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Modest Dietary Reductions in Blood Cholesterol Have Important Public Health Benefits

University of Miami Miller School of Medicine, Coral Gables, Florida, chenneke{at}fau.edu, Nova Southeastern University, Davie, Florida, Florida Atlantic University, Boca Raton, Florida

Wendy R. Schneider, MSN, RN

Florida Atlantic University, Boca Raton, Florida

E. Joan Barice, MD, MPH

University of Miami Miller School of Medicine, Coral Gables, Florida, Nova Southeastern University, Davie, Florida, Florida Atlantic University, Boca Raton, Florida

Patricia R. Hebert, PhD

Florida Atlantic University, Boca Raton, Florida

Large reductions in blood cholesterol produce major clinical and public health benefits. Based on extrapolations from randomized evidence, assuming no threshold, a 3% to 4% reduction in blood cholesterol would decrease risk of coronary heart disease (CHD) by 12%. If so, treating larger numbers of people at lower risk would yield greater reductions in CHD than treating smaller numbers at higher risk. High- and moderate-risk patients require evidence-based doses of high-potency statins, as adjuncts to dietary management and benefits to individuals are large and easily quantifiable in randomized trials. In low-risk patients, however, dietary modifications contribute to a public health benefit while that benefit to any individual is small. Thus, the hypothesis that modest dietary reductions in blood cholesterol have important public health benefits is easily quantifiable by extrapolation from existing data but impossible to test among randomized individuals, as the sample sizes and costs are prohibitively large.

Key Words: dietary reductions • cholesterol • public health

This version was published on June 1, 2009

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 14, No. 2, 85-88 (2009)
DOI: 10.1177/1074248409333489


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