Assessment of the Longer Term Effects of a Dietary Portfolio of Cholesterol Lowering Foods in Hypercholesterolemia

Objective To determine the effectiveness under real‐world conditions of dietary advice to consume a combination of cholesterol‐lowering foods (dietary portfolio)compared with published data from the same subjects eating the same diet under metabolic conditions or taking a statin. Methods For six months sixty‐six hyperlipidemic subjects were prescribed diets high in plant sterols (1.0 g/1000 kcal), soy protein (22.5 g/1000 kcal), viscous fibers (10 g/1000 kcal) and almonds (23 g/1000 kcal). Sixty‐one subjects completed the six‐month study. Four‐week data were also compared with published results on the same subjects (n=29) who had undergone separate one‐month metabolic trials of the diet and a statin. Results At 12 and 24 weeks, LDL‐cholesterol reductions appeared stable at 14.0±1.6% (P<0.001) and 13.1±1.6% (P<0.001), respectively. These reductions were significantly less than following the metabolic diet or a statin. Nevertheless, 32% of subjects on the ad libitum diet (n= 21/66) showed LDL‐cholesterol reductions ≥20% (mean 27.1±1.1%). The LDL‐C reductions in this group were not different from their respective metabolically controlled portfolio or statin treatments. A correlation was found between total compliance and LDL reduction (r=0.43, P<0.001). Only two subjects with less than 55% compliance (n=25) achieved ≥20% LDL‐cholesterol reduction at 24‐weeks. Conclusions Just over 30% of motivated subjects who ate the dietary portfolio of cholesterol‐lowering foods under real world conditions were able to lower LDL‐cholesterol ≥20%, which was not significantly different from their response to a first generation statin, taken under metabolically controlled conditions. Support: Almond Board of California