From Healio Cardiology Today: Lifestyle therapies to decrease atherogenic cholesterol and promote CV health: A summary of recent recommendations

By Carol Kirkpatrick, PhD, RDN, LDN, CLS, FNLA; Geeta Sikand, MA, RDN, FAND, CLS, CDE, FNLA; Ralph LaForge, MSc, CLS, FNLA

In September, the National Lipid Association released its new Recommendations for Patient-Centered for Dyslipidemia Management – Part 2. These recommendations include a thorough review of the lifestyle therapies — nutrition and physical activity — that promote atherosclerotic CVD risk reduction through lowering atherogenic cholesterol and other atherosclerotic CVD risk factors.

Targets of lifestyle therapies

The targets of lifestyle therapies for atherosclerotic CVD (ASCVD) risk reduction are atherogenic cholesterol levels, primarily LDL and non-HDL. When the triglyceride level is greater than 500 mg/dL, triglyceride concentration becomes a target of therapy, primarily to reduce the risk for acute pancreatitis. Other ASCVD risk factors affected by lifestyle therapies include overweight/obesity, hypertension, and hyperglycemia and diabetes.

Nutrition therapies

A cardioprotective dietary pattern is recommended to reduce atherogenic cholesterol and other ASCVD risk factors, such as hypertension. Components of a cardioprotective dietary pattern that reduce atherogenic cholesterol include:

• reducing saturated fat intake to less than 7% of daily energy;
• minimal intake of trans fatty acids;
• less than 200 mg/day dietary cholesterol;
• increasing intake of viscous fibers by consuming a variety of plant foods; and
• reducing intake of sugars and refined carbohydrates.

Saturated and trans fatty acids

Both the National Lipid Association (NLA) Recommendations – Part 2 and the 2013 American Heart Association/American College of Cardiology Guideline on Lifestyle Management to Reduce Cardiovascular Risk include recommendations to limit the intake of foods rich in saturated fatty acids and trans fatty acids to reduce atherogenic cholesterol levels. Results from controlled-feeding trials have illustrated the predicted effects of replacing 5% of daily energy from saturated fatty acids with 5% of daily energy from polyunsaturated fatty acids, monounsaturated fatty acids and carbohydrates (see Table below).

Decreasing the intake of saturated fatty acids in a cardioprotective dietary pattern can be achieved by choosing foods rich in polyunsaturated fatty acids and monounsaturated fatty acids or foods low in saturated fatty acids:

• liquid vegetable oils (ie, corn, canola, olive and safflower oils) instead of butter or coconut oil;
• nuts and seeds: 1 oz four times per week;
• natural peanut butter or avocado as a spread on toast; and
• lean protein foods: legumes, seafood, lean meats, and non- or low-fat dairy products.

Trans fatty acids increase levels of atherogenic cholesterol. Hydrogenated fat in processed foods is the main source of trans fatty acids in the food supply. Patients should be educated to avoid foods with “partially hydrogenated oil” on the ingredient list, eg, some cookies, pastries, biscuits, crackers, microwaved popcorn and frozen dinners.

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