Despite good compliance, very low fat diet alone does not achieve recommended cholesterol goals in outpatients with coronary heart disease

• Published in: European heart journal 1999-07, Vol.20 (14), p.1020-1029
• Main Authors: Aquilani, R., Tramarin, R, Pedretti, R.F.E., Bertolotti, G., Sommaruga, M., Mariani, P., Ruffato, L., Catapano, M., Boschi, F., Dossena, M., Pastoris, O.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cholesterol - blood; Cholesterol, HDL - blood; Cholesterol, LDL - blood; compliance; Coronary artery disease; Coronary Disease - blood; Coronary Disease - diet therapy; Coronary Disease - metabolism; Coronary heart disease; Diet, Fat-Restricted; Dietary Fats - administration & dosage; Energy Metabolism; Heart; Humans; hypolipidic diet; Male; Medical sciences; Middle Aged; Patient Compliance; resting energy expenditure; secondary prevention; Treatment Failure
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1053/euhj.1999.1402

Aim A low-saturated, low-cholesterol diet is important in the treatment of hypercholesterolaemia in patients with coronary heart disease. The aim of this study was to investigate the efficacy of a very low fat diet to achieve a targeted serum low density lipoprotein (LDL) cholesterol level (⩽2·59mmol.l−1) in outpatients with coronary heart disease. Methods One hundred and twenty-six male patients (all ex-smokers) with coronary heart disease and a serum LDL cholesterol >3·37mmol.l−1were investigated 12–14 weeks after an acute coronary event. After overnight fasting each patient had (a) his resting energy expenditure measured (indirect calorimetry using standard protocol) and (b) venous blood sampled from a forearm vein to determine lipid profile. All the patients were randomly allocated to four groups of treatment:Group Aon a very low fat diet (resting energy expenditure-fat diet, where fat intake was ⩽20% resting energy expenditure);Group Bon a low fat diet from the National Cholesterol Education program (National Cholesterol Education Program step 2 diet);Group Con resting energy expenditure-fat diet+simvastatin 10mg daily;Group Don National Cholesterol Education Program step 2 diet+simvastatin 10mg daily. For all patients the prescribed energy intakes were equal to their respective resting energy expenditures. Results At 6 months, the average decrease in serum LDL cholesterol was not different between Group A and Group B, but the increase in high density lipoprotein cholesterol (HDL) (+29%) observed in Group A led to a reduced LDL cholesterol/HDL cholesterol ratio (P