Bottomline: What you eat can be an effective way to lower heart disease and improve health---without the risks from taking statin medications.

Commentary

There’s been a lot of buzz about the JUPITER study, (1), which showed that statins lower the inflammatory marker, high-sensitivity C-reactive protein (CRP) in healthy patients, and prevented heart attacks, strokes and deaths. Yet, there are compelling studies, which show that diet reduces CRP,  prevents heart disease and death (but there’s not much hoopla, even though the data exist!)  We need to consider the powerful impact of diet as a means of primary disease prevention in healthy people, before popping statin pills as the first line of defense.

Portfolio Diet Just as Effective as a Statin
The Portfolio Diet (a diet high in soluble fiber) went head-to-head with a statin and was shown to be just as effective as a statin in lowering cholesterol and CRP in men and women with high cholesterol. (Jenkins)

Healthy Diet Reduce CRP’s by 41%
 Healthy women who scored high on the Alternate Eating Index had a 41% reduction in CRP’s.  This index reflects core components reflecting a healthy diet, associated with disease prevention (Fargnoli).

Lyon Diet Reduced All-Cause Mortality
Let’s not forget the stunning results from the Lyon Diet Heart Trial (de Lorgeril), which compared the effects of eating a Mediterranean-style diet to the standard prudent heart diet recommended by the American Heart Association. The results were so striking, that the study was halted mid-way by an ethics committee (It was supposed to be a 5-year study).   Remarkably, there was a complete prevention of cardiac sudden death.  Yet the control group, which followed the classic heart-health-diet had no such benefit. 

The results of the 4-year follow-up of the Lyon Diet Heart Study were even more remarkable--an unprecedented lower death rate from all causes, especially cancer.  This was an unexpected finding.  The impact of this diet was also reflected in the blood phospholipids, with a lower ratio of omega-6 to omega-3 fats. The classic cardiac diet does not distinguish between the types of polyunsaturated fat, which is mostly omega-6 fat, and failed to improve the overall prognosis.  But the Lyon Diet limits the amount of dietary omega-6 fats to no more than 7 grams per day, because it reflects one of the features of the classic Mediterranean diet.  To put this into perspective, the typical American consumes twice this amount of omega-6 fat.

Statins Reduce Omega-6 Fats
While statins are well known for lowering cholesterol, they also by blunt the effects of excessive omega-6 fats, which are at the root of inflammation.  For example, statins prevents the:

• Release of arachidonic acid from the LDL-cholesterol (Kim).  Arachidonic acid is the potent omega-6 fat, which increases blood clots, arrhythmias and stiffens arteries.

• Formation of isoprenoids, another particularly potent group of inflammatory compounds, which are derived from Arachidonic acid (Lands).

While this might sound like I’m making the case for statins, to the contrary—it’s another reason to eat a Mediterranean diet, which is low in omega-6 fat and high in omega-3 fats.

When you lower omega-6 fats, you lower the fuel for inflammation. The higher dietary DHA and EPA (from fish) displaces arachidonic acid from the cell membranes, reducing inflammation further. Let’s also not forget the recent trial where fish oil out-performed statins in patients with chronic heart failure. 

We also need to be mindful of possible side-effects of long-term use of statins, including muscle weakness, fatigue and deterioration.  There is also a possible increase in breast cancer (Okuyama), although larger studies are needed validate this risk.  The first line of defense against chronic diseases begins with a fork and a knife at the kitchen table, not reaching for pills from the medicine cabinet.


Links to Sources:

de Lorgeril M 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 (Free full text)

Fargnoli,JL et al. Adherence to healthy eating patterns is associated with higher circulating total and high-molecular-weight adiponectin and lower resistin concentrations in women from the Nurses' Health Study. Am J Clin Nutr 2008 88: 1213-1224

Jenkins David J. A. et al.
Effects of a Dietary Portfolio of Cholesterol-Lowering Foods vs Lovastatin on Serum Lipids and C-Reactive Protein. JAMA. 2003;290(4):502-510 (Free Full Text).

JUPITER Study Group. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein N Engl J Med 2008 0: NEJMoa0807646. (Free Full Text).

Kim JY et al.
Lipoprotein-associated phospholipase A2 activity is associated with coronary artery disease and markers of oxidative stress: a case-control study. Am J Clin Nutr 2008 88: 630-637.

Lands, B
A critique of paradoxes in current advice on dietary lipids.
Progress in Lipid Research Volume 47, Issue 2, March 2008, Pages 77-106.

Okuyama H et al.
Pleiotropic effects of statins in the prevention of coronary heart disease-potential side effects.
World Rev Nutr Diet. 2007;96:55-66.