January 26, 2022

expert reaction to study of food to lower LDL cholesterol

A study published in the Journal of Nutrition looks at the use of food intervention to reduce low-density lipoprotein (LDL) cholesterol.

Prof Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist, University of Sheffield, said:

“In my view the press release gives the wrong impression by saying this food intervention ‘can be as effective as medications for lowering cholesterol’ (a direct quote from the press release title).

“On average, low dose statins reduce LDL cholesterol by around 30%, while higher doses can reduce LDL by up to 50% on average. This food intervention reduced LDL cholesterol by only 8% on average, suggesting it’s only about a third as effective as low dose medications, or a fifth as effective as high dose medications. The press release mentions some people had a fall in cholesterol of 30%, but does not mention some actually showed an increase in LDL cholesterol.

“The study was only a few weeks long and it would be important to understand whether the food intervention can keep cholesterol lowered for the years necessary to lower risk of heart disease, and if people are able to keep eating (and affording) the food.

“We need to stop talking about diet and medication as if only one or the other is the “right” answer, when they are both hugely important. A healthy diet should be essential for everyone, while in some people drugs in addition to a healthy diet is the right way to reduce the chances of later heart disease.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is a small trial with a very modest reduction in LDL-cholesterol, far below what even a lower dose of commonly used statins can achieve.  We can also already reduce LDL-cholesterol with ezetimibe, as an alternative or additive to statins, by around 20% or more.  That is not to say there is no value in discovering novel food substances that lower cholesterol modestly; but for those patients who have higher cardiovascular risk sufficient to be recommended statins, or have existing cardiovascular disease, the aim would be to reduce cholesterol by well over 30-40% to maximise benefits. As such, some form of lipid lowering therapy would be needed regardless of what can be achieved by changes in dietary components.   Finally, the vast majority of people eligible for statins can take them without side effects.”

Prof Robert Storey, Professor of Cardiology at the University of Sheffield, said:

“Our understanding of the role of ‘bad’ cholesterol, known as LDL cholesterol, in causing heart attacks and strokes has led to much more effective treatment and prevention of these conditions through the use of cholesterol-lowering medications. This has helped to transform the outlook for patients suffering from cardiovascular diseases. Lifestyle measures are important in lowering risk, including healthy diet, regular exercise and not smoking. However, these measures cannot fully address the genetic factors that lead to heart attacks and most strokes, including inheriting a high level of bad cholesterol. Diet alone is not effective enough in tackling this bad cholesterol and the report of an average 9% reduction in bad cholesterol levels with this new diet system illustrates this since, in most cases, we aim for an average 50% reduction in bad cholesterol levels in order to reduce heart attack and stroke risk. Statins are usually well tolerated and highly effective during long-term treatment and new drugs are available that can further boost the effects of statins if necessary. This is particularly important in people who have developed fatty deposits in the blood vessels of their heart or elsewhere since achieving and maintaining really low levels of bad cholesterol with medication can prevent further build up of fat, which otherwise can lead to blood clots blocking the blood vessels and causing heart attack or stroke. On the other hand, diet and other lifestyle measures alone may be appropriate in people who don’t have evidence of fatty deposits in their blood vessels and are not at high risk of heart attack.”

‘Reduction in Serum LDL Cholesterol Using a Nutrient Compendium in Hyperlipidemic Adults Unable or Unwilling to Use Statin Therapy: A Double-Blind Randomized Crossover Clinical Trial’ by Stephen L Kopecky et al. is published in the Journal of Nutrition.

DOI: https://doi.org/10.1093/jn/nxab375

Declared interests

Prof Naveed Sattar: “Have consulted for Amgen and on steering committee for VESALIUS trial.”

Prof Tim Chico: “no conflicts.”

None others received.