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• W2019156740 abstract "The crucial role of cholesterol-lowering therapy in the treatment of cardiovascular disease is the result of a century of painstaking scientific discovery, from early studies on the composition of the atherosclerotic plaque1 to recent confirmation of the cholesterol hypothesis. Until publication of the Scandinavian Simvastatin Survival Study,2 this subject was one of persistent controversy with widely divergent opinions. Among the latter were views-subsequently repudiated by the evidence-summarily dismissing the connection between cholestrol and coronary heart disease.3 A major factor in the final verification of the cholesterol hypothesis was development of the statins, whose potency and safety demonstrated that lowering serum cholesterol reduces coronary heart disease. In current practice, these drugs are our most effective and widely utilized weapons for managing hypercholesterolemia. Their benefits have been demonstrated in landmark clinical trials of secondary and primary prevention in patients with very high and with average serum cholesterol.4 The success of these agents has even led some to suggest that they may end the coronary epidemic.5 While this view fails to recognize the multiplicity of factors that result in coronary heart disease, which are beyond the therapeutic reach of any single treatment, it does reflect the beneficial impact of statins on this problem. Indeed, an important concern in current practice is the underuse of these agents in patients with established cardiac disease,4 for whom they have done the greatest good in the shortest time. In this issue of Preventive Cardiology, Esselstyn presents an alternative approach to our current focus on drug therapy of hyperlipidemia. Noting the abundant evidence linking diet and coronary heart disease, he ardently states the case for the primacy of a nutritional strategy in addressing the epidemic of hyperlipidemia and coronary heart disease.6 In addition to support by epidemiologic data and clinical studies, he provides illustrations of the potential of a plant-based diet to improve atherosclerotic lesions in patients with coronary artery disease. He appeals to the medical community for greater recognition of the importance of diet and the primacy of a plant-based nutritional approach to combating coronary heart disease. How do we respond to Esselstyn's appeal? On the one hand, many would say it is unrealistic and self-defeating because of the problem of compliance with a radical change in diet on a population-wide scale. As quipped by Mark Twain, “It's easy to change one's habits, as long as they're not your own.” There are additional considerations. Reliance on diet rather than a statin following a coronary event might deprive patients of the early benefits of rapid lipid lowering conferred by these drugs. Additional effects of statins include modest augmentation of high-density lipoprotein cholesterol and reduction of triglycerides. There is also evidence that statins have favorable actions independent of their lipid lowering effects.7 However, most would agree that we are not utilizing dietary modification adequately. In this regard, the recommendations of the National Cholesterol Education Program (NCEP) III8 call for increased attention to dietary alterations and other lifestyle changes. It is essential that physicians recognize the real potential of diet to produce favorable effects on serum lipids, coronary lesions, and clinical events. The effects of diet, like other forms of therapy, follow a dose-response relationship in the great majority of patients, as indicated in the Table. Patients may be motivated to utilize more intensive dietary modification if they are apprised of the efficacy of this approach. This requires physician awareness and patient education. The benefits of nondrug therapy on coronary artery lesions and events have been demonstrated in controlled trials.9, 10 Reduction of serum cholesterol can be rapid following substantial dietary alteration. It should be recognized that some patients may be willing to radically alter their diets if informed of the demonstrable benefits. Others may be able to improve their diets, allowing reduction in cholesterol-lowering medications. Still others will require full doses of these drugs to reach current targets for serum lipids. It is helpful to recall that the good is not the enemy of the best. Safe and effective modification of serum lipids requires a comprehensive strategy tailored to each patient. Utilization of all proven methods will best serve the goal of stemming the coronary epidemic." @default.
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• W2019156740 date "2001-10-01" @default.
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• W2019156740 title "Diet: How Important Is It in the Treatment of Hypercholesterolemia?" @default.
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• W2019156740 doi "https://doi.org/10.1111/j.1520-037x.2001.00546.x" @default.
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