Diet, Lifestyle & Cholesterol
Despite a modest decline in total cholesterol (TC) levels of Australian men and women between 2004 and 2008, the burden of cardiovascular disease (CVD) remains a constant concern.
The 2011 Australia’s Cholesterol Crossroads report found that
36% and 56% of men and 38% and 54% of women had sub-optimal TC and
low density lipoproteins (LDL-C) respectively.
Discussing modifiable risk factors with hypercholesterolaemic patients is equally important whether the patient requires lipid-modulating pharmacotherapy or not.2 Lifestyle approaches such as dietary modifications, physical exercise, quitting smoking and weight control can assist in achieving desirable lipid levels.
Dietary modification can decrease TC, LDL-C and triglyceride levels whilst increasing high density lipoprotein (HDL-C) levels1. Dietary modification can include:
• Reducing energy intake;
• Decreasing saturated fat intake; and
• Replacing saturated fats with polyunsaturated or monounsaturated fats and carbohydrates (excluding sugars and syrup).
Plant sterols (phytosterols) have received considerable attention in recent years, as an effective cholesterol-lowering food additive. Margarines containing esterified phytosterols are no longer exclusive to this market.
A study by Clifton et al, demonstrated that phytosterols added to milk, yogurt, bread and cereal lower serum LDL cholesterol. Milk was the most effective vehicle with a 15.9% lowering of LDL-C in participants who ingested 500mL of milk fortified with 1.6 g/day of phytosterols for three weeks.
The following key recommendations have been developed for GPs:
• Comprehensively assess all cardiac risk factors including modifiable lifestyle factors;
• Identify absolute CVD risk; and
• Discuss dietary modification and lifestyle approaches as part of a wider cholesterol management plan.
Useful URLs:
Baker IDI Heart and Diabetes Institute www.bakeridi.edu.au
Heart Foundation www.heartfoundation.org.au
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