Ernährung - Ernährungsmuster - Lebensstil - kardiovaskuläres Risiko - koronare Herzkrankheit

Keywords

nutrition - dietary pattern - lifestyle - cardiovascular risk - coronary heart disease

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