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Are current dietary guidelines relevant to subjects on cholesterol-lowering drugs?

Authors
  • Salter, Andrew M1
  • 1 Division of Food, Dietetics and Nutrition, School of Biosciences & Future Food Beacon, University of Nottingham, Sutton Bonington Campus, LoughboroughLE12 5RD, UK.
Type
Published Article
Journal
Proceedings of The Nutrition Society
Publisher
Cambridge University Press
Publication Date
Feb 01, 2020
Volume
79
Issue
1
Pages
88–94
Identifiers
DOI: 10.1017/S0029665119000685
PMID: 31133081
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The present paper reviews the evidence as to whether patients on lipid-lowering drugs should restrict dietary SFA intake. Premature mortality from atherosclerotic CVD has fallen dramatically in many high-income countries. This appears to be due to a combination of improved treatment following a cardiovascular event and reduced risk factors, including LDL-cholesterol. Whether this reduction is due to changes in dietary habits, or the increasing availability of highly potent cholesterol-reducing drugs remains to be firmly established. While reducing dietary SFA intake has been the cornerstone of public health nutrition policy for several decades, the efficacy of such dietary changes has been challenged in recent years. While there remains a lack of consensus in the literature, there is an emerging view that dietary advice should be specifically modified to emphasise replacing SFA with PUFA in the diet rather than carbohydrate. The advice to moderate dietary SFA intake given to the general population is usually also given to those individuals at high risk of CVD who are prescribed lipid-lowering drugs. There is limited evidence to suggest that any potential benefit of such a diet on LDL-cholesterol may be offset by a concurrent decrease in HDL-cholesterol. However, as diets rich in SFA are frequently energy-dense, and rich in red and processed meat (potential risk factors for CVD in themselves), it would seem prudent to continue to advise patients on lipid-lowering drugs to maintain a low-fat diet.

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