What do you think of the value of nutrition in preventing and treating coronary disease?
It is intuitive that a good diet and lifestyle should reduce one’s risk of coronary disease. Indeed this is always the first thing I advise patients when I see them. However it should be realized that the reduction in cardiovascular risk from dietary changes is often fairly modest. My own experience, and results from observational studies, would suggest that a very aggressive dietary intervention, such as switching from a high fat diet to one considered “heart healthy,” improves cholesterol control only by about 5-10%. For most patients I see with coronary disease, they need to get their cholesterol down by 30% or more for optimal risk control. Yet many people try to delude themselves into thinking they don’t need cholesterol lowering medications because they will change to a healthy diet.
It isn’t that having a healthy diet is not important; it certainly is. Diet is always step one and likely has benefits beyond what physicians like myself measure on the lipid panel: e.g. vitamin intake, nutrients, other cholesterol particles such as chylomicrons, and many other benefits. Every major guideline emphasizes the importance of a healthy diet for minimizing your disease risk. However its benefit on the lipid panel is relatively modest. The lipid panel is by no means a perfect tool but it is quite predictive of cardiovascular disease risk. For most people with established coronary disease, medications are required to lower the LDL to the guideline-suggested target. I would venture that these medications are necessary for a good number of patients without coronary disease as well, at least those who are intermediate or high-risk for coronary disease.
What do you think? Do you think medications are over-prescribed for cholesterol control? Do physicians do a good job of explaining the need for medications?