NEW YORK — Diet can work almost as well as a statin for cutting a patient's level of LDL cholesterol.
Patients who stuck with a highly structured diet rich in plant sterols, soy protein, viscous fibers, and almonds maintained their serum LDL-cholesterol level at 30% below their baseline level for a year, a decrease that was similar to the average 33% drop seen in patients treated with 20 mg of lovastatin daily, David J.A. Jenkins, M.D., reported at an international symposium on triglycerides and HDL cholesterol.
“Using cholesterol-lowering foods bridges the therapeutic gap between a generally good diet and statin therapy,” said Dr. Jenkins, a professor in the department of nutritional sciences at the University of Toronto.
The special diet also dropped the average starting serum level of C-reactive protein by about 30%, compared with an average 35% with lovastatin. The year-long study began with a total of 66 patients with LDL-cholesterol levels of at least 158 mg/dL at baseline who had not taken statins for 2 weeks prior to the study and were otherwise healthy; 58 completed the study.
The diet was built on a foundation of the American Heart Association's step II diet, which is recommended by the National Cholesterol Education Program. Patients randomized to statin treatment also ate the step II diet, as did a control group who received no other intervention beyond the step II diet.
The group assigned to the special diet also ate the following lipid-lowering foods: plant sterols, 1 g/1,000 kcal of diet, consumed as a plant sterol-enriched margarine; viscous fiber, 9.8 g/1,000 kcal of diet, which came from oats, barley, and psyllium; soy protein, 21.4 g/1,000 kcal of diet, in the form of soy milk and meat analogs made from soy; and whole almonds, 14 g/1,000 kcal of diet.
After a year, the control patients had an average 8% reduction in their LDL-cholesterol level, compared with baseline, and no change in their C-reactive protein level, said Dr. Jenkins at the symposium, sponsored by the Giovanni Lorenzini Foundation. A detailed assessment of a subgroup of the participants showed that compliance with the prescribed lipid-lowering diet was the major factor linked to substantial reductions in LDL-cholesterol levels, Dr. Jenkins said.