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Am Fam Physician. 1998;57(6):1307-1309

See related article on coronary artery disease.

What is coronary artery disease?

The vessels that bring blood to the heart are called the coronary arteries. They are like narrow tubes. A fatty substance called plaque can build up in these arteries and make them even more narrow, so less blood gets to the heart. If you have coronary artery disease, your heart isn't getting the blood and oxygen it needs to work like it should. Coronary artery disease can lead to serious health problems, including angina (pain or pressure in the chest) and heart attack.

Several things increase your risk for coronary artery disease, including hypertension, cigarette smoking, diabetes, obesity, being male, a family history of the disease and a high cholesterol level. Although you can't change all of the things that increase your risk for coronary artery disease, you can lower your cholesterol level by making changes in your diet (see columns A and B in chart on page 3), and you can quit smoking (if you smoke now).

What is cholesterol?

Cholesterol is a substance present in all of us. Our bodies make cholesterol. It's also present in meat and dairy foods. Plant foods don't have cholesterol. There are several types of cholesterol, including low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL cholesterol is called “bad” cholesterol because it can build up on the inside of your arteries, causing them to become narrow. HDL is called “good” cholesterol because it protects your arteries from plaque buildup.

How does lowering LDL cholesterol help?

Lowering your LDL cholesterol level will help keep plaque from building up in your arteries. This makes it easier for your heart to get the blood and nutrients it needs.

If you already have coronary artery disease, your doctor will probably want you to lower your LDL level by at least 30 to 35 percent through dieting, exercising and possibly, medicines. Another way to help is to increase your HDL level. If you can reduce your LDL level to less than 130 and increase your HDL level to at least 50, you're on the right track.

What foods should I add to my diet?

When trying to lower your LDL cholesterol, you want to add foods that are low in cholesterol and saturated fats, because your body turns saturated fats into cholesterol. To do this, add foods that are high in soluble fiber (see column B in chart on page 3).

There are lots of ways to add healthy foods to your diet. Follow the tips and the serving-size guidelines below:

  • Start your day out right. Have some form of grain (like whole-grain bread or whole-grain cereal) and fruit for breakfast.

  • Think of grains and vegetables as your main dish in lunches and dinners. If you're serving meat or poultry as a main dish, add a tossed salad or a vegetable to the plate.

  • Add beans to leafy salads, pasta salads and stews—chick peas, kidney beans and navy beans have been shown to reduce LDL cholesterol levels.

  • Drink fat-free or 1 percent milk, not whole milk or 2 percent milk. Look for low-fat yogurt and cheese, too.

  • Try soy products. Soy has come a long way in the last few years. Today, you can find soy products in many grocery stores and health food stores. Try veggie-soy burgers, soy pepperoni, tofu or soy milk.

  • Serve raw or cooked fruits with low-fat yogurt for dessert.

  • Eat only a little oil. If you want to use oil for cooking, try olive oil or canola oil instead of oils high in polyunsaturated fats, such as corn oil, peanut oil and many margarines. Both olive oil and canola oil are high in monounsaturated fat, which decreases LDL and total cholesterol levels.

  • Eat only small amounts of sweets.

  • Eat one to two servings of fish or seafood each week if you have coronary artery disease. People with coronary artery disease seem to benefit from eating fish and seafood.

  • Cook with garlic. Several studies have shown that garlic reduces LDL cholesterol and lowers blood pressure.

  • Eat moderate amounts of nuts that are rich in monounsaturated fat, like hazelnuts, almonds, pecans, cashews, walnuts and macadamia nuts. These nuts have been shown to improve cholesterol levels. Avoid eating nuts by the handful. Instead, garnish food with one tablespoon of chopped nuts per person.

What else can I do if I have coronary artery disease?

Besides changing your diet, you should talk to you doctor about an exercise program that's right for you. If you smoke, quit. If you're overweight, try to lose weight (changing your diet and exercising will help you lose weight). Talk with your doctor about reducing other risk factors, such as high blood pressure or diabetes.

What if changing my diet doesn't help?

Your body will need time to respond to changes in your diet. You doctor will watch your progress. If your cholesterol level hasn't improved after two to six months, your doctor may prescribe medicine to lower your cholesterol. However, you'll still need to eat a healthy diet to help the medicine work.

A. Eat less of these foods:B. Instead, eat more of these foods:
Potato chips, french fries and other “junk” foodsWhole-grain breads and pasta, brown rice, bagels
Vegetables cooked in butter, cheese or cream saucesFresh, frozen, baked or steamed fruits and vegetables
Fried foodsSteamed, baked or fresh foods
Whole milk1 percent or fat-free milk
Bacon, sausage and organ meats (like liver)Fish, skinless poultry, lean cuts of meat with fat trimmed away, soy products and dried beans
Egg yolksEgg whites, egg substitutes
Cheesecake, pastries, doughnuts, ice creamAngel food cake, fig bars, animal crackers, graham crackers, air-popped popcorn, low-fat frozen desserts (yogurt, sherbet, ice milk)
Butter and margarineOlive oil or canola oil (small amounts)

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Copyright © 1998 by the American Academy of Family Physicians.

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