Direct comparison of dietary portfolio vs statin on C-reactive protein

Background: 3-Hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) markedly reduce serum cholesterol and have anti-inflammatory effects. The effect of cholesterol-lowering diets on inflammatory biomarkers is less well known. Objective: To compare the efficacy of a dietary combination ( portfolio) of cholesterol-lowering foods vs a statin in reducing C-reactive protein (CRP) as a biomarker of inflammation linked to increased cardiovascular disease risk. Methods: In all, 34 hyperlipidemic subjects completed three 1-month treatments as outpatients in random order: a very low-saturated fat diet ( control); the same diet with 20 mg lovastatin ( statin); and a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds ( 14 g/1000 kcal) ( portfolio). Fasting blood samples were obtained at weeks 0, 2, and 4. Results: Using the complete data, no treatment reduced serum CRP. However, when subjects with CRP levels above the 75th percentile for previously reported studies (>3.5 mg/ l) were excluded, CRP was reduced similarly on both statin, - 16.3 +/- 6.7% ( n = 23, P = 0.013) and dietary portfolio, - 23.8 +/- 6.9% ( n = 25, P = 0.001) but not the control, 15.3 +/- 13.6% ( n = 28, P = 0.907). The percentage CRP change from baseline on the portfolio treatment ( n = 25) was greater than the control ( n = 28, P = 0.004) but similar to statin treatment ( n = 23, P = 0.349). Both statin and portfolio treatments were similar in reducing CRP and numerically more effective than control but only the change in portfolio was significant after the Bonferroni adjustment. Conclusions: A combination of cholesterol-lowering foods reduced C-reactive protein to a similar extent as the starting dose of a first-generation statin.