Yudkin and colleagues in the 1960s3 and 1970s4 found that a higher intake of sugar was associated with

increased CVD in both within-country and cross-country comparisons. A few recent studies have
examined the link between sugar consumption and coronary heart disease (CHD). The Iowa Women’s
Health Study5 showed no relation between the intake of sweets or desserts and risk of ischemic heart
disease in 34 492 women monitored for 9 years. However, some major sources of sugar such as soft
drinks were not considered. The Scottish Heart Health Study of 10 359 men and women found that
neither extrinsic nor intrinsic sugars were significant independent correlates of prevalent CHD after
adjustment for other major risk factors, but the data were not adjusted for other dietary variables. A
recent report from the Nurses’ Health Study showed that women who consumed diets with a high
glycemic load* (increased blood glucose excursions associated with intake of sweets or highly processed
starches and sweets) had an increased CHD risk, with those in the highest quintile having a >2-fold risk
during 10 years of follow-up.7 Simple carbohydrate alone was also predictive but did not reach statistical
significance. This analysis controlled for total energy intake and other major dietary and nondietary risk
factors.

Yudkin J. Sugar and ischaemic heart disease. Practitioner. 1967; 198: 680–683.Medline

Yudkin J. Dietary factors in atherosclerosis: sucrose. Lipids. 1978; 13: 370–372.CrossrefMedline

Recent large, prospective studies also show a direct inverse association between fruit and vegetable
intake and the development of CVD incidents such as coronary heart disease and stroke. However, the
biologic mechanisms whereby fruits and vegetables may exert their effects are not entirely clear and are
likely to be multiple. Many nutrients and phytochemicals in fruits and vegetables, including fiber,
potassium, and folate, could be independently or jointly responsible for the apparent reduction in CVD
risk. Functional aspects of fruits and vegetables, such as their low dietary glycemic load and energy
density, may also play a significant role. Although it is important to continue our quest for mechanistic
insights, given the great potential for benefits already known, greater efforts and resources are needed
to support dietary changes that encourage increased fruit and vegetable intake.

The American Heart Association recommends 30-60 minutes of aerobic exercise three to four times peer
week to promote cardiovascular fitness. In 1996 the Report of the Surgeon General on Physical Activity
and Health recommended the minimum level of physical activity required to achieve health benefits was
a daily expenditure of 150 kilocalories in moderate or vigorous activities. This recommendation is
consistent with guidelines established by the Centers for Disease Control and Prevention, and American
College of Sports Medicine. It also is consistent with the 1996 consensus statement from the National
Institutes of Health, recommending adults to accumulate at least 30 minutes of moderate activity most
days of the week. Moderate activities include pleasure walking, climbing stairs, gardening, yard work,
moderate-to-heavy housework, dancing and home exercise. More vigorous aerobic activities, such as
brisk walking running, swimming, bicycling, roller skating and jumping rope — done three or four times a
week for 30-60 minutes — are best for improving the fitness of the heart and lungs.

What are the consequences of physical inactivity for cardiovascular disease (CVD)?
Regular physical activity reduces the risk of dying prematurely from CVD. It also helps prevent the
development of diabetes, helps maintain weight loss, and reduces hypertension, which are all
independent risk factors for CVD. Less active, less fit persons have a 30-50 percent greater risk of
developing high blood pressure. Physical inactivity is a significant risk factor for CVD itself. It ranks
similarly to cigarette smoking, high blood pressure, and elevated cholesterol. One reason it has such a
large affect on mortality is because of its prevalence. Twice as many adults in the United States are
physically inactive than smoke cigarettes. Regular physical activity has been shown to help protect
against first cardiac episode, help patients' recovery from coronary surgeries, and will reduce the risk of
recurrent cardiac events.

A total of 77,389 community-dwelling adults, aged ≥65 years, were followed between 2006 and 2010.
Mortality was determined using matching cohort identifications with national death files. Cox
proportional hazards regression models were used to evaluate the relationship of BP with all-cause,
cardiovascular disease (CVD), and expanded-CVD mortalities.

The mortality risks of the stage 2–3 hypertension group were substantial (all-cause mortality: hazard
ratio [HR]: 1.23; 95% confidence interval [CI]: 1.10–1.37; CVDs mortality: HR: 1.31; 95% CI: 1.05–1.64;
expanded-CVDs mortality: HR: 1.40; 95% CI: 1.15–1.71). The cardiovascular and expanded-cardiovascular
mortality risks were lowest when systolic blood pressures were 120 to 129 mm Hg, and increased
significantly when systolic blood pressures (SBPs) were ≥160 mm Hg or diastolic BPs were ≥90 mm Hg. A
J-curve phenomenon for SBP on CVD and expanded-CVD mortality was observed. The impacts of stage
2–3 hypertension on mortality risks were significantly increased among women. The mortality risks of
hypertension were not attenuated with older age.

Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks. US
population data. Arch Intern Med 1993; 153:598–615. [PubMed]

Lawes CM, Vander Hoorn S, Rodgers A, et al. Global burden of blood-pressure-related disease, 2001.
Lancet 2008; 371:1513–1518. [PubMed]

As the prevalence of DM continues to rise, associated CVD - through both traditional CV risk factors and
the direct effects of DM on CVD - can also be expected to rise. Accordingly, proper control and treatment
of DM, along with aggressive treatment of associated CV risk factors is central to curbing the growing
prevalence and progression of DM and CVD. While the previous studies had focused on reducing
cholesterol in diabetic patients using statin therapy, other research groups have investigated the effect of
non-statin lipid-lowering therapies on CVD in diabetic patients.

Kannel WB. Lipids, diabetes, and coronary heart disease: insights from the Framingham Study. Am Heart
J. 1985;110:1100–1107
Fang ZY, Schull-Meade R, Leano R, Mottram PM, Prins JB, Marwick TH. Screening for heart disease in
diabetic subjects. Am Heart J. 2005;149:349–354. [PubMed]