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Cited by 620Lipoproteins and Cardiovascular HealthCholesterol and Lipid MetabolismNutritional Studies and Diet

Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein

Jenkins, David J. A.·2003·JAMA
DOI 10.1001/jama.290.4.502
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Abstract

CONTEXT: To enhance the effectiveness of diet in lowering cholesterol, recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers, and the American Heart Association supports the use of soy protein and nuts. OBJECTIVE: To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). DESIGN: Randomized controlled trial conducted between October and December 2002. SETTING AND PARTICIPANTS: Forty-six healthy, hyperlipidemic adults (25 men and 21 postmenopausal women) with a mean (SE) age of 59 (1) years and body mass index of 27.6 (0.5), recruited from a Canadian hospital-affiliated nutrition research center and the community. INTERVENTIONS: Participants were randomly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month: a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n = 14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (n = 16; dietary portfolio). MAIN OUTCOME MEASURES: Lipid and C-reactive protein levels, obtained from fasting blood samples; blood pressure; and body weight; measured at weeks 0, 2, and 4 and compared among the 3 treatment groups. RESULTS: The control, statin, and dietary portfolio groups had mean (SE) decreases in low-density lipoprotein cholesterol of 8.0% (2.1%) (P =.002), 30.9% (3.6%) (P<.001), and 28.6% (3.2%) (P<.001), respectively. Respective reductions in C-reactive protein were 10.0% (8.6%) (P =.27), 33.3% (8.3%) (P =.002), and 28.2% (10.8%) (P =.02). The significant reductions in the statin and dietary portfolio groups were all significantly different from changes in the control group. There were no significant differences in efficacy between the statin and dietary portfolio treatments. CONCLUSION: In this study, diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia.

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  • The LDL-C lowering effect of the Portfolio dietary pattern components was additive when combined as part of the dietary pattern.

    “Controlled feeding trials of the portfolio dietary pattern demonstrated that each of the components had a low-density lipoprotein cholesterol (LDL-C) lowering effect of 5-10% [14][15][16][17][18] and that the effect was additive when combined as part of this dietary pattern.[8][9][10][11][12][13]”

    From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [10]

  • An early randomized controlled trial showed that the maximal LDL-C lowering efficacy of the Portfolio dietary pattern was similar to that of 20 mg lovastatin (-28.6% versus -30.9%) in a head-to-head comparison when all foods were provided under metabolically controlled conditions.

    “An early randomized controlled trial showed the maximal LDL-C lowering efficacy was similar to that of 20 mg lovastatin (-28.6% versus -30.9%) in a “head-to-head” comparison when all foods were provided under metabolicallycontrolled conditions 10”

    From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [10]

  • The LDL-C lowering effect of 5-10% of each of the 4 core food components can be considered additive.

    “These data provide confirmation that the LDL-C lowering effect of 5-10% [14][15][16][17][18] of each of the 4 core food components can be considered additive, [8][9][10][11][12][13]”

    From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [10]

  • Nutraceuticals can be useful in statin intolerance if they improve low-grade systemic inflammation and lipid abnormalities, with LDL-C reductions usually below 10-20%.

    “With this background, nutraceuticals can be very useful in case of statin intolerance if they improve the control of low-grade systemic inflammation (157) and lipid abnormalities (LDL-C reduction usually <10% to 20%).”

    From The Role of Nutraceuticals in Statin Intolerant Patients (2018) · cites this paper as [157]

  • The mechanisms through which hPDI could reduce CHD risk are likely shared with the mechanisms for type 2 diabetes risk reduction.

    “The mechanisms through which hPDI could reduce CHD risk are likely shared with the mechanisms for type 2 diabetes risk reduction.(2, 24–32)”

    From Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults (2017) · cites this paper as [26]

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Authors
Jenkins, D. J. A.
Affiliations
St. Michael's Hospital (CA)
Corresponding author
Jenkins, David J. A.
ORCID
Jenkins, David J. A.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-07-23
Volume
290
Issue
4
Pages
502
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.290.4.502
OpenAlex
W2126128848
Cited by
620
References
42
Citations by year
2026: 11 · 2025: 18 · 2024: 19 · 2023: 11 · 2022: 15 · 2021: 20 · 2020: 16 · 2019: 17 · 2018: 15 · 2017: 21 · 2016: 19 · 2015: 22 · 2014: 31 · 2013: 28 · 2012: 27
FWCI
47.30
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
phytosterols, soy protein, almond, low saturated fat diet, lovastatin, statins, LDL cholesterol, C-reactive protein, hyperlipidemia, postmenopausal women, blood pressure, body weight, cardiovascular risk reduction, dietary intervention
MeSH terms
Anticholesteremic Agents, C-Reactive Protein, Cholesterol, Dietary, Diet, Atherogenic, Dietary Fiber, Female, Humans, Hyperlipidemias, Lipids, Lovastatin, Male, Middle Aged, Diet, Vegetarian, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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