Original Communication

European Journal of Clinical Nutrition (2005) 59, 851–860. doi:10.1038/sj.ejcn.1602152 Published online 18 May 2005

Direct comparison of dietary portfolio vs statin on C-reactive protein

Guarantor: DJA Jenkins.

Contributors: Study concept and design: DJAJ, CWCK, DAF. acquisition of data: DJAJ, CWCK, AM, DAF, JMWW, R de S, AE, TLP, TJL, PWC; analysis and interpretation of data: DJAJ, CWCK, DAF, ARJ, TJL, RGJ, LAL, PWC; drafting of the manuscript: DJAJ, CWCK, AM; critical revision of the manuscript for important intellectual content: DJAJ, CWCK, AM, DAF, ARJ, JMWW, R de S, AE, TLP, TJL, RGJ, LAL, WS, PWC; statistical expertise: TJL; obtained funding: DJAJ, CWCK; administrative, technical or material support: CWCK, AM, DAF, JMWW, R de S, AE, TLP, RGJ, LAL, WS, PWC; study supervision: DJAJ, CWCK, DAF.

D J A Jenkins1,2,3,4, C W C Kendall1,3, A Marchie1,3, D A Faulkner1,3, A R Josse1, J M W Wong1,3, R de Souza1,3, A Emam1,3, T L Parker1,3, T J Li3, R G Josse1,2,3,4, L A Leiter1,2,3,4, W Singer1,2,4 and P W Connelly2,4,5

  1. 1Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada
  2. 2Department of Medicine, Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario, Canada
  3. 3Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Correspondence: DJA Jenkins, Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, 61 Queen St East, Toronto, Ontario, Canada M5C 2T2. E-mail: cyril.kendall@utoronto.ca

Received 28 June 2004; Revised 4 March 2005; Accepted 18 March 2005; Published online 18 May 2005.

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Abstract

Background:

 

3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) markedly reduce serum cholesterol and have anti-inflammatory effects. The effect of cholesterol-lowering diets on inflammatory biomarkers is less well known.

Objective:

 

To compare the efficacy of a dietary combination (portfolio) of cholesterol-lowering foods vs a statin in reducing C-reactive protein (CRP) as a biomarker of inflammation linked to increased cardiovascular disease risk.

Methods:

 

In all, 34 hyperlipidemic subjects completed three 1-month treatments as outpatients in random order: a very low-saturated fat diet (control); the same diet with 20 mg lovastatin (statin); and a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (portfolio). Fasting blood samples were obtained at weeks 0, 2, and 4.

Results:

 

Using the complete data, no treatment reduced serum CRP. However, when subjects with CRP levels above the 75th percentile for previously reported studies (>3.5 mg/l) were excluded, CRP was reduced similarly on both statin, -16.3plusminus6.7% (n=23, P=0.013) and dietary portfolio, -23.8plusminus6.9% (n=25, P=0.001) but not the control, 15.3plusminus13.6% (n=28, P=0.907). The percentage CRP change from baseline on the portfolio treatment (n=25) was greater than the control (n=28, P=0.004) but similar to statin treatment (n=23, P=0.349). Both statin and portfolio treatments were similar in reducing CRP and numerically more effective than control but only the change in portfolio was significant after the Bonferroni adjustment.

Conclusions:

 

A combination of cholesterol-lowering foods reduced C-reactive protein to a similar extent as the starting dose of a first-generation statin.

Keywords:

almonds, soy protein, viscous dietary fiber, plant sterols, national cholesterol education program diet, low saturated fat

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