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

Aim a low-saturated, low-cholesterol diet is important in the treatment of hypercholesterolaemia in patients with coronary heart disease. The aim of t his study was to investigate the efficacy of a very low fat diet to achieve a targeted serum low density lipoprotein (LDL) cholesterol level (less tha n or equal to 2.59 mmol . l(-1)) in outpatients with coronary heart disease . Methods One hundred and twenty-six male patients tall ex-smokers) with coro nary heart disease and a serum LDL cholesterol >3.37 mmol . l(-1) were inve stigated 12-14 weeks after an acute coronary event. After overnight fasting each patient had (a) his resting energy expenditure measured (indirect cal orimetry using standard protocol) and (b) venous blood sampled from a forea rm vein to determine lipid profile. All the patients were randomly allocate d to four groups of treatment: Group A on a very low fat diet (resting ener gy expenditure-fat diet, where fat intake was less than or equal to 20% res ting energy expenditure); Group B on a low fat diet from the National Chole sterol Education program (National Cholesterol Education Program step 2 die t); Group C on resting energy expenditure-fat diet+simvastatin 10 mg daily; Group D on National Cholesterol Education Program step 2 diet+simvastatin 10 mg daily. For all patients the prescribed energy intakes were equal to t heir 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 lip oprotein cholesterol (HDL) (+29%) observed in Group A led to a reduced LDL cholesterol/HDL cholesterol ratio (P<0.001). As expected, a more important serum lipid improvement was found in the groups supplemented with diet+drug association, but the decrease in LDL cholesterol was higher in Group C tha n in Group D (-37 +/- 9.7% vs -24.5 +/- 15%; P<0.00001) as well as LDL chol esterol/HDL cholesterol ratio (P<0.001). No patient on diet alone achieved the recommended LDL cholesterol level less than or equal to 2.59 mmol . l(- 1). Conclusion Diet alone does not allow patients with coronary heart disease t o achieve the recommended blood cholesterol levels, even if its fat content is highly reduced.