American Heart Association Refines Cholesterol Guidance

By Jonathan Springston, Editor, Relias Media

A new advisory from the American Heart Association expounds on the relationship between healthy eating and cholesterol levels. Specifically, the advisory notes there is inadequate research to support a specific numerical limit on cholesterol from food.

The advisory authors reiterate the well-known importance of avoiding excess salt and sugar in favor of fruit, vegetables, fish, and nuts, while pivoting the conversation to the need to consume more polyunsaturated fats (found in fish and some nuts) and less saturated fats (found in red meat and full-fat dairy products).

“Consideration of the relationship between dietary cholesterol and cardiovascular disease risk cannot ignore two aspects of diet," Jo Ann Carson, chair of the advisory's writing committee, said in a statement. "First, most foods contributing cholesterol to the U.S. diet are usually high in saturated fat, which is strongly linked to an increased risk of too much LDL cholesterol. Second, we know from an enormous body of scientific studies that heart-healthy dietary patterns, such as Mediterranean-style and DASH-style diets are inherently low in cholesterol.”

The advisory authors went one step further, noting that certain foods high in cholesterol, like eggs, are safe to consume in proper quantities. The point is broad blanket recommendations may not always be the best course, at least as far as cholesterol is concerned.

“A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health,” the advisory authors concluded.

A pair of articles in the December 2019 issue of Integrative Medicine Alert concern nutrition and health. First, Eric Neilson, MD, wrote about vegetarians and stroke risk. Specifically, a prospective cohort study in the United Kingdom demonstrated that vegetarians have a 22% lower incidence of ischemic heart disease, but a 20% increased incidence of total stroke, mostly related to hemorrhagic stroke, when compared to meat eaters. No difference in ischemic stroke or acute myocardial infarction was found.

Notably, like the recent American Heart Association advisory, Neilson noted how this study “indicates the need for physicians to have discussions with patients regarding the risks and benefits of individual dietary considerations.”

Second, Ellen Feldman, MD, wrote about possible links between soft drink consumption and mortality. Investigators found drinking more soft drinks, both artificially sweetened and sugar-sweetened, is associated with a higher risk of death, cardiovascular illness, and digestive illnesses.

“The clinician is on solid ground informing patients that there is mounting evidence that soft drink consumption of any type (artificially or sugar-sweetened) is linked to earlier death, and that this link is not necessarily related directly to obesity or diabetes,” Feldman concluded. “This is an additional reminder of the importance and benefit of including a dietary assessment in health visits, especially when creating a comprehensive, patient-centered health and wellness plan.”

For more critical analysis of the latest clinical research in cardiovascular medicine, be sure to check out recent issues of Clinical Cardiology Alert.