Physicians' Academy for Cardiovascular Education

Dietary pulse intake lowers LDL-cholesterol

Literature - Ha V et al., CMAJ. 2014 - CMAJ. 2014 Apr 7

 
Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials

 
Ha V, Sievenpiper JL, de Souza RJ et al.
CMAJ. 2014 Apr 7
 

Background

Dietary and lifestyle modifications are essential in the prevention and management of cardiovascular disease. Dietary non-oil-seed pulses, such as beans, chickpeas, lentils and peas, are believed to contribute to reducing the risk of cardiovascular disease. Observational studies have shown that consumption of dietary pulses was associated with a reduction in cardiovascular disease [1]. Small trials have show improvement of LDL-c levels [2-4].
Although many guidelines on the prevention of chronic diseases encourage consumption of dietary pulses as part of a healthy lifestyle, they do not address the specific lipid-lowering or CV risk reducing benefits. Dyslipidemia guidelines do not address dietary pulse intake directly [5,6].
This is a systematic review and meta-analysis of randomised controlled trials (RCTs) on the effect of dietary pulse intake on established therapeutic lipid targets for CV risk reduction. 26 RCTs were included, with data on 1037 hyperlipidemic patients or patients with normal lipid profiles. Different methods of increasing dietary pulse intake were applied in the different studies.
 

Main results

  • Gastrointestinal symptoms were reported, but most studies reported that symptoms improved over the course of the dietary pulse intervention.
  • Intervention diets significantly lowered LDL-c as compared to control diets (mean difference: -0.17 mmol/L, 95%CI: -0.25 to 0.09). Inter-study heterogeneity was, however, high (I2=80%).
  • A post-hoc subgroup analysis by gender showed that studies with more men tended to show a greater reduction in LDL-c than those in which the majority was female (this reduced heterogeneity to 53%; other subgroup analyses shed little light on the source of heterogeneity).
  • No significant effect of dietary pulse intake was seen on levels of apolipoprotein B, nor on non-HDL levels.
 

Conclusion

This meta-analysis suggests that consumption of dietary pulses (median dose 130 g/d, about 1 serving daily) reduces LDL-c with 0.17 mmol/L, over a median follow-up of 6 weeks. Levels of apolipoprotein B and non-HDL were not significantly affected, although only few studies reported these values. Since most of the included trials were of low methodological quality, the effect of dietary pulses need confirmation in longer, better-designed trials, which should also measure apolipoprotein B and non-HDL.
 
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References

1. Bazzano LA, He J, Ogden LG, et al. Legume consumption and risk of coronary heart disease in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med 2001;161: 2573-8.
2. Abete I, Parra D, Martinez JA. Legume-, fish-, or high-protein-based hypocaloric diets: effects on weight loss and mitochondrial oxidation in obese men. J Med Food 2009;12:100-8.
3. Duane WC. Effects of legume consumption on serum cholesterol, biliary lipids, and sterol metabolism in humans. J Lipid Res 1997; 38:1120-8.
4. Hermsdorff HH, Zulet MA, Abete I, et al. A legume-based hypocaloric diet reduces  proinflammatory status and improves metabolic features in overweight/obese subjects. Eur J Nutr 2011; 50:61-9.
5. National Cholesterol Education Program Expert Panel on Detection E. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
6. Anderson TJ, Gregoire J, Hegele RA, et al. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 2013;29:151-67.

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