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2/1/2010
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Eating more fish and less saturated fat is linked to blood-fat benefits that statin drugs did not boost any further
by Craig Weatherby


Surprisingly, there is relatively little evidence on the extent to which blood fat and cholesterol levels in older persons respond to dietary changes.

Nor has it been clear whether dietary changes add to or rival the effects that statin-type drugs exert on people’s cholesterol profiles.

Now a new study designed to help answer these questions has produced encouraging results.

Its findings suggest that modest dietary changes match the effects of statin-type drugs on key cardiovascular risk factors.

As lead author Anette Buyken, Ph.D., told Reuters Health, it looks like the “…benefits of reducing saturated fat and increasing omega-3 fat are the same for those on statins and those who are not” (Norton A 2010).

The study involved 900 Australian adults aged 49 or older who were followed for 10 years (Buyken AE et al. 2010).

Their fat intakes were assessed by diet questionnaires and confirmed by three blood tests over the course of the decade.

Cholesterol profiles improved among the participants who gradually ate less saturated fat and more omega-3s… with no real advantages seen among those who made these changes and were also taking a statin drug such as Lipitor, Crestor, or Pravachol.

Those who gradually shifted from foods high in saturated fats (butter, meat) to fish full of omega-3 fats enjoyed two key improvements:
  • Lower total cholesterol levels
  • Lower blood triglyceride levels
  • Higher blood levels of “good” (HDL) cholesterol
We should mention here the strong evidence that, when gauging a person's cardiac risk, his or her total cholesterol levels matter less than their levels of all non-HDL cholesterol in relation to HDL levels… a ratio that omega-3s improve.

Diet changes appear to rival statins' blood-fat benefits
When the study began, five percent of the participants were taking a cholesterol-lowering medication, usually a statin drug.

By the end of the study 10 years later, one-quarter of the participants had been prescribed drugs to control their cholesterol... mostly statins.

The analysis showed that people who cut back on saturated fats lowered their total cholesterol levels, regardless of whether they were taking a statin drug (Buyken AE et al. 2010).

And when study participants started eating more fish and omega-3 fatty acids, their “good” HDL cholesterol levels rose modestly and their triglyceride levels dropped substantially.

HDL levels lower than 40 mg/dL are considered a risk factor for heart disease, while levels of 60 mg/dL or higher are linked to lowered heart risks.

For every one percent increase in omega-3 intake, people’s HDL levels rose by about 2.5 mg/dL

Interestingly, higher intakes of omega-6 fats—the kind that dominate American diets and predominate in our most commonly consumed vegetable oils (e.g., corn, soy, sunflower)—were not linked to improvements in participants’ total cholesterol, LDL cholesterol, or triglyceride levels.

(See “Report Finds Americans Need More Omega-3s and Less Omega-6s” and “Heart Association Ignores Overall Risks of America's Omega-Imbalance.”)

As Dr. Buyken noted, the impact on blood fat profiles will likely be greater if a person cuts back on sources of saturated fat and replaces them with omega-3-rich fish such as salmon, sardines, tuna, sablefish, and mackerel.

Don’t toss your statin pills… but do adjust your diet
The new findings do not suggest that statins are useless, if only because certain risk groups—such as diabetics with cardiovascular disease—appear to benefit more clearly than most heart patients.

Also, some people’s bodies cannot regulate blood cholesterol levels, making these folks prime candidates for statin therapy

Still, the new findings do suggest that the value of statin drugs may be more limited than people tend to believe.

And that value may lie in an area other than the blood-lipid-lowering seen as their key contribution to reductions in risk factors, and is some cases, to the risk of heart attacks or death.

Inflammation, not cholesterol, may be the true prevention target
Conventional cardiovascular wisdom holds that many people need to lower their cholesterol levels considerably.

However, as recent articles in The New York Times and The Boston Globe demonstrated, there are increasingly serious doubts that high blood cholesterol levels and/or diets high in cholesterol and saturated fats are primary causes of heart disease.

For links to those analyses, see “Cholesterol Fiasco Undermines Accepted Theory.”

Instead, there’s increasing evidence that cardiovascular disease is driven by chronic, “silent” inflammation and the nutritional deficiencies that promote that condition.

Inflammation generates free radicals that oxidize cholesterol. Oxidized cholesterol elicits an inflammatory immune response that results in buildup of plaque in artery walls… an unstable conglomeration of damaged cholesterol and fats and the immune system cells that ingest them.

Chronic inflammation also makes blood sticky and clot prone and can destabilize arterial plaque, causing it to rupture and form artery-blocking clots that can yield heart attacks and sudden cardiac death.

Sadly, inflammation-inducing dietary deficiencies describe the standard American diet to a “T”.

These inflammation-inducing deficiencies include excess sugar, starch, and omega-6 fats, combined with low intakes of omega-3s (from fish and green plant foods) and nutrient-dense plant foods (fruits, veggies, nuts, and whole grains).

In fact, although some (not all) statin drugs are proven to reduce the risk of dying from cardiovascular disease, it appears increasingly likely that this benefit flows as much or more from their proven anti-inflammatory powers as from their cholesterol-lowering effects.

What gets left unsaid to most heart patients is that diet is a powerful anti-inflammatory ally. Omega-3s are critical to the body’s ability to control this insidious enemy, thanks to their anti-inflammatory influences within the immune system.

This is one reason why the American Heart Association recommends eating fatty fish twice a week.

The new study is only the latest research to question the value of statin drugs, versus diet and lifestyle changes.

For more on this topic see “Statin Drug Beaten by Alternative Cholesterol Treatment,” “Cholesterol Fiasco Undermines Accepted Theory,” “Omega-3s Seen Rivaling Statins at Reducing Risk of Death,” and “Does Statins’ SuperStar Status Make Sense?


Sources
  • Ali R, Alexander KP. Statins for the primary prevention of cardiovascular events in older adults: a review of the evidence. Am J Geriatr Pharmacother. 2007 Mar;5(1):52-63. Review.
  • Becker DJ, Gordon RY, Morris PB, Yorko J, Gordon YJ, Li M, Iqbal N. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.
  • Buyken AE, Flood V, Rochtchina E, Nestel P, Brand-Miller J, Mitchell P. Modifications in dietary fat quality are associated with changes in serum lipids of older adults independently of lipid medication. J Nutr. 2010 Jan;140(1):88-94. Epub 2009 Nov 18.
  • Norton A. Diet changes improve older adults' cholesterol too. Reuters Health. January 11, 2010. Accessed at http://www.reuters.com/article/idUSTRE60S63920100129
  • Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, Yeo W, Payne N. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess. 2007 Apr;11(14):1-160, iii-iv. Review.

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