Assessing the Effects of Diet and Behavior on Cardiovascular Disease: The Role of Biomarkers in Understanding Biology and Mechanism.
Cardiovascular disease (CVD)2 remains a major cause of morbidity and mortality in western societies, such as those in North America and Europe, and is a rapidly growing cause of death in the rest of the world. A substantial portion of the worldwide burden of CVD is due to unhealthy behaviors including smoking, lack of exercise, unhealthy diet, and alcohol consumption (1) Epidemiologic studies have established the association between these behaviors and the development of CVD, and considerable resources have been directed at favorably modifying these apparently unhealthy behaviors to reduce the burden of CVD (2) However, despite robust evidence of strong associations between healthy behaviors and reduced risk of heart disease, our understanding of the mechanisms by which these behaviors alter CVD pathogenesis remains incomplete. Furthermore, the results of studies examining these associations in diverse populations often differ. Ultimately, physical activity, diet and alcohol consumption are complex behaviors that have real impacts on cardiovascular health, but our understanding of the mechanisms of benefit (or harm) are often impaired by the limitations intrinsic to observational epidemiologic studies. One important example that highlights these challenges is the observed association between alcohol consumption and CVD (3) The mechanisms by which regular alcohol consumption might alter cardiovascular risk remain obscure, and studies that have examined the association between alcohol consumption and measures of atherosclerosis have produced inconsistent findings (4, 5) Furthermore, moderate alcohol consumption appears to be associated with a reduced risk of CVD, whereas higher alcohol consumption is associated with hypertension, stroke and increased cardiovascular risk (6) The pathways by which alcohol affects the cardiovascular system remain uncertain, and putative intermediates such as HDL cholesterol (HDL C) and fibrinogen may be important markers of alcohol's effect on metabolism, subclinical inflammation, and thrombosis but may not actually
Clinical chemistry