Skip to main content
Log in

Diet and coronary heart disease: Clinical trials

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Dietary intervention trials using coronary heart disease (CHD) mortality and morbidity as endpoints have demonstrated that restriction of dietary total and saturated fat or replacement of the latter with polyunsaturated fatty acids (PUFAs), in particular n-3 PUFAs, is of great benefit with respect to CHD risk. This is likewise the case for intervention trials using angiographic endpoints, with many studies showing that such diets not only retard progression of coronary atherosclerosis but can cause regression as well. The role that antioxidants, such as vitamin E, may play in the development and progression of CHD is less clear. The results of large-scale clinical trials evaluating the effect of vitamin E supplementation on CHD risk do not support the concept that this agent is cardioprotective. The purpose of this report is to review dietary intervention trials that support a direct relationship between diet, lipoproteins, and CHD risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. American Heart Association: 1998 heart and stroke statistical update. Dallas, TX, American Heart Association, 1998:B4.

    Google Scholar 

  2. The Expert Panel: Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988, 148:36–69.

    Article  Google Scholar 

  3. The Expert Panel: Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). JAMA 1993, 269:3015–3023.

    Article  Google Scholar 

  4. The Expert Panel: Second report of the Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II). Circulation 1994, 89:1333–1345.

    Google Scholar 

  5. Spady DK, Bilheimer DW, Dietschy JM: Rates of receptor-dependent and -independent low density lipoprotein uptake in the hamster. Proc Natl Acad Sci USA 1983, 80:3499–3503.

    Article  PubMed  CAS  Google Scholar 

  6. Brinton EA, Eisenberg S, Breslow JL: A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates. J Clin Invest 1990, 85:144–151.

    Article  PubMed  CAS  Google Scholar 

  7. Velez-Carrasco W, Lichtenstein AH, Welty FK, et al.: Dietary restriction of saturated fat and cholesterol decreases HDL apoA-I secretion. Arterioscler Thromb Vasc Biol 1999, 19:918–924.

    PubMed  CAS  Google Scholar 

  8. Yu-Poth S, Zhao G, Etherton T, et al.: Effects of the National Cholesterol Education Program’s Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr 1999, 69:632–646.

    PubMed  CAS  Google Scholar 

  9. Mattson FH, Grundy SM: Comparison of the effects of dietary saturated, monoun-saturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man. J Lipid Res 1985, 26:194–202.

    PubMed  CAS  Google Scholar 

  10. Dreon DM, Vranizan KM, Krauss RM, et al.: The effects of polyunsaturated fat vs monounsaturated fat on plasma lipoproteins. JAMA 1990, 263:2462–2466.

    Article  PubMed  CAS  Google Scholar 

  11. Mensink RP, Katan MB: Effect of dietary fatty acids on serum lipids and lipoproteins: a meta-analysis of 27 trials. Arterioscler Thromb 1992, 12:911–919.

    PubMed  CAS  Google Scholar 

  12. Mensink RP, Katan MB: Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. N Engl J Med 1990, 323:439–445.

    Article  PubMed  CAS  Google Scholar 

  13. Zock PL, Katan MB: Hydrogenation alternatives: effects of trans fatty acids and stearic acid versus linoleic acid on serum lipids and lipoproteins in humans. J Lipid Res 1992, 33:399–410.

    PubMed  CAS  Google Scholar 

  14. Judd JT, Clevidence BA, Muesing RA, et al.: Dietary trans fatty acids: effects on plasma lipids and lipoproteins of healthy subjects. Am J Clin Nutr 1994, 59:861–868.

    PubMed  CAS  Google Scholar 

  15. Lichtenstein AH, Ausman LM, Jalbert SM, et al.: Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. N Engl J Med 1999, 340:1933–1940.

    Article  PubMed  CAS  Google Scholar 

  16. Kris-Etherton PM, Yu S: Individual fatty acid effects on plasma lipids and lipoproteins: human studies. Am J Clin Nutr 1997, 65:1628S-1644S.

    PubMed  CAS  Google Scholar 

  17. Morrison LM: A nutritional program for prolongation of life in coronary atherosclerosis. JAMA 1955, 159:1425–1428.

    CAS  Google Scholar 

  18. Morrison LM: Diet in coronary atherosclerosis. JAMA 1960, 173:884–888.

    PubMed  CAS  Google Scholar 

  19. Nelson AM: Treatment of atherosclerosis by diet. North W Med 1956, 55:643–649.

    CAS  Google Scholar 

  20. Lyon TP, Yankley A, Gofman JW, et al.: Lipoproteins and diet in coronary heart disease. Calif Med 1956, 84:325–328.

    PubMed  CAS  Google Scholar 

  21. Turpeinen O, Roine P, Pekkarinen M, et al.: Effect on serum cholesterol level of replacement of dietary milk fat by soy bean oil. Lancet 1960, 1:196–198.

    Article  PubMed  CAS  Google Scholar 

  22. Joliffe N, Baumgartner L, Rinzler S, et al.: The Anti-Coronary Club. The first four years. New York St J Med 1963, 63:69–79.

    Google Scholar 

  23. Koranyi A: Prophylaxis and treatment of the coronary syndrome. Ther hung 1963, 11:17–20.

    Google Scholar 

  24. Bierenbaum ML, Green DP, Florin A, et al.: Modified-fat dietary management of the young male with coronary disease: a five-year report. JAMA 1967, 202:1119–1123.

    Article  PubMed  CAS  Google Scholar 

  25. Christakis G, Rinzler SH, Archer M, et al.: The anti-coronary club: a dietary approach to the prevention of coronary heart disease: seven-year report. Am J Public Health Nations Health 1966, 56:299–314.

    PubMed  CAS  Google Scholar 

  26. Turpeinen O, Miettinen M, Karvonen MJ, et al.: Dietary prevention of coronary heart disease: long-term experiment: I. observations of male subjects. Am J Clin Nutr 1968, 21:255–276.

    PubMed  CAS  Google Scholar 

  27. Miettinen M, Turpeinen O, Karvonen MJ, et al.: Effect of cholesterol-lowering diet on mortality from coronary heart-disease and other causes. Lancet 1972, 2:835–838.

    Article  PubMed  CAS  Google Scholar 

  28. Turpeinen O: Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 1979, 59:1–7.

    PubMed  CAS  Google Scholar 

  29. Leren P: The effect of plasma cholesterol lowering diet in male survivors of myocardial infarction. Acta Med Scand 1966, 466:1–92.

    CAS  Google Scholar 

  30. Dayton S, Pearce ML, Goldman H, et al.: Controlled trial of a diet high in unsaturated fat for prevention of atherosclerotic complications. Lancet 1968, 2:1060–1062.

    Article  PubMed  CAS  Google Scholar 

  31. Frantz ID, Jr, Dawson EA, Ashman PL, et al.: Test of effect of lipid lowering by diet on cardiovascular risk: the Minnesota Coronary Survey. Arteriosclerosis 1989, 9:129–135.

    PubMed  Google Scholar 

  32. Blum CB, Levy RI: Epidemiological and public health studies of treatment of hyper-cholesterolemia. In Primary Hyperlipoproteinemias. Edited by Steiner G, Shafrir E. New York, McGraw-Hill, 1991:129.

    Google Scholar 

  33. Burr ML, Gilbert JF, Holliday RM, et al.: Effects of changes in fat, fish, and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial (DART). Lancet 1989, 2:757–761.

    Article  PubMed  CAS  Google Scholar 

  34. de Lorgeril M, Renaud S, Mamelle N, et al.: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet 1994, 343:1454–1459.

    Article  PubMed  Google Scholar 

  35. de Lorgeril M, Salen P, Martin J-L, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.

    PubMed  Google Scholar 

  36. GISSI-Prevenzione Investigators: Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet 1999, 354:447–455.

    Article  Google Scholar 

  37. The HOPE Study Investigators: The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. Can J Cardiol 1996, 12:127–137.

    Google Scholar 

  38. The Heart Outcomes Prevention Evaluation Study Investigators: Vitamin E supplementation and cardiovascular events in high-risk patients. N Engl J Med 2000, 342:154–160.

    Article  Google Scholar 

  39. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study group: The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 1994, 330:1029–1035.

    Article  Google Scholar 

  40. Stephens NG, Parsons A, Schofield PM, et al.: Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study. Lancet 1996, 347:781–786.

    Article  PubMed  CAS  Google Scholar 

  41. Gould KL, Ornish D, Kirkeeide R, et al.: Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol 1992, 69:845–853.

    Article  PubMed  CAS  Google Scholar 

  42. Ornish DM, Brown SE, Scherwitz LW, et al.: Can lifestyle changes reverse coronary heart disease? Lancet 1990, 336:129–133.

    Article  PubMed  CAS  Google Scholar 

  43. Ornish DM, Scherwitz LW, Billings JH, et al.: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998, 280:2001–2007.

    Article  PubMed  CAS  Google Scholar 

  44. Schuler G, Hambrecht R, Schlierf G, et al.: Regular physical exercise and low-fat diet: effects of progression on coronary artery disease. Circulation 1992, 86:1–11.

    PubMed  CAS  Google Scholar 

  45. Blankenhorn DH, Johnson RL, Mack WJ, et al.: The influence of diet on the appearance of new lesions in human coronary arteries. JAMA 1990, 263:1646–1652.

    Article  PubMed  CAS  Google Scholar 

  46. Watts GF, Lewis B, Brunt JNH, et al.: Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St. Thomas’ Atherosclerosis Regression Study (STARS). Lancet 1992, 339:563–569.

    Article  PubMed  CAS  Google Scholar 

  47. Haskell WL, Alderman EL, Fair JM, et al.: The effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events: the Stanford Coronary Intervention Project (SCRIP). Circulation 1994, 89:975–990.

    PubMed  CAS  Google Scholar 

  48. Quinn TG, Alderman EL, McMillan A, et al.: Development of new coronary atherosclerotic lesions during a 4-year multifactor risk reduction program: The Stanford Risk Intervention Project (SCRIP). J Am Coll Cardiol 1994, 24:900–908.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brousseau, M.E., Schaefer, E.J. Diet and coronary heart disease: Clinical trials. Curr Atheroscler Rep 2, 487–493 (2000). https://doi.org/10.1007/s11883-000-0048-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-000-0048-6

Keywords

Navigation