Lowering LDL-cholesterol through diet: potential role in the statin era

A healthy diet should be rich in vegetables and fruits, whole-grain, high-fiber foods, and fish and should contain a small amount of saturated and trans fats. In addition to these recommendations, some food ingredients such as plant sterol/stanol soy protein and isoflavones may help reduce cholesterol levels. Increased dietary fiber intakes are associated with significantly lower prevalence of cardiovascular disease and lower LDL-cholesterol concentration of about 5-10%. Beyond LDL-cholesterol lowering effects, other benefits have been observed on hypertension, diabetes mellitus. In this review, we summarize the different dietary approaches proven to be associated with LDL-cholesterol decrease. Nutritional interventions that do not exert significant LDL-cholesterol decrease have not been included in this review.

On top of a 'classical' step 1 and step 2 diet, the cornerstone of dietary recommendations, recent findings confirm the deleterious effects of trans fatty acid or the beneficial effects of sterols/stanols and nuts.

Dietary recommendations may have an impressive impact on cardiovascular events because they can be implemented early in life and because the sum of the effect on LDL-cholesterol is far from being negligible: step 1 diet (-10%), dietary fibers (-5 to -10%), plant sterols/stanols (-10%), nut consumption (-8%), and soy protein (-3 to -10%).