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Diet and Heart Disease
Robert M. Russell, M.D. and Alice H. Lichtenstein, D. Sc.
Table 3: Recommended Diets to Reduce Risk and/or Blood Cholesterol Levels
| Dietary Factor |
Step 1 |
Step 2 |
| Total Fat |
30% energy |
30% energy |
| Saturated Fat |
8-10% energy |
7% energy |
| Cholesterol |
300 mg/day |
200 mg/day |
| Carbohydrate |
55% energy |
55% energy |
| Protein |
15% energy |
15% energy |
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Table 4. Primary Prevention Without Evidence of Coronary Heart Disease
| Desirable Blood Cholesterol (< 200 mg/dl [> 5.2 mmol/L]) |
| HDL cholesterol > 35 mg/dl |
- Provide education on Step 1 diet, physical activity and risk factor reduction
- Repeat total and HDL cholesterol within 5 years
|
| HDL cholesterol < 35 mg/dl |
- Lipoprotein analysis to determine LDL cholesterol (see Table 5)
|
HDL cholesterol > 35 mg/dl
and fewer than 2 risk factors |
- Provide education on Step 1 diet, physical activity and risk factor reduction
- Reevaluate patient 1 to 2 years (repeat total and HDL cholesterol measures)
- Reinforce nutrition and physical activity education
|
HDL cholesterol < 35 mg/dl
or 2 or more risk factors |
- Lipoprotein analysis to determine LDL cholesterol (see Table 5)
|
| Borderline-High Blood Cholesterol (201-239 mg/dl [5.2-6.2 mmol/L]) |
| HDL cholesterol > 35mg/dl and fewer than 2 risk factors |
- Provide education on Step 1 diet, physical activity and risk factor reduction
- Reevaluate patient 1 to 2 years (repeat total and HDL cholesterol measures)
- Reinforce nutrition and physical activity education
|
| HDL cholesterol < 35mg/dl or 2 or more risk factors |
- Lipoprotein analysis to determine LDL cholesterol (see Table 5)
|
| High-Blood Cholesterol (>240 mg/dl [>6.2 mmol/L]) |
| |
- Lipoprotein analysis to determine LDL cholesterol (see Table 5)
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Table 5. Classification on Basis of Low Density Lipoprotein (LDL)
Cholesterol -- Primary Prevention in Adults without Evidence of Coronary Heart Disease
Lipoprotein analysis after fasting 9-12 hours:
| Desirable LDL Cholesterol (< 130 mg/dl [3.4 mmol/L]) |
| |
- Provide education on Step 1 diet, physical activity and risk factor reduction
- Repeat total and HDL cholesterol wiithin 5 years
|
| Borderline-High Risk LDL Cholesterol (130 to 159 mg/dl [3.4 to 4/1 mmol/L]) |
| fewer than two risk factors |
- Provide education on Step 1 diet and physical activity
- Reevaluate patient status annually, repeat lipoprotein
analysis, reinforce nutrition and physical activity education
|
| 2 or more risk factors |
- Do clinical evaluation (history, physical examination and laboratory tests)
- Evaluate secondary causes and familial disorders (when indicated)
- Initiate Step 1 diet, if inadequate response achieved, initiate Step 2 diet
|
| High Risk LDL Cholesterol (>160 mg/dl [4.1 mmol/L]) |
| |
- Do clinical evaluation (history, physical examination and laboratory tests)
- Evaluate secondary causes and familial disorders (when indicated)
- Initiate Step 1 diet, if inadequate response achieved, initiate Step 2 diet
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Table 6. Treatment Based on LDL Cholesterol Levels
| Therapy type |
LDL level at which to initiate therapy |
LDL Goal |
| Diet Therapy |
| Without CHD and fewer than 2 risk factors |
> 160 mg/dl |
< 160 mg/dl |
| Without CHD and 2 or more risk factors |
> 130 mg/dl |
< 130 mg/dl |
| With CHD |
> 100 mg/dl |
< 100 mg/dl |
| |
| Drug Therapy |
| Without CHD and fewer than 2 risk factors |
> 190 mg/dl |
< 160 mg/dl |
| Without CHD and 2 or more risk factors |
> 160 mg/dl |
< 130 mg/dl |
| With CHD |
> 130 mg/dl |
< 100 mg/dl |
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Table 7. Foods Relatively High in Saturated Fat
| Animal fats |
Plant oils |
- Full fat dairy products (butter, whole fat milk, cheese, ice cream)
- Meat (beef, pork, poultry with skin)
|
- coconut oil
- palm oil
- palm kernel oil
- cocoa butter
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