Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 12876093 · doi:10.1001/jama.290.4.502
What was done
Forty-six healthy hyperlipidemic adults (25 men, 21 postmenopausal women; mean age 59 years, mean BMI 27.6) were randomized to 1 of 3 outpatient dietary interventions for 1 month: a control diet low in saturated fat (n = 16); the control diet plus lovastatin 20 mg/d (n = 14); or a dietary portfolio diet containing plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (n = 16). Fasting lipids, C-reactive protein (CRP), blood pressure, and body weight were measured at weeks 0, 2, and 4.
What was found
Mean (SE) LDL cholesterol decreased by 8.0% (2.1%) in the control group (P = .002), 30.9% (3.6%) in the statin group (P < .001), and 28.6% (3.2%) in the dietary portfolio group (P < .001). C-reactive protein decreased by 10.0% (8.6%) with control (P = .27), 33.3% (8.3%) with statin (P = .002), and 28.2% (10.8%) with the dietary portfolio (P = .02). Both statin and portfolio groups had significantly greater reductions than control, with no statistically significant differences in efficacy between the statin and dietary portfolio groups.
Why it matters
Combining multiple cholesterol-lowering food components into a single dietary portfolio produces short-term reductions in LDL cholesterol and CRP that are clinically comparable to first-generation statin monotherapy.
Limits
The sample size was very small (46 participants across three arms), and the study duration was limited to 4 weeks. Long-term adherence to this intensive dietary regimen, sustainability of the lipid reductions, and hard cardiovascular clinical endpoints were not assessed.