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936 PA R T V / Health Promotion and Disease Prevention
recommends a high-quality diet that contains limited amounts of 6. Advisory Board Second International Heart Health Conference. (1995).
fat, saturated fat, cholesterol, sodium, and refined sugars and am- The Catalonia declaration investing in heart health. Declaration of the Ad-
ple servings of fruits, vegetables, and whole grain products. 31,32 visory Board of the Second International Heart Health Conference,
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Barcelona, Catalonia (Spain). June 1, 1995. Retrieved October 1, 2008,
Although high intakes of fat, salt, and refined sugar have not been from http://www.internationalhearthealth.org/Publications/catalonia
a concern for developing countries, recent global trends toward 1995.pdf
eating unhealthy fast food make these problems increasingly rele- 7. International Heart Health Conference Advisory Board. (1992). The Vic-
vant for these countries as well. 33,34 In China, the gastronomic toria Declaration on heart health. Declaration of the Advisory Board of the
International Heart Health Conference, Victoria, Canada, May 28, 1992.
change to a “Western diet” has been linked to a dramatic increase Retrieved October 1, 2008, from http://www.internationalhearthealth.org/
in the CHD mortality rate. 35 Publications/victoria_eng_1992.pdf
On the other hand, dietary modifications have been shown to 8. New Zealand Guidelines Group (NZGG). (2002). Cardiac rehabilitation.
slow the progression of CVD. Consumption of oily fish at least Retrieved October 1, 2008, from http://www.nzgg.org.nz/guide-
lines/0001/cardiac_rehabilitation.pdf
twice a week demonstrated a 32% reduction in coronary heart 9. Lopez, A. D., Mathers, C. D., Ezzati, M., et al. (2006). Global and re-
disease mortality and a 29% reduction in all-cause mortality. 36 A gional burden of disease and risk factors, 2001: Systematic analysis of
Mediterranean-type diet enriched with linolenic acid was associ- population health data. Lancet, 367(9524), 1747–1757.
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ated with reduction in coronary and all-cause mortality of 10. WHO Regional Office for Europe. (1995). Protocol and guidelines: Coun-
65%. 37,38 Another cohort study supported the beneficial effects trywide Integrated Noncommunicable Disease Intervention (CINDI) Pro-
gramme (Document EUR/JPC/CIND9402/PB04). Copenhagen, Den-
of fruits (risk ratio [RR] 0.73; 95% confidence interval [CI]: mark: Author.
0.54, 0.98) and vegetables (raw vegetables: RR 0.67; 95% CI: 11. Pan American Health Organization. (1998). Protocol de CARMEN (CAR-
0.56, 0.79; cooked vegetables: RR 0.84; 95% CI: 0.71, MEN Protocol). Washington, DC: OPS.
1.00). 39 Furthermore, interventional studies that examined diets 12. Yusuf, S., Hawken, S., Ounpuu, S., et al. (2004). Effect of potentially
rich in fibers (fruits, vegetables, nuts, and legumes), fish, and en- modifiable risk factors associated with myocardial infarction in 52 coun-
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tries (the INTERHEART study): Case-control study. Lancet, 364(9438),
hanced intake of unsaturated fatty acids, such as olive oils or mar- 937–952.
garines, concluded that mortality was significantly reduced. 40–42 13. Iestra, J., Kromhout, D., van der Schouw, Y., et al. (2005). Effect size
Finally, consuming a diet rich in fruits, vegetables, reduced dairy estimates of lifestyle and dietary changes on all-cause mortality in coro-
fat, and whole grains and low in red and processed meats, fast nary artery disease patients: A systematic review. Circulation, 112,
924–934.
foods, and soda was associated with smaller gains in body mass 14. Okrainec, K., Banerjee, D., & Eisenberg, M. (2004). Coronary artery dis-
index and waist circumference (see Chapters 35, 36, 38, and ease in the developing world. American Heart Journal, 148(1), 7–15.
40). 43 15. Mosca, L., Banka, C., Benjamin, E., et al. (2007). Evidence-based guide-
lines for cardiovascular disease prevention in women: 2007 update. Circu-
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lation, 115, 1481–1501.
SUMMARY 16. Gajalakshmi, C. K., Jha, P., Ranson, K., et al. (2000). Global patterns of
smoking and smoking-attributable mortality. In P. Jha & F. Chaloupka
(Eds.), Tobacco control in developing countries. Geneva, Switzerland: OUP
The evidence is overwhelming that control of smoking, regular for World Bank and World Health Organization.
physical activity, and a heart-healthy diet are important lifestyle 17. Yousef, J. (2003). Evaluation of the Agency’s non-communicable disease pre-
vention and control programme. Jordan: UNRWA.
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interventions that can improve CVD. Adopting healthy lifestyles 18. WHO. (2005). Water pipe tobacco smoking: Health effects, research needs
is not an easy task. The nursing profession, however, is uniquely and recommended actions by regulations. The WHO study group on tobacco
positioned to promote the following key messages in our commu- product regulation. Retrieved October 1, 2008, from http://www.who.int/
nities: tobacco/global_interaction/tobreg/Waterpipe%20recommendation_Final.
pdf (cited June 20, 2006).
■ Do not use tobacco products. 19. Shihadeh, A., & Saleh, R. (2005). Polycyclic aromatic hydrocarbons, car-
■ Exercise at least 30 minutes most days of the week. bon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the
narghile water pipe. Food and Chemical Toxicology, 43(5), 655–661.
■ Eat vegetables, fruits, and whole grains.
20. Maziak, W., Eissenberg, T., & Ward, K. D. (2005). Patterns of waterpipe
■ Restrict salt and sugar consumption. use and dependence: Implications for intervention development. Pharma-
cology, Biochemistry, and Behavior, 80(1), 173–179.
21. Maziak, W. (2004). Prevalence and characteristics of narghile smoking
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