What the Latest Evidence Tells Us About Fat and Cardiovascular Health
Diabetes has long been considered a risk equivalent to coronary heart disease (CHD) (1,2). The first report of the National Cholesterol Education Program, released in 1988, encouraged therapeutic lifestyle changes (nutrition, weight management, and physical activity) as first-line therapy for treating high blood cholesterol. Included in these recommendations was advice to eat a low-fat, low-cholesterol diet (3). This article presents a summary of the current evidence regarding dietary fat as it relates to diabetes and heart health, including the shift to thinking about type (or quality) of fat, rather than focusing as much on quantity.
In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the treatment of blood cholesterol. These guidelines recommended a significant shift from aiming for specific LDL cholesterol goals to considering the overall risk level for having both a heart attack and stroke (4). The guidelines also identified four major groups of patients for whom statin medications are indicated because they have the greatest likelihood of preventing stroke and heart attacks, including individuals with diabetes who are 40–75 years of age. Although treating based on risk now trumps treating to LDL targets, the ACC/AHA re-emphasized that lifestyle modification remains a crucial component of cardiovascular disease (CVD) risk reduction, both before and with the use of cholesterol-lowering medications (5).
As of 2015, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes have aligned with the ACC/AHA guidelines and recommend statin therapy for all adults with diabetes who have CVD risk factors or overt CVD, unless contraindicated or not tolerated (6). Current diabetes nutrition recommendations center around individualized eating patterns that focus on a nutrient-rich, whole-foods approach (in appropriate portions) to attain individual blood glucose, blood pressure, blood lipid, and body weight goals, as well …