Cholesterol lowering diets and coronary heart disease
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7188.945a (Published 03 April 1999) Cite this as: BMJ 1999;318:945
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Dear sir,
I want to reinforce Evans opinion. In his report Evans find a 22% in
cholesterol reduction by a standard cholesterol reducing diet (1).
In a recent study we investigate the influence of a Mediterranean
diet combined with changes in habits on 100 non treated
hypercholesterolemic patients free of coronary heart disease(2).
By paired t test analysis we find a 13.4% and 15.8 % reduction from
initial values in total cholesterol and LDL-ch respectively and an average
rise of 13.5% in HDL-ch after 3 to 6 monthes of treatment (p<_0.00001. p="p"/> By linear regression we find that a reduction in BMI, a younger age
and an initial higher cholesterol level partially explains the cholesterol
reduction.
These results support the notion that the Mediterranean diet is more
appropriate for lipids normalization than the actual recommended diet.
More well controlled studies are required for a future change in dietary
recommendations.
Nestor Lipovetzky MSc RD
PhD student in Epidemiology and Preventive Medicine
Department of Epidemiology and Preventive Medicine, Sackler Scholl of
Medicine, Tel Aviv University
1. David W Evans and Raj Bhopal. Cholesterol lowering diets and coronary heart disease BMJ 1999; 318: 945a
2.Nestor Lipovetzky. Influence of Mediterranean Diet Combined with Changes in Habits on
Blood Lipids
Israely Cardiology Nurses Update 1999; 9:35-36 (in Hebrew)
Competing interests: No competing interests
Dear Editor:
The debate about whether diet can lower lipids should not omit
information on the ability of diet to reduce mortality among patients with
established coronary atherosclerosis. This is especially true of the
Mediterranean-type diet, which was not discussed by the authors of several
recent BMJ letters.
In a moderate-sized randomized clinical trial, de Lorgeril et al
demonstrated that, during a follow-up of 4 years, a Mediterranean-type
diet was far superior to the step 1 American Heart Association diet. They
found a relative risk reduction of 56% for all-cause mortality, 61% for
cancers, and 56% for the combination of deaths and cancers. The patterns
of lipid reduction and other nutritional parameters paralleled these
mortality findings <1>.
Reference:
<1> de Lorgeril M, Salen P, Martin J, Monjaud I, Boucher P,
Mamelle N. Mediterranean Dietary Pattern in a Randomized Trial Prolonged
Survival and Possible Reduced Cancer Rate
Arch Intern Med 1998; 158: 1181-1187.
Competing interests: No competing interests
Farmed or wild fish for heart disease
Dear Editor
The benefits from eating fish, in particular oil-rich fish on
coronary related morbidity and mortality have again been confirmed (1).
Debate continues about the amount of oil-rich fish needed on a weekly
basis to confer such benefits. Bhopal et al (2) point out that farmed
fish, as opposed to wild fish, may have lower fat composition, in
particular relating to omega 3, the long-chain polyunsaturated fatty acid
(PUFA)believed to be the agent of benefit. However, it is also true that
levels of omega-3 in wild fish have considerable variation. This is
thought to be influenced by the specific species of the fish, the season
in which it was caught, its feeding ground, its sex, its point in the
mating cycle, and the methods used for handling, processing and storing
it. Studies investigating the effects of eating oil-rich fish usually fail
to control for these variations, but still reported significant benefits
from its consumption. Therefore, the source of the fish - whether farmed
or wild - should not be used to detract from encouraging everyone to eat
more of this natural primary and secondary preventative intervention.
As Bhopal et al point out, it is possible to alter levels of omega-3
in farmed fish through dietary manipulation of the fish. This could enable
standardisation of omega-3 levels in farmed fish, enabling consumers to
meet their 'recommended weekly intake' once one has been confirmed.
Competing interests: No competing interests