Doctors may not be prepared to counsel patients on heart healthy diets

A study about diet to be presented at at the American College of Cardiology's 64th Annual Scientific Session in San Diego suggests cardiologists and other doctors may not be prepared to counsel patients on heart healthy diets, so efforts to help patients adopt healthier diets may fall short.

The small study, based on a survey of 236 cardiologists and internal medicine physicians and trainees at a large tertiary academic medical center, found that although physicians rate nutrition to be as important as statins in terms of reducing the risk of cardiovascular disease, only 13.5 percent agreed or strongly agreed that they were adequately trained to discuss nutrition with patients. The 28-question online survey was administered to identify gaps in nutritional knowledge and assess physician attitudes and practices related to nutrition for cardiovascular disease prevention. Two out of three fact-based questions were answered correctly. Cardiologists and internal medicine physicians scored about the same. Nearly all (89.7 percent) knew the Mediterranean diet was shown to reduce cardiovascular disease in randomized controlled trials, but less than half (45.5 percent) knew that low-fat diets had never been shown to do so.

What was surprising to researchers was how many physicians surveyed were not equipped to give practical recommendations for choosing heart healthy foods. For example, while the physicians knew about the blood pressure lowering effects of fruits and vegetables and LDL-cholesterol lowering effects of soluble fiber (81.7 and 87.6 percent, respectively), a much smaller percentage of respondents were able to correctly identify foods high in soluble fiber or an oily fish (69.5 and 30.8 percent, respectively).

"It's one thing to know an oily fish is a good thing, but being able to advise patients on which types of fish are high in omega-3 fatty acid is another," said Eugenia Gianos, M.D., assistant professor of medicine in the Leon H. Charney Division of Cardiology at NYU Langone Medical Center.

Authors say the study underscores the need for additional training in nutrition for cardiologists and other physicians, as well as more opportunities to educate patients. Nearly two out of three doctors spent less than three minutes counseling patients about diet and lifestyle modifications. "In some ways we were pleased to see that most doctors were spending any time discussing diet and exercise given how short medical appointments are these days, but we would have liked to see more referrals to dieticians," Gianos said.