Sexual Health

June 2009

Professional

Dietary intervention to lower serum cholesterol

Volume 38, No.6, June 2009 Pages 424-428

Peter Clifton

David Colquhoun

Claire Hewat

Peter Jones

John Litt

Manny Noakes

Richard O’Brien

Bill Shrapnel

Murray Skeaff

Background

Dietary intervention to lower serum LDL-cholesterol (LDL-C) is effective, yet underutilised in general practice.

Objective/s

This report summarises the findings of an expert roundtable convened to review the evidence relating to dietary interventions to lower serum LDL-C.

Discussion

Interventions that lower LDL-C lower the risk of cardiovascular disease. Comprehensive dietary intervention is indicated in all patients with an absolute 5 year risk for coronary disease of 10% or greater. Short term trials indicate that these interventions have the potential to lower LDL-C by approximately 20%. A year long trial has shown mean LDL-C lowering of 13%, with about one-third of subjects achieving a reduction greater than 20%, highlighting the importance of adherence to dietary advice. The most effective dietary strategies are replacing saturated and trans fatty acids with poly- and monounsaturated fats and increasing intake of plant sterols. Losing weight and increasing soluble fibre and soy protein intake can also lower serum cholesterol and may be considered when recommending a nutritionally balanced, cholesterol lowering diet. Motivational interviewing by general practitioners can improve the effectiveness of brief, behaviour orientated advice and dietary counselling to lower serum cholesterol.

It has been known for decades that raised total cholesterol and serum LDL-cholesterol (LDL-C) are associated with increased risk of coronary disease.1 Population studies conducted as part of the Asia-Pacific Cohort Studies Collaboration (APCSC ) suggest a doubling of relative coronary risk in the highest versus lowest quartiles of LDL-C.2 There is also a definite, though less profound, rise in stroke risk associated with increasing cholesterol.3 Randomised, controlled dietary trials to lower LDL-C,4,5 conducted in the 1960s and 1970s, lowered coronary event rates. More recently, many studies with statins have demonstrated a cardiovascular benefit from lowering LDL-C, with more aggressive LDL-C reduction producing the greatest benefits. Although most studies have been conducted in middle aged males, all patients at high risk of cardiovascular disease appear to benefit from cholesterol lowering, irrespective of the initial cholesterol concentration.6

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Correspondence afp@racgp.org.au

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