Food Funct., 2016, Accepted Manuscript
Received 07 Jan 2016, Accepted 16 Apr 2016
First published online 18 Apr 2016
The Seven Countries Study suggested an association between serum cholesterol and cardiovascular disease (CVD), despite the association not being consistent across the various cohorts of participants in different countries. In particular, the association was weak in Southern European and Japanese cohorts, but very clear in US and Northern European cohorts. Nevertheless, the study triggered research into cholesterol-lowering drug strategies, ultimately leading to the development of statins and some more recent adjunctive therapies. Clinical evidence in support of statins is strong and the vast majority of the medical community advocate these drugs as highly effective first-line therapeutics in primary and secondary prevention of CVD. However, growing evidence of side-effects associated with statins in a significant proportion of patients suggests that these drugs are not a universal solution to CVD. There is a need, therefore, to revisit the evidence and to re-appraise the relative importance of cholesterol amongst many other lipids as potential modulators of atherogenesis. In this review, we re-appraise the role of cholesterol, unsaturated fatty acids and triglycerides in CVD, and assess the merits of a novel approach to tackle inflammation and the onset of CVD that is focused on the polar lipid fractions of various foods (e.g. fish and olive oil). We conclude that careful design around the lipid components of dietary interventions presents a credible alternative in patients who are intolerant to statins or averse to taking such drugs.