Table 2. Comparing the recommendations to reduce clinical risk factors for ASCVD between the ACC/AHA and Korea.
| Clinical risk factors | 2013/2019 ACC/AHA guideline recommendations18,34 | Korean recommendations35,39,40,44,45,* |
|---|---|---|
| ASCVD | 1. Increase intake of vegetables, fruits, legumes, nuts, whole grains, and fish | 1. Reduce intake of calories from saturated fat and trans fat |
| 2. Replace saturated fat with dietary monounsaturated and polyunsaturated fats | 2. Replace saturated fat with dietary polyunsaturated fat | |
| 3. Reduce intake of cholesterol and sodium | ||
| 4. Minimize intake of processed meats, refined carbohydrates, and sweetened beverages | ||
| 5. Decrease intake of trans fats | ||
| Overweight/obesity | 1. Counseling and comprehensive lifestyle interventions, including calorie restriction | 1. Individualized calorie restriction and intake of carbohydrate, protein, and fat |
| 2. Restriction of certain food types (such as high-carbohydrate foods, low-fiber foods, and/or high-fat foods) | 2. High dietary quality | |
| 3. Limit alcohol consumption | ||
| T2DM | 1. Tailored nutrition plan focusing on a heart-healthy dietary pattern | 1. Individualized medical nutrition therapy by a clinical dietitian |
| 2. Maintain optimal weight | 2. Reduce energy intake while maintaining a healthy eating pattern | |
| 3. Increase consumption of plant-based foods and consume large amounts of polyunsaturated and monounsaturated fatty acids | 3. Individualize intake of carbohydrates, protein, and fat (in general, carbohydrates should account for approximately 50–60% of total calories) | |
| 4. Avoid trans fatty acids and limit saturated fatty acid intake | 4. Limit sodium intake to 2,000 mg/day | |
| 5. Increase dietary fiber intake (20–25 g/day), and fiber should originate from various sources such as whole grains | ||
| 6. Restrict alcohol consumption | ||
| Dyslipidemia | 1. A dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats. | 1. Decrease intake of calories from saturated fat and trans fat |
| 2. A dietary pattern that achieves 5%–6% of calories from saturated fat. | 2. Replace saturated fat with dietary polyunsaturated fat | |
| 3. Restrict percentage of calories from saturated fat. | 3. Decrease total calories from alcohol and carbohydrates | |
| 4. Decrease percentage of calories from trans fat | ||
| Hypertension | 1. Lose weight | 1. Eat a balanced diet (carbohydrates, proteins, fats, fiber, minerals, vitamins) |
| 2. Follow a heart-healthy diet | 2. Decrease sodium intake | |
| 3. Decrease sodium intake | 3. Reduce intake of simple sugars, saturated fat, and total fat | |
| 4. Supplement dietary potassium | 4. Follow the Mediterranean diet and consume fish twice per week | |
| 5. Limit alcohol consumption | 5. Increase intake of vegetables and fruit | |
| 6. Consume adequate amounts of coffee |
ASCVD, atherosclerotic cardiovascular disease; ACC/AHA, American College of Cardiology/American Heart Association; T2DM, type 2 diabetes mellitus.
*Korean recommendations: 2018 Evidence-based Recommendations for Dyslipidemia in Primary Care; 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity; 2015 Treatment Guidelines for Diabetes; 2015 Korean Guidelines for the Management of Dyslipidemia; 2018 Korean Society of Hypertension Guidelines for the Management of Hypertension.