Forty-six healthy, hyperlipidemic men and women (mean age, 59 years) were randomly assigned to one of three weight-maintaining diets for one month: 1) a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (control diet); 2) the same diet plus lovastatin (20 mg/day); or 3) a dietary portfolio high in plant sterols (1.0 g/1,000 kcal, from a plant sterol ester-enriched margarine), soy protein (21.4 g/1,000 kcal, from soy milk and soy meat analogs), viscous fibers (9.8 g/1,000 kcal, from oats, barley, eggplant, okra, and psyllium), and almonds (14 g/1,000 kcal). The control, lovastatin, and dietary portfolio groups had mean decreases in LDL cholesterol of 8.0%, 30.9%, and 28.6%, respectively. Reductions in C-reactive protein levels were 10.0%, 33.3%, and 28.2%, respectively. The changes in the statin and dietary portfolio groups were all significantly different from the changes in the control group, but did not differ significantly from each other. The authors concluded that using a combination of cholesterol-lowering dietary interventions increased the effectiveness of diet as a treatment for hypercholesterolemia. Moreover, this diet decreased LDL cholesterol and C-reactive protein levels to a similar extent as lovastatin.

Comment: Statins have become the standard of care for people who have, or are at risk of developing, cardiovascular disease. While some of the benefit of these drugs is presumably due to lowering of LDL-cholesterol levels, the anti-inflammatory effect of statins (as reflected by a reduction in C-reactive protein levels) may be at least as important as the cholesterol-lowering effect. A growing body of evidence indicates that C-reactive protein is an independent risk factor for heart disease.

The results of the present study demonstrate that a comprehensive dietary program can be as effective as a statin drug in reducing both LDL-cholesterol and C-reactive protein levels. For motivated people, dietary modification seems like a viable alternative to statin drugs.

Jenkins DJA, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;290:502-510.