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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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