Key Points
• Source: MDPI
• Conclusions/Relevance: “Foods such as nuts and brans, especially within a prudent, plant-based diet low in saturates complemented by supplements such as phytosterols, have the potential to reduce LDLc further. A combination of such foods has been shown to lower LDLc by 20%. A nutritional approach requires backing from industry to develop and market LDLc-lowering products before pharmacology replaces the diet option. Energetic support from health professionals is vital.”
• The most powerful dietary strategy to lower LDL-C that is attainable by most patients is the substitution of 5% or more of saturated fatty acid content with similar amounts of polyunsaturated fatty acid. This change could lead to a 10% or more decrease in LDL. Substitution with monounsaturated fatty acids is less effective, although substitution with both unsaturated fatty acid-enriched foods and oils would be advised and is practical from a clinical perspective.
• “A large number of other foods, including nuts, brans, and supplements such as phytosterols, which have been shown to lower LDLc by around 5% if eaten in adequate amount, could be considered. What is uncertain is the extent to which combinations of these foods and supplements would produce a substantial additive benefit,” the authors wrote.
• The emergence of drugs that are stronger than statins, such as PCSK9 inhibitors, which decreases LDL by 25% or greater and necessitates only twice-yearly subcutaneous injections, will compete with diet strategies, as these drugs become cheaper.
• “For the large population with mild-to-moderate hypercholesterolemia, successful interventions through diet are more desirable but more difficult to achieve currently than pharmacologically. Enthusiastic support from health professionals is essential. Appropriate manufacturing and pricing of foods fortified to lower LDLc is required,” the authors concluded.