title: Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants.
abstract: BACKGROUND
  3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors reduce serum cholesterol and are increasingly advocated in primary prevention to achieve reductions in LDL cholesterol. Newer dietary approaches combining cholesterol-lowering foods may offer another option, but these approaches have not been compared directly with statins in the same persons.
  
  
  OBJECTIVE
  The objective was to compare, in the same subjects, the cholesterol-lowering potential of a dietary portfolio with that of a statin.
  
  
  METHODS
  Thirty-four hyperlipidemic participants underwent all three 1-mo treatments in random order as outpatients: a very-low-saturated-fat diet (control diet), the same diet plus 20 mg lovastatin (statin diet), and a diet high in plant sterols (1.0 g/1000 kcal), soy-protein foods (including soy milks and soy burgers, 21.4 g/1000 kcal), almonds (14 g/1000 kcal), and viscous fibers from oats, barley, psyllium, and the vegetables okra and eggplant (10 g/1000 kcal) (portfolio diets). Fasting blood samples were obtained at 0, 2, and 4 wk.
  
  
  RESULTS
  LDL-cholesterol concentrations decreased by 8.5+/-1.9%, 33.3+/-1.9%, and 29.6+/-1.3% after 4 wk of the control, statin, and portfolio diets, respectively. Although the absolute difference between the statin and the portfolio treatments was significant at 4 wk (P=0.013), 9 participants (26%) achieved their lowest LDL-cholesterol concentrations with the portfolio diet. Moreover, the statin (n=27) and the portfolio (n=24) diets did not differ significantly (P=0.288) in their ability to reduce LDL cholesterol below the 3.4-mmol/L primary prevention cutoff.
  
  
  CONCLUSIONS
  Dietary combinations may not differ in potency from first-generation statins in achieving current lipid goals for primary prevention. They may, therefore, bridge the treatment gap between current therapeutic diets and newer statins.
authors.affiliation: Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Canada. cyril.kendall@utoronto.ca
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.forename: Augustine
authors.initials: A
authors.lastname: Marchie
authors.forename: Dorothea A
authors.initials: DA
authors.lastname: Faulkner
authors.forename: Julia M W
authors.initials: JM
authors.lastname: Wong
authors.forename: Russell
authors.initials: R
authors.lastname: de Souza
authors.forename: Azadeh
authors.initials: A
authors.lastname: Emam
authors.forename: Tina L
authors.initials: TL
authors.lastname: Parker
authors.forename: Edward
authors.initials: E
authors.lastname: Vidgen
authors.forename: Elke A
authors.initials: EA
authors.lastname: Trautwein
authors.forename: Karen G
authors.initials: KG
authors.lastname: Lapsley
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: William
authors.initials: W
authors.lastname: Singer
authors.forename: Philip W
authors.initials: PW
authors.lastname: Connelly
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002791:Cholesterol, Dietary / Q000008:administration & dosage*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D018592:Cross-Over Studies; D004043:Dietary Fiber / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000178:diet therapy* / Q000188:drug therapy* / Q000517:prevention & control; D008148:Lovastatin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000627:therapeutic use; D011322:Primary Prevention; D030262:Soybean Proteins; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D008078:Cholesterol, LDL; D004043:Dietary Fiber; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010840:Phytosterols; D030262:Soybean Proteins; D008148:Lovastatin