Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol

Traditionally, the effects of diet on coronary heart disease have been attributed to the effects of medium-chain fatty acids, soluble fiber, and dietary cholesterol on serum low-density-lipoprotein (LDL) cholesterol concentrations. We review evidence here that many other dietary substances may affect risk, often via mechanisms not involving LDL-cholesterol concentrations directly. Such substances include phytosterols, tocotrienols, arginine, and antioxidant vitamins. The effects of diet on high-density-lipoprotein-cholesterol concentrations, triglycerides (fasting and postprandial), oxidized LDL particles, prostaglandins, and endothelium-derived relaxing factor are described. Finally, an illustration of some epidemiologic associations between diet and coronary disease events is made from the Adventist Health Study data.