Warding-off Heart Disease Through Nutrition

Introduction

Atherosclerotic Cardiovascular Disease (ASCVD), the leading cause of morbidity and mortality worldwide, most strongly linked to the atherogenic lipoproteins also know as ApoB particles, particularly low-density lipoprotein and the cholesterol carried inside it (LDL-C). Recent studies have highlighted the significant impact of dietary interventions on lipoprotein profiles and the subsequent risk of ASCVD. In this context, the findings of Kirkpatrick CF et al. in their 2023 study provide valuable insights into how specific dietary changes can lead to a reduction in LDL-C levels​​.1

The good news is most studies on dietary interventions on LDL-C were short, which means the improvements they saw will happen quickly. Let’s say your LDL-C or ApoB is 120 mg/dL and your target is to get below 90. The literature suggests is likely achievable to get to your target, relatively quickly (6 weeks or so) through diet change. 

1. Replacing Saturated with Unsaturated Fats

A shift from saturated to unsaturated fats is associated with a 5% to 10% reduction in LDL-C​​. This is echoed by Mozaffarian et al. who emphasize the benefits of unsaturated fats found in nuts, seeds, avocados, and certain fish, in reducing heart disease risk​​.2

2. Increased Plant Fiber Intake

Consuming 7.5g/day of plant fiber from sources like oats, barley, eggplant, okra, and sweet potato can lower LDL-C by 6% to 9%​​. This is supported by Threapleton et al., who found that dietary fiber intake significantly reduces cardiovascular risk​​.3

3. Plant Sterols and Stanols

Ingesting 2g/day of plant sterols or stanols, often found in supplements, can decrease LDL-C levels by 5% to 8%​​. A study by AbuMweis et al. corroborates the cholesterol-lowering effect of plant sterols​​.4

4. Plant Protein Consumption

Replacing animal protein or carbohydrates with 30g/day of plant protein can result in a 3% to 5% reduction in LDL-C​​. According to a study by Jenkins et al., plant-based diets, including soy and legumes, offer cardiovascular benefits beyond cholesterol reduction​​.5

5. Weight Loss

For individuals with excess body fat, losing 5% of body weight is linked to a 3% to 5% decrease in LDL-C​​. The work of Wing et al. highlights the role of weight loss in improving lipid profiles​​.6

Cultural Adaptation Across America

These dietary interventions can be adapted to various cultural diets across America. For instance, the Mediterranean diet, rich in unsaturated fats from olive oil and nuts, aligns with the first recommendation. Similarly, the traditional diets of many Asian communities, which are high in plant proteins like tofu and legumes, naturally incorporate the fourth recommendation. Many diets of the Southern USA, with emphasis on roasted/grilled vegetables and legumes, also align well with the increased intake of plant fiber and protein.

Conclusion

The challenge to a diet-based strategy to reducing LDL-C is keeping the habits going throughout a lifetime. Regular monitoring of LDL-C and ApoB can serve as a motivator and reminder. It can also help track if the changes to diet are working or not. Overall, the modification of diet, as elucidated by Kirkpatrick CF et al., presents a promising avenue for reducing ASCVD risk. This approach, coupled with other positive lifestyle changes, can be a cornerstone in the management and prevention of cardiovascular diseases.

References

1. Kirkpatrick CF, et al. "Impact of Dietary Changes on Lipoprotein Profiles and the Risk of ASCVD". J Clin Lipidol. 2023 Jun 2:S1933-2874(23)00185-X. doi: 10.1016/j.jacl.2023.05.099.

2. Mozaffarian D, et al. "Health Benefits of Omega-3 Fatty Acids from Plant and Marine Sources". Prog Cardiovasc Dis. 2011;54(2):92-99. doi: 10.1016/j.pcad.2011.06.003.

3. Threapleton DE, et al. "Dietary Fiber Intake and Risk of Cardiovascular Disease: Systematic Review and Meta-analysis". BMJ. 2013;347:f6879. doi: 10.1136/bmj.f6879.

4. AbuMweis SS, et al. "Plant Sterols and Stanols in the Management of Dyslipidaemia and Prevention of Cardiovascular Disease". Atherosclerosis. 2014;232(2):346-360. doi: 10.1016/j.atherosclerosis.2013.11.043.

5. Jenkins DJ, et al. "Effect of a 6-Month Vegan Low Carbohydrate ('Eco-Atkins') Diet on Cardiovascular Risk Factors and Body Weight in Hyperlipidaemic Adults: A Randomised Controlled Trial". BMJ Open. 2014;4(2):e003505. doi: 10.1136/bmjopen-2013-003505.

6. Wing, R. R. et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 34, 1481–1486 (2011)