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A Special Diet That Might Be As Good As a Statin
Hyperlipidemic adults without histories of heart disease might have a first-line alternative to drug therapy.
The National Cholesterol Education Program currently recommends plant sterols and viscous fibers as "therapeutic dietary options" to lower LDL cholesterol (JAMA 2001; 285:2486), and the American Heart Association highlights the potential cholesterol-lowering benefit of a diet that includes soy protein and nuts (Circulation 2000; 102:2284). However, a diet with these elements has not been compared directly with statin treatment for lowering cholesterol and C-reactive protein (CRP) levels.
Investigators in Canada randomized 46 hyperlipidemic adults (mean age, 59; mean body-mass index, 27.6; mean total cholesterol, 257 mg/dL; mean LDL cholesterol, 172 mg/dL) without histories of cardiovascular disease to one of three 1-month cholesterol-lowering regimens: a diet simply low in saturated fat (control); a low-saturated-fat diet plus lovastatin (20 mg/day); or a special low-saturated-fat diet that was high in plant sterols, soy protein, almonds, and viscous fibers (e.g., oats, barley, eggplant). All diets were vegetarian, and most foods were provided to participants.
Compared with the control group, both the statin and special-diet groups had similarly significant 1-month declines in both LDL and CRP levels. LDL decreased by 8% in the control group, by 31% in the statin group, and by 29% in the special-diet group; CRP declines were 10%, 33%, and 28%, respectively.
Comment: In this small study, a special vegetarian diet that was low in saturated fat and that included plant sterols, soy protein, viscous fibers, and nuts lowered LDL and CRP levels as much as a regimen that included a low-saturated-fat vegetarian diet plus a statin. An editorialist recommends dietary intervention as a first-line approach (about 6-12 weeks) for motivated hyperlipidemic patients without histories of cardiovascular disease. Future research should address whether the special dietary intervention in this study can improve outcomes.
— JoAnne M. Foody, MD
Published in Journal Watch Cardiology September 5, 2003
Citation(s):
Jenkins DJA et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003 Jul 23/30; 290:502-10.
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- Medline abstract (Free)
Anderson JW. Diet first, then medication for hypercholesterolemia. JAMA 2003 Jul 23/30; 290:531-3.
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- Medline abstract (Free)