Cardiovascular Division (Clinical) Elliott Antman, MD Donald S. Baim, MD Joshua Beckman, MD Charles M. Blatt, MD Eugene Braunwald, MD Christopher Cannon, MD Ming Hui Chen, MD Michael Chin, MD, PhD Howard Cooper, MD Mark Creager, MD Victor Dzau, MD Elazer Edelman, MD, PhD Andrew Eisenhauer, MD Laurence Epstein, MD James Fang, MD Jonas Galper, MD, PhD Peter Ganz, MD J. Michael Gaziano, MD Marie Gerhard-Hermen, MD Robert Giugliano, MD Michael Givertz, MD Samuel Z. Goldhaber, MD Thomas B. Graboys, MD Howard Hartley, MD Mukesh Jain, MD John Jarcho, MD Paula Johnson, MD Ralph Kelly, MD Scott Kinlay, MD Jamil Kirdar, MD James Kirshenbaum, MD Gideon Koren, MD Richard Kuntz, MD Raymond Kwong, MD Michael J. Landzberg, MD Jennifer Larsen, MD Dara Lee, MD Richard Lee, MD James Liao, MD Peter Libby, MD (Division Chief) Leonard Lilly, MD Bernard Lown, MD William Maisel, MD Thomas Michel, MD, PhD David Morrow, MD Karen Moulton, MD Gilbert Mudge, MD Patrick O’Gara, MD Marc A. Pfeffer, MD, PhD (Editor) Jorge Plutzky, MD Jeffrey Popma, MD Shmuel Ravid, MD Frederic Resnic, MD Paul Ridker, MD Thomas Rocco, MD Campbell Rogers, MD Maria Rupnick, MD, PhD Arthur Sasahara, MD Jay Schneider, MD Christine Seidman, MD Andrew Selwyn, MD Daniel Simon, MD Laurence Sloss, MD Regina Sohn, MD Scott Solomon, MD Lynne Stevenson, MD William Stevenson, MD Peter Stone, MD Michael Sweeney, MD Frederick Welt, MD Brigham and Women’s Hospital Fax: (617) 732-5291 Website: www.heartdoc.org The editorial content of Cardiology Rounds is determined solely by the Cardiovascular Division of Brigham and Women’s Hospital. This publication is made possible by an educational grant. A Teaching Hospital of HARVARD MEDICAL SCHOOL During my 18 years of clinical practice in hyperlipidemia at Brigham and Women’s Hospital and my teaching in this field, I have heard various views from practicing physicians on dietary treatment. First, many of these physicians usually have an intense interest in, and sophisticated knowledge about, the latest dietary information to give their patients, or to use themselves. In fact, I have always mar- veled that when I give a continuing medical education lecture devoted solely to drug therapy for hyperlipidemia, questions often focus on diet. These physicians pass on the information to their patients, knowing that many will not adhere to the recom- mendations. While recognizing the potential effectiveness of diet to prevent CVD, a second nihilistic view is dominated by disappointment in how poorly many patients fare with nonpharmacological therapy; thus, many physicians virtually abandon any mention of diet or exercise in their practice. As discussed below, modest changes in several areas of lifestyle can result in important reductions in risk that are not always reflected in marked changes in the lipid profile or blood pressure. A third view can be described, sadly, as disinterest, often coupled with a resistance to data demonstrating that one’s habits are at the root of most cardiovascular problems and the major cause of disease in our society. This issue of Cardiology Rounds is the first of a two-part series concerning dietary treatment to prevent cardiovascular disease (CVD). This issue will focus on blood pressure control and the next issue on hyperlipidemia. Diet and other lifestyle choices are critical factors affecting heart disease. These articles are designed to offer physi- cians with any of the viewpoints mentioned above, and by extention their patients, constructive approaches to diet therapy. There is no doubt that diet modification and exercise – in fact, any alteration of an individual’s habits – is difficult, and most often, a change is more difficult to maintain than to initiate. In order to assist a patient in making lifestyle choices that could make a differ- ence in disease prognosis, an informed, encouraging, optimistic, and compassionate approach by the physician is essential. Explicitly acknowledging the obstacles that many of Dietary treatment to prevent cardiovascular disease Part I: Lowering blood pressure FRANK M. SACKS, M.D. JANUARY 1999 Volume 3, Issue 1 August 2001 Volume 5, Issue 6 ™ Now available on the Internet www.cardiologyrounds.org Now available on the Internet www.cardiologyrounds.org