Intended for healthcare professionals


Cholesterol lowering diets and coronary heart disease

BMJ 1998; 317 doi: (Published 31 October 1998) Cite this as: BMJ 1998;317:1253

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

  1. M F Oliver, Professor emeritus
  1. Cardiac Medicine, National Heart and Lung Institute, London SW3 6LY
  2. 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 …

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