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Serum lipids after a low-fat diet.

2reducing fat intake to 10% of energy consumed and dietary cholesterol to 10 mg/d resulted in a 37% decrease in low-density lipoprotein (LDL) after 1 year compared with only 6% in the control group on a Step II diet (and compared with 5%-13% in the lowest-fat category of the study by Knopp et al). Thus, “aggressive fat restriction” clearly offers further benefits in reducing LDL. High-density lipoprotein (HDL) levels decreased and triglyceride levels increased somewhat in our experimental group patients—yet these same patients showed overall regression in coronary atherosclerosis as measured by quantitative coronary arteriography 2 and improvements in myocardial perfusion as measured by cardiac positron emission tomographic scans. 3 We measured even more reversal after 4 years than after 1 year. 4 We found a dose-response relationship of dietary fat and cholesterol intake and changes in coronary artery stenoses as measured by angiography. These patients also reported a 91% reduction in the frequency of anginal episodes. The control group patients in our study were following a Step II diet, yet their coronary artery atherosclerosis had worsened after 1 year and coronary artery stenoses had progressed even more after 4 years. 4 Also, we found that the number of cardiac events was twice as high in the control group as in the experimental group. Clearly, lowering HDL and raising triglycerides by changing diet did not harm these patients. 4 Diet-induced lowering of HDL cholesterol does not confer the same risk of atherosclerosis as does the presence of low HDL cholesterol levels in Americans consuming a high-fat diet. 5 A low HDL level in the context of a low-fat, low-cholesterol, low‐animal protein diet may have very different prognostic significance than a low HDL level in someone eating a typical American diet. More than a dozen arteriographic studies have demonstrated that the majority of patients with coronary artery disease who follow a Step I or Step II diet show worsening of coronary artery disease as measured by coronary arteriography. 6