Dietary intervention to lower serum LDL-cholesterol (LDL-C) is
effective, yet underutilised in general practice.
This report summarises the findings of an expert roundtable
convened to review the evidence relating to dietary interventions to
lower serum LDL-C.
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
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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