Dietary Effects on Cardiovascular Disease Risk Factors: Beyond Saturated Fatty Acids and Cholesterol

Abstract

Hypercholesterolemia represents a significant risk for cardiovascular disease (CVD). While diet intervention remains the initial choice for the prevention and treatment of CVD, the nature of the dietary modification remains controversial. For example, reducing calories from total fat, without decreasing saturated fat intake results in insignificant changes in low density lipoprotein cholesterol (LDL-C). Similarly, diet interventions that focus solely on lowering dietary cholesterol and saturated fat intake not only decrease LDL-C, but also high density lipoprotein cholesterol (HDL-C) and therefore may not improve the lipoprotein profile. This brief review summarizes dietary interventions that lower LDL-C without affecting HDL-C levels. These interventions include soy protein, soluble fiber, soy lecithin and plant sterols. This review also includes some of the reported dietary interventions, such as polyphenols, isoflavones, folic acid and vitamins B₆ and B₁₂, which reduce the risk of CVD without changes in lipoprotein cholesterol.

• hypercholesterolemia
• saturated fat
• soy protein
• lecithin
• fiber
• phytosterols
• corn fiber oil
• rice bran oil
• homocysteinemia

Key teaching points:

• Hypercholesterolemia is one of several risk factors for coronary heart disease (CHD).

• Dietary interventions should be designed to produce optimal lipoprotein profiles which decrease LDL-C without reductions in HDL-C.

• In general, dietary interventions which focus on reducing saturated fatty acids and cholesterol lower both LDL-C and HDL-C, thereby not improving the lipoprotein profile.

• Interventions including soy protein, soluble fiber, soy lecithin and plant sterols, especially sterol or stanol esters, are nutrients which reduce LDL-C without associated reductions in HDL-C and may be prescribed for individuals with low HDL-C.

• Polyphenols in fruits, vegetables and minimally-processed vegetable oils are antioxidants which could reduce the incidence and severity of CHD.

• Recent intervention studies which utilize vitamin E supplements have not demonstrated efficacy in humans as it relates to preventing or treating CHD.

Key teaching points:

• Hypercholesterolemia is one of several risk factors for coronary heart disease (CHD).

• Dietary interventions should be designed to produce optimal lipoprotein profiles which decrease LDL-C without reductions in HDL-C.

• In general, dietary interventions which focus on reducing saturated fatty acids and cholesterol lower both LDL-C and HDL-C, thereby not improving the lipoprotein profile.

• Interventions including soy protein, soluble fiber, soy lecithin and plant sterols, especially sterol or stanol esters, are nutrients which reduce LDL-C without associated reductions in HDL-C and may be prescribed for individuals with low HDL-C.

• Polyphenols in fruits, vegetables and minimally-processed vegetable oils are antioxidants which could reduce the incidence and severity of CHD.

• Recent intervention studies which utilize vitamin E supplements have not demonstrated efficacy in humans as it relates to preventing or treating CHD.

Notes

Presented in part at Ross Products Research Conference on Medical Issues, “Synergy in Medical Nutritional Therapy.” November 6–8, 2000, Key Largo, Florida.