Copyright © 1999 by the European Society of Cardiology.
Despite good compliance, very low fat diet alone does not achieve recommended cholesterol goals in outpatients with coronary heart disease
a Service of Metabolic-Nutritional Pathophysiology and Clinical Nutrition, Tradate Medical Centre-IRCCS-Tradate (VA), Italy
b Division of Cardiology, Tradate Medical Centre-IRCCS-Tradate (VA), Italy
c Service of Psychology, Tradate Medical Centre-IRCCS-Tradate (VA), Italy
d Institute of Pharmacology, Faculty of Science, University of Pavia, Italy
revised October 26, 1998; accepted October 28, 1998
Abstract
Aim A low-saturated, low-cholesterol diet is important in the treatment of hypercholesterolaemia in patients with coronary heart disease. The aim of this study was to investigate the efficacy of a very low fat diet to achieve a targeted serum low density lipoprotein (LDL) cholesterol level (
2·59mmol.l–1) in outpatients with coronary heart disease.
Methods One hundred and twenty-six male patients (all ex-smokers) with coronary heart disease and a serum LDL cholesterol >3·37mmol.l–1were investigated 12–14 weeks after an acute coronary event. After overnight fasting each patient had (a) his resting energy expenditure measured (indirect calorimetry using standard protocol) and (b) venous blood sampled from a forearm vein to determine lipid profile. All the patients were randomly allocated to four groups of treatment:Group Aon a very low fat diet (resting energy expenditure-fat diet, where fat intake was 20% resting energy expenditure);Group Bon a low fat diet from the National Cholesterol Education program (National Cholesterol Education Program step 2 diet);Group Con resting energy expenditure-fat diet+simvastatin 10mg daily;Group Don National Cholesterol Education Program step 2 diet+simvastatin 10mg daily. For all patients the prescribed energy intakes were equal to their respective resting energy expenditures.
Results At 6 months, the average decrease in serum LDL cholesterol was not different between Group A and Group B, but the increase in high density lipoprotein cholesterol (HDL) (+29%) observed in Group A led to a reduced LDL cholesterol/HDL cholesterol ratio (P<0·001). As expected, a more important serum lipid improvement was found in the groups supplemented with diet+drug association, but the decrease in LDL cholesterol was higher in Group C than in Group D (–37±9·7% vs –24·5±15%;P<0·00001) as well as LDL cholesterol/HDL cholesterol ratio (P<0·001). No patient on diet alone achieved the recommended LDL cholesterol level 2·59mmol.l–1.
Conclusion Diet alone does not allow patients with coronary heart disease to achieve the recommended blood cholesterol levels, even if its fat content is highly reduced.
Key Words: Coronary artery disease • secondary prevention • resting energy expenditure • hypolipidic diet • compliance
f1 Correspondence: Dr Pastoris Ornella, Istituto di Farmacologia, Facoltà di Scienze MM.FF.NN, Università di Pavia, Piazza Botta 11, 27100 Pavia, Italy.