LOS ANGELES — For patients with high levels of so-called bad cholesterol, doctors routinely reach for two remedies: cholesterol-lowering statin drugs and a diet that cuts out foods high in saturated fat, such as ice cream, red meat and butter.

But new research has found that when it comes to lowering artery-clogging cholesterol, what you eat may be more important than what you don’t eat.

Released online Tuesday in the Journal of the American Medical Association, the study found that incorporating several cholesterol-lowering foods – such as soy protein and nuts – into a diet can reduce bad cholesterol far more effectively than a diet low in saturated fat.

In fact, the authors assert, levels of LDL, the “bad” cholesterol, can drop to half that seen by many patients who take statins, sold under such names as Lipitor, Crestor and Zocor. That could drive down a person’s risk of fatal heart attack or stroke by 20 percent, the authors wrote.

But this doesn’t mean that people on statins should go dump their drugs for tofu, said Cleveland Clinic cardiologist Dr. Steve Nissen, who was not involved in the study. Dietary changes do not have nearly the research track record that statins have racked up for heart attack prevention, he said.

“Patients don’t want to take the medications, and I’m afraid that if you tell them there’s a diet that works just as well, then they’ll do that instead,” he said.

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Nearly 1 in 6 Americans has a high overall cholesterol level, which makes one nearly twice as likely to suffer a heart attack or stroke as someone whose total cholesterol falls into a healthy range. Low-density lipoprotein, or LDL cholesterol, is one component of this overall number.

Last year, statin and other lipid-regulating drugs were the nation’s most commonly prescribed medications, with more than 355 million prescriptions dispensed, according to the health care information company IMS Health.

The multicenter Canadian study tested a diet that contained a portfolio of cholesterol-fighting foods such as soy protein, nuts, “sticky” fiber such as that found in oats and barley, and plant sterols. Subjects were instructed to eat a handful of nuts such as almonds or walnuts every day, and to substitute milk and meats with soy and tofu products as much as possible.

One of the most potent cholesterol-busters in that mix, plant sterols (sometimes called stanols), occurs in small amounts in many grains, nuts, vegetables, legumes and fruits and also can be added to foods or taken as a dietary supplement. Plant sterols mimic LDL cholesterol particles in the gut, preventing the absorption of those particles so that they pass through the body and are disposed of as waste.

The 345 subjects in the study, which was coordinated by a team based at St. Michael’s Hospital, Toronto, all suffered high cholesterol levels and were considered at elevated risk of coronary heart disease.

 


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