Dietary Approaches to Lowering LDL-C

Abstract

Multiple epidemiological, experimental, genetic, and interventional trials have unequivocally established that low-density lipoprotein (LDL) is a causal risk factor for the initiation and progression of atherosclerosis. LDL-cholesterol (LDL-C) is a key goal for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) according to international guidelines. To achieve this, the 2019 American College of Cardiology/American Heart Association Guideline on the primary prevention of cardiovascular disease emphasizes the importance of adopting a healthy dietary pattern. This guideline document suggests that rather than focus on specific micronutrients, it may be more important to consider dietary patterns for the prediction and mitigation of cardiovascular disease risk. Current evidence suggests that adopting a healthy dietary pattern that includes fruits, vegetables, whole grains, nuts, legumes and, optionally, low-fat dairy and fish, and reduced consumption of red and processed meats, is a useful approach to lowering LDL-C. Here, we briefly review the role of LDL in the genesis of atherosclerosis, the importance of lowering LDL-C for primary and secondary prevention of ASCVD, and approaches to LDL-C lowering with dietary interventions and medical therapy. This chapter also evaluates the current evidence of different dietary patterns such as the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and plant-based vegetarian diets, with a specific focus on their impact on LDL-C.