2024 Stats on CVD & Impact of Nutrition (especially Mediterranean Diet)

Jack’s Podcast on Slowing Aging

Briefing Document: Review of Heart Health Statistics, the Importance of Colorful Diets, and the Mediterranean Diet

Date: October 26, 2023 Prepared For: [Your Intended Audience] Subject: Review of Key Insights on Cardiovascular Health, the Role of Fruit and Vegetable Variety, and the Benefits of the Mediterranean Diet.

This briefing document summarizes the main themes and important facts from three sources: the American Heart Association's "2024 Heart Disease and Stroke Statistics Update Fact Sheet," Ocean Robbins' article "Eat the Rainbow: Why Color Variety Matters With Fruits & Vegetables," and Beth Ann Mayer's "8 Ways the Mediterranean Diet Can Help You Live a Longer and Healthier Life."

Source 1: American Heart Association "2024 Heart Disease and Stroke Statistics Update Fact Sheet"

Main Themes: This fact sheet provides a statistical overview of heart disease, stroke, other cardiovascular diseases (CVD), and their risk factors in the United States, with some global context. It also briefly highlights the American Heart Association's role in research funding.

Key Ideas and Facts:

• Prevalence and Mortality of CVD: CVD remains a leading cause of death in the US. In 2021, it accounted for 931,578 deaths, surpassing the combined mortality of all forms of cancer and chronic lower respiratory disease.
• Quote: "Heart disease and stroke claimed more lives in 2021 in the United States than all forms of cancer and chronic lower respiratory disease combined."
• Economic Burden of CVD: The financial impact of CVD is substantial. Between 2019 and 2020, direct and indirect costs totaled $422.3 billion.
• Quote: "Between 2019 and 2020, direct and indirect costs of total CVD were $422.3 billion ($254.3 billion in direct costs and $168.0 billion in lost productivity/mortality)."
• Disparities in CVD Prevalence: Non-Hispanic Black adults have the highest prevalence of CVD.
• Quote: "In 2017 to 2020 in the United States, 59.0% of non-Hispanic Black females and 58.9% of non-Hispanic Black males had some form of CVD. This race category had the highest prevalence of CVD."
• Leading Causes within CVD: Coronary heart disease (CHD) was the leading cause of CVD-related deaths in the US in 2021 (40.3%), followed by stroke (17.5%) and high blood pressure (13.4%).
• Quote: "In 2021 in the United States, coronary heart disease (CHD) was the leading cause of deaths (40.3%) attributable to CVD in the United States, followed by stroke (17.5%), other CVD (17.1%), high blood pressure (13.4%), heart failure (9.1%), diseases of the arteries (2.6%)."
• Stroke Impact: Stroke is a major cause of death and disability. In 2021, it accounted for approximately 1 in every 21 deaths in the US, and someone died of stroke every 3 minutes 14 seconds. While the CHD death rate decreased, the age-adjusted stroke death rate increased by 8.4% from 2011 to 2021.
• Quote: "In 2021, stroke accounted for approximately 1 of every 21 deaths in the United States."
• Quote: "On average in 2021, someone died of stroke every 3 minutes 14 seconds in the United States."
• Sudden Cardiac Arrest: In 2021, there were 20,114 underlying cause sudden cardiac arrest deaths in the US. Most out-of-hospital cardiac arrests occur at home, and survival to hospital discharge is low (9.3% overall).
• Key Risk Factors: Life's Essential 8: The AHA highlights eight key health factors and behaviors ("Life's Essential 8") that influence heart disease and stroke risk: not-smoking, physical activity, healthy diet, healthy body weight, sleep health, and control of cholesterol, blood pressure, and blood sugar.
• Smoking: Remains a leading preventable cause of death and disability, with significant risks associated with both direct smoking and secondhand smoke exposure.
• Quote: "In the United States, smoking was the leading risk factor for years of life lost to premature mortality and the third leading risk factor for years of life lived with disability or injury in 2019."
• Physical Inactivity: Only a minority of US adults (24.2% in 2020) meet the recommended guidelines for aerobic activity.
• Nutrition: Diet scores based on the AHA's metric are low across demographic groups, with high sodium intake, low whole grain intake, and low legume intake being leading dietary risk factors globally.
• Quote: "Using the AHA’s Life’s Essential 8 scoring metric, diet was among the 4 metrics with the lowest scores; the range for diet across demographic groups was 23.8 to 47.7 out of 100."
• Overweight/Obesity: A significant portion of US adults are overweight or obese (41.8% in 2017-2020).
• Cholesterol, Sleep, Diabetes, and High Blood Pressure: The fact sheet provides statistics on the prevalence of high cholesterol, insufficient sleep, diagnosed and undiagnosed diabetes (including prediabetes), and hypertension in US adults, all of which are significant risk factors for CVD.
• Quote (High Blood Pressure): "Using data from 2017 to 2020, 122.4 million (46.7%) US adults had hypertension."
• AHA Research Funding: The AHA is a major non-profit funder of cardiovascular and cerebrovascular research, having funded over $5 billion since 1949, and ten Nobel Prize recipients have received AHA support.

Source 2: Ocean Robbins "Eat the Rainbow: Why Color Variety Matters With Fruits & Vegetables"

Main Themes: This article emphasizes the importance of consuming a diverse range of colorful fruits and vegetables for optimal health, highlighting the role of phytonutrients.

Key Ideas and Facts:

• Rainbow Nutrition: Eating a "rainbow" of fruits and vegetables ensures a broader intake of vitamins, minerals, antioxidants, and phytonutrients, which are more powerful collectively than individual supplements.
• Quote: "In fact, the variety of vitamins, minerals, antioxidants, and phytochemicals in fruits and vegetables may be more powerful for your health than any pill."
• Phytonutrients and Color: Each color in fruits and vegetables is attributed to specific phytonutrients, natural compounds that protect plants and may offer health benefits to humans, including protection against lifestyle diseases.
• Quote: "Each color in fruits and vegetables is created by specific phytonutrients, which are natural compounds that help protect plants from germs, bugs, the sun, and other threats. And each color indicates an abundance of specific nutrients."
• Low Intake of Colorful Foods: A significant majority of Americans do not meet the recommended intake levels for fruits and vegetables and fall short in virtually every color category of phytonutrients.
• Quote: "In 2013, 13.1% of respondents met fruit intake recommendations and 8.9% met vegetable recommendations."
• Quote: "…8 out of 10 people in the US are falling short in virtually every color category of phytonutrients."
• Specific Color Benefits and Examples: The article details the potential health benefits associated with different color groups:
• Red Foods (lycopene, ellagic acid): May fight cancer, reduce diabetes and heart disease risk, improve skin quality (e.g., tomatoes, watermelon, beets, berries).
• Yellow and Orange Foods (vitamin C, carotenoids like beta-carotene, lutein, zeaxanthin): May improve immune function, reduce heart disease risk, promote eye health (e.g., citrus fruits, carrots, sweet potatoes).
• Quote (Citrus): "Citrus fruits, like oranges, contain a unique phytonutrient called hesperidin, which helps to increase blood flow. This has important health ramifications... consuming citrus may also reduce your risk of stroke."
• Green Foods (lutein, isothiocyanates, isoflavones, vitamin K, folate): May boost the immune system, aid detoxification, restore energy, support blood and bone health, and potentially slow cognitive decline (e.g., leafy greens, broccoli, avocado, kiwi).
• Quote (Leafy Greens): "Research has even shown that eating leafy greens is associated with a slower rate of cognitive decline... likened to being 11 years younger in age, compared to those who consumed fewer greens."
• Purple and Blue Foods (anthocyanins, resveratrol): May reduce cancer and heart disease risk, support cognition, decrease inflammation, and improve skin health (e.g., blueberries, red grapes, red cabbage).
• Brown and White Foods (sulforaphane, allicin, quercetin): May protect against certain cancers, keep bones strong, and are heart-healthy choices (e.g., cauliflower, garlic, onions, mushrooms).
• Whole Foods vs. Supplements: Emphasizes that obtaining phytonutrients from whole foods is generally more beneficial than taking supplements, which may even increase cancer risk in some cases.
• Quote: "Getting your phytonutrients from whole foods is best. In fact, some studies show that taking phytonutrients, like lycopene and beta-carotene, in supplement form may actually increase the risk of cancer. But consuming these phytonutrients in whole food form, like tomato sauce, may help decrease the risk of cancer."
• Practical Tips for Eating the Rainbow: Provides actionable advice on how to incorporate a variety of colorful fruits and vegetables into daily meals, such as starting with a colorful breakfast, enjoying large salads, making vegetables the main dish, and creating "rainbow meals."
• Recipe Ideas: Includes several colorful recipe suggestions to inspire variety in the diet.
• Retraining Taste Buds: Offers steps for individuals (and children) to learn to appreciate a wider range of fruits and vegetables by avoiding processed foods and repeatedly trying new produce in different ways.

Source 3: Beth Ann Mayer "8 Ways the Mediterranean Diet Can Help You Live a Longer and Healthier Life"

Main Themes: This article highlights recent research supporting the numerous health benefits of the Mediterranean diet, which prioritizes whole, nutrient-dense foods.

Key Ideas and Facts:

• Top-Ranked Diet: The Mediterranean diet has consistently been ranked as a top healthy diet due to its emphasis on whole foods and limitation of processed items.
• Quote: "The Mediterranean diet has been named the top diet by U.S. News & World Report for six consecutive years."
• Focus on Whole Foods: The diet emphasizes produce, lean or plant-based proteins, and healthy fats while limiting processed and refined foods, unhealthy fats, added sugars, and salt.
• Quote (Trista Best, RD): "The Mediterranean diet is considered healthy because it emphasizes whole, nutrient-dense foods and limits processed and refined foods, which are often high in unhealthy fats, added sugars, and salt."
• Sustainability: Unlike restrictive diets, the Mediterranean diet is considered sustainable as it is based on overall eating patterns and can be tailored to individual preferences.
• Scientifically Supported Benefits: Recent research indicates the Mediterranean diet may contribute to:
• Better Sleep: Higher adherence to the diet is linked to longer and better sleep, potentially due to lower processed food intake and higher levels of omega-3 fatty acids that regulate melatonin.
• Reduced Inflammation: The diet's richness in plant-based foods, whole grains, and healthy fats may lower inflammatory markers, potentially protecting against diseases like heart disease and COVID-19.
• Quote (Mary Sabat, RDN, LD): "Reducing inflammation in the diet is a primary concern for anyone looking to remain well."
• Increased Lifespan: A long-term study associated the Mediterranean diet with a reduced risk of all-cause and cause-specific mortality (including CVD, cancer, and respiratory disease), likely due to its high antioxidant, vitamin, mineral, and fiber content.
• Quote (Denise Pate, MD): "The Mediterranean diet is high in fruits, vegetables, legumes, whole grains, and nuts, which are all rich in antioxidants, vitamins, minerals, and fiber. These foods have been linked to reduced inflammation, improved immune function, and a lower risk of chronic diseases."
• Lower Risk of Heart Disease in Women: Studies suggest women with higher adherence to the Mediterranean diet have a lower risk of developing or dying from cardiovascular disease and coronary heart disease.
• Quote (Joanna Troulakis, MD): "By limiting saturated and trans fats, the diet decreases LDL — or bad — cholesterol, which causes plaque buildup in the arteries, or atherosclerosis, and can lead to heart attacks and strokes. By encouraging healthy unsaturated fats, it combats inflammation and promotes brain health."
• Reduced Dementia Risk: Following the Mediterranean diet more closely is associated with a lower risk of dementia, potentially due to reduced inflammation, oxidative stress, and improved cardiovascular and metabolic health.
• Quote (Trista Best, MPH, RD, LD): "The research suggests that consuming a diet rich in fruits, vegetables, whole grains, and fish, and low in red meat and saturated fats can help protect the brain from cognitive decline."
• Lower Prostate Cancer Odds: Men with higher blood levels of micronutrients found in the Mediterranean diet (like lycopene and selenium) had a lower incidence of prostate cancer.
• Quote (Mary Sabat MS, RDN, LD): "The study clearly indicates that those men with higher concentrations of cancer-protective micronutrients had a lower risk of prostate cancer than men that did not have good levels of micronutrients."
• May Benefit Vision as You Age: Adherence to the Mediterranean diet, rich in nutrients like beta-carotene, lutein, zeaxanthin, and omega-3 fatty acids, is linked to a lower risk of progression of age-related macular degeneration. Lower alcohol intake, also advised in the diet, may be beneficial for vision.
• Quote (Mary Sabat): "The study found that people with higher consumptions of b-carotene, lutein, zeaxanthin, copper, folate, magnesium, vitamin A, niacin, vitamin B6, vitamin C, and omega-3 fatty acids were associated with a lower risk of progression of macular degeneration."
• Boost Mental Health: A small study indicated that following the Mediterranean diet improved the quality of life in men with moderate to severe depression, potentially due to the vitamins, minerals, fiber, and omega-3 fatty acids that support brain function, regulate blood pressure, improve gut health, and lower inflammation.
• Quote (Mary Sabat): "Fresh fruits and vegetables have vitamins, minerals, and fiber, which boost brain functioning. Fiber regulates blood pressure, which may aid in reducing anxiety and depression. Omega-3 fatty acids may boost mood and lower inflammation. Improved gut health, which can affect mood."
• Starting the Mediterranean Diet: Experts recommend making gradual changes, focusing on incorporating more Mediterranean-style meals. Examples of a sample daily menu are provided.
• Emphasis on Balance and Moderation: The diet allows for occasional indulgences as long as the overall focus is on healthy, whole foods.

Cross-Cutting Themes and Implications:

• Diet as a Cornerstone of Health: All three sources underscore the critical role of diet in preventing chronic diseases, including CVD, and promoting overall well-being.
• Importance of Fruits and Vegetables: Both the AHA statistics (through risk factors like poor diet) and the "Eat the Rainbow" article highlight the insufficient consumption of fruits and vegetables in the US. The Mediterranean diet also emphasizes their importance.
• Beyond Basic Nutrition: The "Eat the Rainbow" article delves into the benefits of phytonutrients, demonstrating that the variety of compounds in colorful produce offers health advantages beyond basic vitamin and mineral intake, which aligns with the observed benefits of the Mediterranean diet rich in these compounds.
• Preventive Measures: The information presented emphasizes the potential for lifestyle modifications, particularly dietary changes, to mitigate the risk of major health issues like heart disease, stroke, dementia, and certain cancers.
• Public Health Significance: The high prevalence and cost of CVD in the US, as detailed by the AHA, underscore the need for public health initiatives that promote healthier eating patterns, such as those emphasized in the "Eat the Rainbow" and Mediterranean diet articles.

Conclusion:

These sources collectively paint a clear picture of the profound impact of diet on health, particularly concerning cardiovascular disease and other chronic conditions. The AHA statistics highlight the significant burden of CVD, while the "Eat the Rainbow" article provides a framework for improving dietary quality by emphasizing the consumption of a wide variety of colorful fruits and vegetables rich in beneficial phytonutrients. The Mediterranean diet emerges as a scientifically supported eating pattern that aligns with these principles and offers a multitude of health benefits, including reduced risk of major diseases, improved sleep and mental health, and potentially increased longevity. These insights underscore the importance of promoting and adopting dietary patterns rich in whole, colorful foods as a key strategy for improving public health.

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