LDL-cholesterol is the major therapeutic target in the management of cardiovascular risk factors. Several dietary interventions showed significant improvements whilst lowering blood LDL-C levels, such as replacing atherogenic fats by unsaturated fats, eating plant sterols from enriched foods, increasing soluble fiber consumption, consuming unsalted nuts, and, at times reducing dietary cholesterol. When considered separately, each result seems modest. If we however associate the proposed dietary interventions, the results are cumulative, resulting in a greater impact on LDL-C levels that decrease by 20 to 30%. This is relevant for primary prevention and for target groups at the highest cardiovascular risk, thereby increasing the nutritional quality of the diet.
What is already known about the topic?
Dietary advices to lower blood LDL-cholesterol concentrations concern the reduced consumption of saturated fatty acids, trans-fatty acids, and cholesterol, along with an increased intake of dietary fiber, plant sterols, and starchy foods. However, several recent systematic reviews or meta-analyses claim that there was no association found between some of these dietary interventions and cardiovascular risk, with very heterogeneous results.
What does this article bring up for us?
This paper addresses in a more precise manner the nutritional and dietary modifications that significants impact LDL-cholesterol levels. For example, when we talk about the effects of fats on cardiovascular health, it is relevant to distinghuish between atherogenic fatty acids and others. Atherogenic fats are 3-saturated fatty acids as well as industrially-produced trans-unsaturated fatty acids. The key question is to understand which nutrients should replace these fats. Saturated fatty acids must not only been lowered but rather replaced by either cis-unsaturated fatty acids or whole grains, and not by refined starches and sugars. Dietary guidelines must thus carefully take into account the health effects of these recommendations.
Key Words
Blood lipid levels, LDL cholesterol, cholesterol, fatty acids, fat, dietary fibre, plant sterols, dietary intervention