Cholesterol lowering diets and coronary heart disease

doi:10.1136/bmj.317.7167.1253

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Advice should now be to increase intake of vegetable oils and fish

M F Oliver, Professor emeritus

Cardiac Medicine, National Heart and Lung Institute, London SW3 6LY
Hingham Surgery, Norfolk NR9 4JB

EDITOR—The systematic review by Tang et al analysed the effect of various diets, particularly the American Heart Association step 1 and step 2 diets, on reducing total blood cholesterol concentration.1 Overall, the effect of diet on blood cholesterol concentrations in free-living communities was no more than about 6%, with step 1 diets achieving a 3% reduction and diets that increase the ratio of polyunsaturated to saturated fatty acids around an 8% fall.

The effect of diet on coronary heart disease rates is complementary.2 In six primary prevention trials of low fat and low cholesterol diets the odds ratio for death from coronary heart disease was 1.04 (95% confidence interval 0.43 to 2.06) and for non-fatal events 1.05 (0.46 to 2.98); in two secondary prevention trials with a similar regimen the respective odds ratios were 1.21 (0.66 to 1.78) and 1.00 (0.76 to 1.37).

Four secondary prevention trials increased the ratio …