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Q5. Your patient is a 65-year-old male who recently suffered from a myocardial infarction. He does not have diabetes and his LDL cholesterol is currently 79 mg/dL on medications. His blood pressure is well controlled on a beta-blocker. He asks you for a diet to reduce his chance of ‘another heart attack.’ He is not overweight. Which diet would you recommend? YOU MAY CHOOSE MORE THAN ONE □ Lower carbohydrate, higher protein diet (eg, Atkins, South Beach)
□ Low saturated fat, high fruit and vegetable diet
□ Increased intake of fatty fish meals, at least twice a week
□ Low sodium diet
□ None
□ Other
Q6a. Another patient asks your opinion about a low carbohydrate, high protein diet (eg, Atkins, South Beach). He is similar to the patient in Q5 except he is 30 lbs overweight. How do you respond to this patient? □ Strongly recommend it
□ Recommend it
□ No opinion
□ Advise against it
□ Strongly advise against it
Q6b. This same patient asks for your advice regarding dietary fish or supplementation. How do you respond? □ Strongly recommend it
□ Recommend it
□ No opinion
□ Advise against it
□ Strongly advise against it
- Table 2.
Background and Prescribing Practices of Washington State Family Physicians (n = 233)
% (n) Age <40 years old 39.9 (89) 41 to 50 years old 30.5 (68) >50 years old 29.6 (66) Gender Male 132 (59.2) Female 91 (40.8) CVD* patients seen per week 1 to 10 52.5 (117) 11 to 20 30.5 (68) 21 to 30 13.0 (29) >30 4.0 (9) Nutrition training (any) 90.6 (202) CME 74.4 (166) Medical school 51.6 (115) Residency 53.4 (119) Other 22.9 (51) Prescriber of dietary advice† Low (<40%) 10.7 (24) Moderate (40% to 60%) 20.2 (45) High (>60%) 69.0 (154) Prescriber of fish advice† Low (<40%) 53.3 (119) Moderate (40% to 60%) 21.5 (48) High (>60%) 25.1 (56) * CVD, cardiovascular disease; CME, continuing medical education.
† Represents frequency of advice given by respondents to patients with known CVD and categorized into low, moderate, and high prescribers.
Dietary Knowledge* Percent Answering Correctly (n) General diet questions Antioxidants do not reduce CVD† 76.2 (170) Low sodium diets lower blood pressure 70.4 (157) Fruits and vegetables lower blood pressure 32.7 (73) Fish questions Fish oil reduces CVD 56.5 (126) Fish oil reduces triglycerides 43.0 (96) Fish oil reduces sudden cardiac death 26.5 (59) Dietary attitudes Agree (%)‡ Nutrition has an important part to play in the prevention of CVD 99.1 The primary care physician has an essential role in giving dietary advice 91.9 Advice given will impact on what people eat 66.8 Advice given will be effective in reducing CVD 52.5 The primary care physician has sufficient time to advise patients adequately 18.8 * Statements represent correct answers to knowledge questions.
† CVD, cardiovascular disease.
‡ Strongly agree or agree.
- Table 4.
Associations with High Fish Prescribers and Dietary Knowledge, Training, and Attitudes Variables
High Fish Prescribers No (n = 185) Yes (n = 38) DIETARY KNOWLEDGE General diet questions (correctly answered) % (n) % (n) P Value* Antioxidants do not reduce CVD† 77 (143) 71 (27) .410 Low sodium diets lower blood pressure 71 (131) 68 (26) .769 Fruits and vegetables lower blood pressure 32 (59) 37 (14) .554 Fish questions (correctly answered) Fish oil reduces CVD 54 (100) 68 (26) .104 Fish oil reduces triglycerides 42 (77) 50 (19) .342 Fish oil reduces sudden cardiac death 23 (42) 45 (17) .005 NUTRITION TRAINING Any 89 (165) 97.4 (37) .138‡ CME 28 (134) 15.7 (6) .131 Medical school 49.7 (92) 60.5 (23) .225 Residency 52.4 (97) 57.9 (22) .539 Other 23.8 (44) 18.4 (7) .473 DIETARY ATTITUDES P Value§ Nutrition has an important part to play in the prevention of CVD Neutral 1.1 (2) — .730 Agree 32.4 (60) 36.8 (14) Strongly agree 66.5 (123) 63.3 (24) The primary care physician has an essential role in giving dietary advice Strongly disagree 0.5 (1) — .309 Disagree 1.1 (2) — Neutral 7.0 (13) 5.3 (2) Agree 44.3 (82) 39.5 (15) Strongly agree 47.0 (87) 55.3 (21) Advice given will impact on what people eat Disagree 8.6 (16) 7.9 (3) .841 Neutral 24.3 (45) 26.3 (10) Agree 55.1 (102) 50.0 (19) Strongly agree 11.9 (22) 15.8 (6) Advice given will be effective in reducing CVD Strongly disagree 0.5 (1) – .095 Disagree 7.6 (14) 5.3 (2) Neutral 41.6 (77) 31.6 (12) Agree 43.8 (81) 50.0 (19) Strongly agree 6.5 (12) 13.2 (5) The primary care physician has sufficient time to advise patients adequately Strongly disagree 29.7 (55) 15.8 (6) .018 Disagree 41.6 (77) 36.8 (14) Neutral 11.9 (22) 18.4 (7) Agree 15.7 (29) 28.9 (11) Strongly agree 1.1 (2) * CVD, cardiovascular disease; CME, continuing medical education.
† χ2 test.
‡ Fisher’s exact test.
§ Mann-Whitney U.
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