Relationship between Adiponectin and Leptin, and Blood Lipids in Hyperlipidemia Patients Treated with Red Yeast Rice Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Effects of substituting dietary soybean protein and oil for milk protein and fat in subjects with hypercholesterolemia. Effect of Red Yeast Rice and Coconut, Rice Bran or Sunflower Oil Combination in Rats on Hypercholesterolemic Diet. Eulipidemic effects of berberine administered alone or in combination with other natural cholesterol-lowering agents. A single-blind clinical investigation. Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial Effect of a high monounsaturated fatty acids diet and a Mediterranean diet on serum lipids and insulin sensitivity in adults with mild abdominal obesity. Full-fat rice bran and oat bran similarly reduce hypercholesterolemia in humans. Dietary cholesterol suppresses the ability of olive oil to delay the development of atherosclerotic lesions in apolipoprotein E knockout mice. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Novel soybean oils with different fatty acid profiles alter cardiovascular disease risk factors in moderately hyperlipidemic subjects. Interaction between the Gln-Arg 192 variants of the paraoxonase gene and oleic acid intake as a determinant of high-density lipoprotein cholesterol and paraoxonase activity. Butter increased total and LDL cholesterol compared with olive oil but resulted in higher HDL cholesterol compared with a habitual diet. Effect of fish oil on lipoproteins, lecithin:cholesterol acyltransferase, and lipid transfer protein activity in humans. Comparing palmolein with different predominantly monounsaturated oils: effect on plasma lipids Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors Clinical evidence of efficacy of red yeast rice and berberine in a large controlled study versus diet Corn oil improves the plasma lipoprotein lipid profile compared with extra-virgin olive oil consumption in men and women with elevated cholesterol: results from a randomized controlled feeding trial. Comparison of plasma lipids and vitamin E in young and middle-aged subjects on potato crisps fried in palmolein and highly oleic sunflower oil. Fish-oil concentrate: effects on variables related to cardiovascular disease. EFFECT OF MONOUNSATURATED FATTY ACIDS VERSUS COMPLEX CARBOHYDRATES ON HIGH-DENSITY LIPOPROTEINS IN HEALTHY MEN AND WOMEN Effect of hydrogenated and saturated, relative to polyunsaturated, fat on immune and inflammatory responses of adults with moderate hypercholesterolemia. Sunflower oil does not protect against LDL oxidation as virgin olive oil does in patients with peripheral vascular disease. Olive oil containing olive oil fatty acid esters of plant sterols and dietary diacylglycerol reduces low-density lipoprotein cholesterol and decreases the tendency for peroxidation in hypercholesterolaemic subjects. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra‐Virgin Olive Oil or Nuts
Background : This study aim ed to investigate the possible relationships between adiponectin and leptin , blood lipids such as total cholesterol , high-density lipoprotein cholesterol ( HDL-C ) , low-density lipoprotein cholesterol ( LDL-C ) , and triglycerides ( TG ) as well as other clinical biomarkers in hyperlipidemia patients treated with red yeast rice .  Methods : 30 patients with primary hyperlipidemia were recruited , treated with red rice yeast capsules 600 mg twice a day for 8 weeks , and followed up for 4 weeks . The primary endpoint was the mean difference in LDL-C from baseline to week 8 , while the secondary endpoints were the mean percentage changes from baseline of total cholesterol , TG , HDL-C , adiponectin , and leptin . Results : At week 8 , the decrease in LDL-C and total cholesterol was -38.11 ± 30.90 mg/dl ( p < 0.0001 ) and -44.54 ± 27.46 mg/dl ( p < 0.0001 ) , respectively , and the increase in adiponectin was 35.83 ± 67.85 μg/ml ( p = 0.017 ) as compared to baseline . Adiponectin also correlated positively with HDL-C ( r2 = 0.39 ; p = 0.001 ) . Serum leptin correlated negatively with TG ( r2 = 0.19 ; p = 0.035 ) , and there was a trend of correlation between leptin and HDL-C , but this was not statistically significant ( r2 = 0.16 ; p = 0.052 ) . Conclusion : Red yeast rice can significantly increase adiponectin and can significantly lower LDL-C and total cholesterol levels . Adiponectin correlates positively with HDL-C while serum leptin correlates negatively with TG  . Red yeast rice has a potentially protective effect in obesity-related and cardiovascular diseases BACKGROUND We examined the cholesterol-lowering effects of a proprietary Chinese red-yeast-rice supplement in an American population consuming a diet similar to the American Heart Association Step I diet using a double-blind , placebo-controlled , prospect ively r and omized 12-wk controlled trial at a university research center . OBJECTIVE We evaluated the lipid-lowering effects of this red-yeast-rice dietary supplement in US adults separate from effects of diet alone . DESIGN Eighty-three healthy subjects ( 46 men and 37 women aged 34 - 78 y ) with hyperlipidemia [ total cholesterol , 5.28 - 8.74 mmol/L ( 204 - 338 mg/dL ) ; LDL cholesterol , 3.31 - 7.16 mmol/L ( 128 - 277 mg/dL ) ; triacylglycerol , 0.62 - 2.78 mmol/L ( 55 - 246 mg/dL ) ; and HDL cholesterol 0.78 - 2.46 mmol/L ( 30 - 95 mg/dL ) ] who were not being treated with lipid-lowering drugs participated . Subjects were treated with red yeast rice ( 2.4 g/d ) or placebo and instructed to consume a diet providing 30 % of energy from fat , < 10 % from saturated fat , and < 300 mg cholesterol daily . Main outcome measures were total cholesterol , total triacylglycerol , and HDL and LDL cholesterol measured at weeks 8 , 9 , 11 , and 12 . RESULTS Total cholesterol concentrations decreased significantly between baseline and 8 wk in the red-yeast-rice-treated group compared with the placebo-treated group [ ( x+/-SD ) 6.57+/-0.93 mmol/L ( 254+/-36 mg/dL ) to 5.38+/-0.80 mmol/L ( 208+/-31 mg/dL ) ; P < 0.001 ] . LDL cholesterol and total triacylglycerol were also reduced with the supplement . HDL cholesterol did not change significantly . CONCLUSIONS Red yeast rice significantly reduces total cholesterol , LDL cholesterol , and total triacylglycerol concentrations compared with placebo and provides a new , novel , food-based approach to lowering cholesterol in the general population OBJECTIVES To determine whether , in individuals with hypercholesterolemia , substituting dietary soybean products for cows ' milk products improves the plasma lipid profile and whether any change in the profile is due partially to soy oil . DESIGN R and omized 3-treatment crossover trial . SETTING Family practice clinics and an outpatient clinic in London , Ont . PARTICIPANTS Seventeen healthy men and 17 healthy women with elevated plasma levels of total and low-density-lipoprotein ( LDL ) cholesterol and with normal plasma levels of triglycerides . INTERVENTIONS Participants incorporated into their normal diet either 2 % cows ' milk products , soybean products or a combination of skim milk products and soy oil , each over period of 4 weeks , with 22-week wash-out periods . Plasma lipid profile , blood pressure and body weight were assessed after each dietary and wash-out period . OUTCOME MEASURES Plasma levels of total and lipoprotein cholesterol , plasma levels of triglycerides , apolipoprotein B and A1 levels , blood pressure and plasma lipid peroxidation . RESULTS The change in diet had no effect on body mass index , levels of apolipoproteins B and A1 and most plasma lipids . During the soybean period , the subjects ' mean level of high-density-lipoprotein ( HDL ) cholesterol increased 9 % ( p < 0.04 ) and their mean LDL/HDL cholesterol ratio decreased 14 % ( p < 0.007 ) . These effects were less pronounced during the skim milk/soy oil period . In the 24 subjects with the highest initial LDL cholesterol level and LDL/HDL cholesterol ratio , the mean LDL cholesterol level decreased 11 % after the soybean period . In all subjects , changes in the LDL/HDL cholesterol ratio induced by a soybean diet were negatively correlated with the initial LDL/HDL cholesterol ratio and positively correlated with the initial HDL cholesterol level . CONCLUSIONS In people with hypercholesterolemia , the plasma lipid profile improved after treatment with a soybean-product diet , and this improvement was partially due to soy oil . The degree of responsiveness was associated with initial risk factors for coronary artery disease INTRODUCTION Dietary supplements provide a novel population based health approach for treating hyperlipidemias . Red yeast rice is known to have lipid lowering effects . Combination of red yeast rice with various oils is taken by different population around the world . AIM In this present work , we aim ed to compare the effects of red yeast rice with different oil ( coconut , rice bran and sunflower oil ) supplementations on lipid levels and oxidative stress in rats fed on hypercholesterolemic diet . MATERIAL S AND METHODS A R and omized controlled study was conducted on 28 male Sprague Dawley rats . It included 4 arms-Control arm ( hypercholesterolemic diet ) , Test arm A ( hypercholesterolemic diet + Red yeast rice + Rice bran oil ) , arm B ( hypercholesterolemic diet + Red yeast rice + Coconut oil ) and arm C ( hypercholesterolemic diet + Red yeast rice + Sunflower oil ) . At the end of one month , serum cholesterol , triglycerides , MDA and paraoxonase was measured . The mean values of analytes between the different groups were compared using student ' t- ' test . RESULTS The rats fed with red yeast rice and rice bran oil combination showed significantly lower levels of serum cholesterol , triglycerides and MDA when compared to the controls . The serum paraoxonase levels were significantly higher in this group when compared to the controls . The rats fed with red yeast rice and coconut oil combination showed significantly lower serum cholesterol and MDA levels when compared to the controls . The mean triglyceride and paraoxonase levels did not show any statistically significant difference from the controls . The rats on red yeast rice and sunflower oil combination did not show any statistically significant difference in the lipid levels and oxidative stress parameters . CONCLUSION The food combination which had best outcome in preventing the development of hyperlipidemia and oxidative stress in rats fed with hypercholesterolemic diet was red yeast rice and rice bran oil . Combining red yeast rice with coconut oil and sunflower oil gave suboptimal benefits Berberine ( BERB ) and a combination ( COMB ) of berberine ( CAS 2086 - 83 - 1 ) with policosanol ( CAS 557 - 61 - 9 ) , red yeast extract ( containing monacolin , CAS 557 - 61 - 9 ) , folic acid and astaxanthin were orally administered daily for 4 weeks to 40 subjects with moderate dyslipidemias divided in two parallel groups each of 20 subjects .  Total cholesterol ( TC ) , LDL , HDL , Non HDL , ApoB , ApoA , Lp(a ) and triglycerides ( TG ) were measured before and at the end of treatments . BERB and COMB significantly reduced TC ( respectively by 16 % and 20 % ) , LDL ( by 20 % and 25 % ) , ApoB ( by 15 % and 29 % ) and TG ( by 22 % and 26 % ) , and increased HDL ( by 6.6 % and 5.1 % ) . Adverse events or impairments of liver transaminases or of CPK were not observed . In conclusion , food supplements containing natural products such as berberine , policosanol , red yeast extracts , folic acid and astaxanthin could be a useful support to diet and life style changes to correct dyslipidemias and to reduce cardiovascular risk in subjects with moderate mixed dyslipidemias Background : The biological functions of high-density lipoproteins ( HDLs ) contribute to explaining the cardioprotective role of the lipoprotein beyond quantitative HDL cholesterol levels . A few small-scale interventions with a single antioxidant have improved some HDL functions . However , to date , no long-term , large-scale , r and omized controlled trial has been conducted to assess the effects of an antioxidant-rich dietary pattern ( such as a traditional Mediterranean diet [ TMD ] ) on HDL function in humans . Methods : This study was performed in a r and om sub sample of volunteers from the PREDIMED Study ( Prevención con Dieta Mediterránea ; n=296 ) after a 1-year intervention . We compared the effects of 2 TMDs , one enriched with virgin olive oil ( TMD-VOO ; n=100 ) and the other enriched with nuts ( TMD-Nuts ; n=100 ) , with respect to a low-fat control diet ( n=96 ) . We assessed the effects of both TMDs on the role of HDL particles on reverse cholesterol transport ( cholesterol efflux capacity , HDL ability to esterify cholesterol , and cholesteryl ester transfer protein activity ) , HDL antioxidant properties ( paraoxonase-1 arylesterase activity and total HDL antioxidant capacity on low-density lipoproteins ) , and HDL vasodilatory capacity ( HDL ability to induce the release of nitric oxide in endothelial cells ) . We also studied the effects of a TMD on several HDL quality -related characteristics ( HDL particle oxidation , resistance against oxidative modification , main lipid and protein composition , and size distribution ) . Results : Both TMDs increased cholesterol efflux capacity relative to baseline ( P=0.018 and P=0.013 for TMD-VOO and TMD-Nuts , respectively ) . The TMD-VOO intervention decreased cholesteryl ester transfer protein activity ( relative to baseline , P=0.028 ) and increased HDL ability to esterify cholesterol , paraoxonase-1 arylesterase activity , and HDL vasodilatory capacity ( relative to control , P=0.039 , P=0.012 , and P=0.026 , respectively ) . Adherence to a TMD induced these beneficial changes by improving HDL oxidative status and composition . The 3 diets increased the percentage of large HDL particles ( relative to baseline , P<0.001 ) . Conclusions : The TMD , especially when enriched with virgin olive oil , improved HDL atheroprotective functions in humans . Clinical Trial Registration : URL : http://www.controlled-trials.com . Unique identifier : IS RCT N35739639 BACKGROUND AND AIMS Diets high in monounsaturated fatty acids ( MUFA ) such as a Mediterranean diet may reduce the risk of cardiovascular diseases by improving insulin sensitivity and serum lipids . Besides being high in MUFA , a Mediterranean diet also contains abundant plant foods , moderate wine and low amounts of meat and dairy products , which may also play a role . We compared the effects of a high MUFA-diet with a diet high in saturated fatty acids ( SFA ) and the additional effect of a Mediterranean diet on insulin sensitivity and serum lipids . METHODS AND RESULTS A r and omized parallel controlled-feeding trial was performed , in 60 non-diabetics ( 40 - 65 y ) with mild abdominal obesity . After a two week run-in diet high in SFA ( 19 energy-% ) , subjects were allocated to a high MUFA-diet ( 20 energy-% ) , a Mediterranean diet ( MUFA 21 energy-% ) , or the high SFA-diet , for eight weeks . The high MUFA and the Mediterranean diet did not affect fasting insulin concentrations . The high MUFA-diet reduced total cholesterol ( -0.41 mmol/L , 95 % CI -0.74 , -0.09 ) and LDL-cholesterol ( -0.38 mmol/L , 95 % CI -0.65 , -0.11 ) compared with the high SFA-diet , but not triglyceride concentrations . The Mediterranean diet increased HDL-cholesterol concentrations ( + 0.09 mmol/L , 95 % CI 0.0 , 0.18 ) and reduced the ratio of total cholesterol/HDL-cholesterol ( -0.39 , 95 % CI -0.62 , -0.16 ) compared with the high MUFA-diet . CONCLUSION Replacing a high SFA-diet with a high MUFA or a Mediterranean diet did not affect insulin sensitivity , but improved serum lipids . The Mediterranean diet was most effective , it reduced total and LDL-cholesterol , and also increased HDL-cholesterol and reduced total cholesterol/HDL-cholesterol ratio Scientific studies support recommendations to increase dietary soluble fiber as part of hyperlipidemia treatment . Rice bran contains minimal soluble fiber , but rice bran oil has a hypolipidemic effect . Full-fat rice bran was compared with oat bran and a rice starch placebo in hyperlipidemic humans to see if it might have a role in the treatment of hyperlipidemia . Moderately hypercholesterolemic ( 5.95 - 8.02 mmol/L ) , nonsmoking , nonobese adults were studied in a 6-wk , r and omized , double-blind , noncross-over trial . Three groups added 84 g/d of a heat-stabilized , full-fat , medium-grain rice bran product ( n = 14 ) , oat bran product ( n = 13 ) or rice starch placebo ( n = 17 ) to their usual low-fat diet .  Serum cholesterol , triglycerides , HDL-cholesterol ( HDL-C ) , LDL-cholesterol ( LDL-C ) , apoA1 and apoB were measured before and at the end of the supplementation period . Serum cholesterol decreased significantly ( P < /= 0.05 ) by 8.3 + /- 2.4 % and 13.0 + /- 1.8 % in the rice bran and oat bran groups , respectively , but there was no change in the rice starch group . This change was attributable to LDL-C , which decreased by 13.7 + /- 2.8 % in the rice bran group and 17.1 + /- 2.4 % in the oat bran group ( P < /= 0.05 ) . Serum apoB decreased proportionately . There was no consistent effect on triglycerides within each group and HDL-C and apoA concentrations did not change . The LDL-C : HDL-C ratio decreased significantly in the rice bran and oat bran groups . Stabilized , full-fat rice bran or oat bran , added to the prudent diet of hyperlipidemic adults , similarly reduced cholesterol and LDL-C and improved lipid ratios in 78 % of these individuals . Rice bran , as well as oat bran , should be included in the prudent diet of individuals with hyperlipidemia To test the hypothesis that cholesterol might suppress the beneficial effect of olive oil in atherosclerosis , we fed apoE KO mice diets containing extra virgin olive oil , either with or without cholesterol , for 10 weeks and assessed the  development of atherosclerosis .  Within each sex , mice were assigned r and omly to one of the following four experimental groups : ( 1 ) a st and ard chow diet , ( 2 ) a chow diet supplemented with 0.1 % cholesterol ( w/w ) cholesterol , ( 3 ) a chow diet enriched with 20 % ( w/w ) extra virgin olive oil and ( 4 ) a chow diet containing 0.1 % cholesterol and 20 % extra virgin olive oil . On the st and ard chow diet , average plasma cholesterol levels were higher in males than in females . Olive oil- and cholesterol-enriched diets , separately or in combination , induced hypercholesterolemia in both sexes , and abolished the difference between the sexes in plasma cholesterol levels . The addition of cholesterol to chow or olive oil diets decreased apolipoprotein A-I significantly in females and serum paraoxonase activities in males . The latter activity was higher in females than in males . In both sexes , the size of aortic atherosclerotic lesions was similar in olive oil- and chow-fed animals and smaller than in cholesterol-supplemented groups . Size of aortic lesions were positively correlated with circulating paraoxonase activity , particularly in males , and the relationship remained after adjusting for apolipoprotein A-I and HDL cholesterol levels . Our results demonstrate that the nutritional regulation of paraoxonase is an important determinant of atherosclerotic lesions dependent on sex . They also suggest that the mere inclusion of olive oil in Western diets is insufficient and the adoption of Mediterranean diet would be more effective in retarding the development of atherosclerotic lesions BACKGROUND Low-fat diets increase plasma triacylglycerol and decrease HDL-cholesterol concentrations , thereby potentially adversely affecting cardiovascular disease ( CVD ) risk . High-monounsaturated fatty acid ( MUFA ) , cholesterol-lowering diets do not raise triacylglycerol or lower HDL cholesterol , but little is known about how peanut products , a rich source of MUFAs , affect CVD risk . OBJECTIVE The present study compared the CVD risk profile of an Average American diet ( AAD ) with those of 4 cholesterol-lowering diets : an American Heart Association/National Cholesterol Education Program Step II diet and 3 high-MUFA diets [ olive oil ( OO ) , peanut oil ( PO ) , and peanuts and peanut butter ( PPB ) ] . DESIGN A r and omized , double-blind , 5-period crossover study design ( n = 22 ) was used to examine the effects of the diets on serum lipids and lipoproteins  : AAD [ 34 % fat ; 16 % saturated fatty acids ( SFAs ) , 11 % MUFAs ] , Step II ( 25 % fat ; 7 % SFAs , 12 % MUFAs ) , OO ( 34 % fat ; 7 % SFAs , 21 % MUFAs ) , PO ( 34 % fat ; 7 % SFAs , 17 % MUFAs ) , and PPB ( 36 % fat ; 8 % SFAs , 18 % MUFAs ) . RESULTS The high-MUFA diets lowered total cholesterol by 10 % and LDL cholesterol by 14 % . This response was comparable with that observed for the Step II diet . Triacylglycerol concentrations were 13 % lower in subjects consuming the high-MUFA diets and were 11 % higher with the Step II diet than with the AAD . The high-MUFA diets did not lower HDL cholesterol whereas the Step II diet lowered it by 4 % compared with the AAD . The OO , PO , and PPB diets decreased CVD risk by an estimated 25 % , 16 % , and 21 % , respectively , whereas the Step II diet lowered CVD risk by 12 % . CONCLUSION A high-MUFA , cholesterol-lowering diet may be preferable to a low-fat diet because of more favorable effects on the CVD risk profile BACKGROUND A variety of soybean oils were developed with improved oxidative stability and functional characteristics for use as alternatives to partially hydrogenated fat . OBJECTIVE The objective was to assess the effect of selectively bred and genetically modified soybean oils with altered fatty acid profiles , relative to common soybean and partially hydrogenated soybean oils , on cardiovascular disease risk factors . DESIGN Thirty subjects ( 16 women and 14 men ) aged > 50 y with LDL-cholesterol concentrations > 130 mg/dL at screening consumed 5 experimental diets in r and om order for 35 d each . Diets contained the same foods and provided 30 % of energy as fat , of which two-thirds was either soybean oil ( SO ) , low-saturated fatty acid soybean oil ( LoSFA-SO ) , high-oleic acid soybean oil ( HiOleic-SO ) , low-alpha-linolenic acid soybean oil ( LoALA-SO ) , or partially hydrogenated soybean oil ( Hydrog-SO ) . RESULTS Plasma phospholipid patterns reflected the predominant fat in the diet . LDL-cholesterol concentrations were 3.66 + /- 0.67(b ) , 3.53 + /- 0.77(b ) , 3.70 + /- 0.66(b ) , 3.71 + /- 0.64(a , b ) , and 3.92 + /- 0.70(a ) mol/L ; HDL-cholesterol concentrations were 1.32 + /- 0.32(a , b ) , 1.32 + /- 0.35(b ) , 1.36 + /- 0.33(a ) , 1.32 + /- 0.33(b ) , and 1.32 + /- 0.32(a , b ) mol/L for the SO , LoSFA-SO , HiOleic-SO , LoALA-SO , and Hydrog-SO diets , respectively ( values with different superscript letters are significantly different , P < 0.05 ) . No significant effects were observed on VLDL-cholesterol , triacylglycerol , lipoprotein(a ) , and C-reactive protein concentrations or on ratios of LDL cholesterol to apolipoprotein B ( apo B ) and HDL cholesterol to apo A-I. Total cholesterol : HDL cholesterol was lower after subjects consumed the unhydrogenated soybean oils than after they consumed the Hydrog-SO diet . CONCLUSIONS All varieties of soybean oils result ed in more favorable lipoprotein profiles than did the partially hydrogenated form . These soybean oils may provide a viable option for reformulation of products to reduce the content of trans fatty acids Olive oil , rich in oleic acid , could play a particular beneficial role in the anti-atherogenic effects attributed to the Mediterranean diet . Paraoxonase ( PON1 ) has emerged as the component of high-density lipoproteins ( HDL ) most likely to explain its ability to attenuate the oxidation of low-density lipoproteins . We hypothesised that oleic acid intake might be associated with changes in PON1-HDL associated particles , and investigated the impact , if any , on this association of the PON1 - 192 polymorphism , a common polymorphism that strongly modulates PON1 activity . Six hundred and fifty-four men r and omly selected from the census were studied .  Oleic acid intake  was calculated from a 72-h recall question naire with specific software . Oleic acid intake groups ( low vs. high ) were created by stratifying the population according the median value as a cut-point . After adjusting for confounding variables , high oleic acid intake was associated with increased HDL cholesterol levels and PON1 activity only in subjects with the QR and the RR genotypes , respectively . Analyses of the variance showed a statistically significant interaction between PON1 - 192 genotypes and  oleic acid intake for log PON1 activity ( P=0.005 ) and a marginally significant interaction for HDL cholesterol ( P=0.066 ) . These results suggest that the beneficial effect of increasing oleic acid intake on HDL and PON1 activity at population level is especially observed in subjects carrying the R allele of the PON1 - 192 polymorphism BACKGROUND Butter is known to have a cholesterol-raising effect and , therefore , has often been included as a negative control in dietary studies , whereas the effect of moderate butter intake has not been eluci date d to our knowledge . OBJECTIVE We compared the effects of moderate butter intake , moderate olive oil intake , and a habitual diet on blood lipids , high-sensitivity C-reactive protein ( hsCRP ) , glucose , and insulin . DESIGN The study was a controlled , double-blinded , r and omized 2 × 5-wk crossover dietary intervention study with a 14-d run-in period during which subjects consumed their habitual diets . The study included 47 healthy men and women ( mean ± SD total cholesterol : 5.22 ± 0.90 mmol/L ) who substituted a part of their habitual diets with 4.5 % of energy from butter or refined olive oil .  RESULTS Study subjects were 70 % women with a mean age and body mass index ( in kg/m² ) of 40.4 y and 23.5 , respectively .  Butter intake increased total cholesterol and LDL cholesterol more than did olive oil intake ( P < 0.05 ) and the run-in period ( P < 0.005 and P < 0.05 , respectively ) and increased HDL cholesterol compared with the run-in period ( P < 0.05 ) . No difference in effects was observed for triacylglycerol , hsCRP , insulin , and glucose concentrations . The intake of saturated fatty acids was significantly higher in the butter period than in the olive oil and run-in periods ( P < 0.0001 ) . CONCLUSIONS Moderate intake of butter result ed in increases in total cholesterol and LDL cholesterol compared with the effects of olive oil intake and a habitual diet ( run-in period ) . Furthermore , moderate butter intake was also followed by an increase in HDL cholesterol compared with the habitual diet . We conclude that hypercholesterolemic people should keep their consumption of butter to a minimum , whereas moderate butter intake may be considered part of the diet in the normocholesterolemic population A group of 33 mildly hypercholesterolemic men were stratified into three groups on diets closely matched except for the polyunsaturated fatty acid supplement . The first group received 14 g/day of linoleic acid ( safflower oil ) ; the second group , 9 g of alpha-linolenic acid ( linseed oil ) ; and the third group , 3.8 g of n-3 fatty acids ( fish oil ) . Only fish oil lowered plasma triglycerides ( by 24 % at 6 weeks , p less than 0.05 compared to safflower oil ) . Very low density lipoprotein ( VLDL ) apoprotein ( apo ) B , triglyceride , and cholesterol all fell significantly with the fish-oil diet ( p less than 0.01 ) . Low density lipoprotein ( LDL ) cholesterol fell by 0.18 and 0.10 mmol/l , respectively , with the safflower-oil and linseed-oil diets , but rose by 0.24 mmol/l with the fish-oil diet ( p less than 0.05 ) . There was a strong correlation between the changes in VLDL triglyceride and LDL cholesterol with the fish-oil diet ( r = -0.84 , p less than 0.002 ) . High density lipoprotein ( HDL ) cholesterol fell slightly in all three groups ( p less than 0.02 with the linseed-oil diet only ) . However , the apo A-I/A-II ratio rose by 5 % ( p less than 0.05 ) , and the HDL2/HDL3 protein ratio increased by 28 % with the fish-oil diet ( p less than 0.005 ) . Fish oil reduced the capacity for transfer of cholesteryl ester between LDL and HDL by 23 % ( p less than 0.02 compared to baseline ) , reduced plasma lecithin : cholesterol acyltransferase activity by 21 % ( p less than 0.05 ) , and reduced maximal stimulated thromboxane production by 9 % ( p less than 0.05 ) . Thus fish oil produced three potentially beneficial changes : significant decreases in VLDL concentration and in thromboxane production and an increase in the HDL2/HDL3 ratio . The increase in the average HDL particle size probably reflected reduced cholesteryl ester acceptor capacity within the smaller pool of VLDL , as well as the decline in lipid transfer activity in plasma involving transfer protein itself , LDL , and HDL Our group has compared plasma lipids in r and omised crossover trials in which approximately half the fat intake of subjects was changed from palmolein to each of three predominantly monounsaturated oils in a series of experiments in free living volunteers . With canola oil total cholesterols were lower than on palmolein ; part of this reduction was due to lower HDL-cholesterol ( HDL-c ) so that total cholesterol/ HDL-c was only 2 % lower . With olive oil mean total cholesterols were the same as on palmolein but HDL-cholesterols were a little lower and LDL-cholesterols a little higher . Plasma lipid fatty acid patterns confirmed the diet change , showing 5 % higher 16 : 0 on palmolein and 11 % higher 18 : 1 on olive oil . To test the possibility that lack of effect of the extra palmitic acid in the palmolein – olive oil comparison was because subjects were young , thin and active , comparison of a third oil , high oleic sunflower oil ( HOSO ) with palmolein was made in both young and middleaged subjects .  Plasma total and LDL-cholesterols were 7 % lower in the whole group on HOSO but HDL-c was also 5 % lower so total cholesterol/HDL-c was only 3 % lower than on palmolein . There was no difference in lowering of LDL-c on HOSO between young and older subjects . In comparisons of all three predominantly monounsaturated oils with palmolein a higher HDL-c on palmolein reduced the presumed health benefit of lower total cholesterols on canola and high oleic sunflower oil . The reason for no reduction of total cholesterol on olive oil compared with palmolein was presumably due to the higher linoleic and higher phytosterols in palmolein and higher squalene in the olive oil Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 mmol/L [ 160 mg/dL ] [ or treatment with hypolipidemic drugs ] , high-density lipoprotein [ HDL ] cholesterol level 1.04 mmol/L [ 40 mg/dL ] , body mass index [ BMI ] 25 kg/m2 , or a family history of premature CHD ) . Exclusion criteria were history of cardiovascular disease , any severe chronic illness , drug or alcohol addiction , history of allergy or intolerance to olive oil or nuts , or low predicted likelihood of changing dietary habits according to the stages-of-change model ( 18 ) . The primary care physicians based participants ' eligibility on review of clinical records and a screening visit . They obtained a list of c and i date s from computer-based records of patients who attended each participating center and review ed their clinical records to exclude those who did not meet eligibility criteria . They then invited suitable c and i date s by telephone to attend a screening visit . The visit included an interview with administration of a 26-item question naire to inquire about medical conditions and risk factors related to eligibility . Of the eligible c and i date s who met entry requirements , 95 % agreed to participate and provided informed consent . R and omization and Intervention After the screening visit , each center r and omly assigned eligible participants to 1 of 3 diet groups by using a computer-generated r and om-number sequence . The coordinating center constructed the r and omization table , and participants were r and omly assigned into blocks of 50 participants balanced by center , sex , and age group ( < 70 years and 70 years ) . We concealed allocation into the intervention groups by using closed envelopes with correlative numbers by prespecified subgroups of sex and age . The baseline examination included the administration of a 14-item question naire , an extension of a previously vali date d question naire ( 19 ) , that assessed the degree of adherence to the traditional Mediterranean diet . We assigned values of 0 or 1 to each item ( Appendix Table 1 ) . We also administered a 137-item vali date d food frequency question naire ( 20 ) ; the vali date d Spanish version ( 21 ) of the Minnesota Leisure Time Physical Activity Question naire ; and a 47-item question naire about education , lifestyle , history of illnesses , and medication use . We performed anthropometric and blood pressure measurements and obtained sample s of fasting blood and spot urine . We repeated all examinations at 3 months . The same dietitian delivered the interventions to the 3 r and omized groups in each center . On the basis of the assessment of individual Mediterranean diet scores , the dietitian gave personalized dietary advice during a 30-minute session to each participant , with recommendations on the desired frequency of intake of specific foods . We advised participants who were allocated to the low-fat diet to reduce intake of all types of fat , and we gave them a leaflet with written recommendations according to the American Heart Association guidelines ( 22 ) . For total fat intake , these recommendations were opposite to those given to participants in the 2 Mediterranean diet groups , who received instructions intended to increase the 14-item Mediterranean diet score , including increased consumption of vegetable fats and oils . We did not suggest any energy restriction . While the participants who were allocated to the low-fat diet did not receive further intervention , those assigned the 2 Mediterranean diet groups had access to more intense intervention in 2 ways . First , they were given a free provision of typical Mediterranean fatty foods ( olive oil or nuts ) . Depending on group assignment , participants were given either free virgin olive oil ( 15 L [ 1 L/wk ] for 3 months ) or free sachets of walnuts , hazelnuts , and almonds ( 1350 g of walnuts [ 15 g/d ] , 675 g of hazelnuts [ 7.5 g/d ] , and 675 g of almonds [ 7.5 g/d ] for 3 months ) . To improve adherence and account for family needs , participants in the corresponding Mediterranean diet groups were given excess olive oil or additional 1000-g packets of nuts . We analyzed the nutrient composition of the olive oil and nuts used in the study by st and ard methods in a reference laboratory ( Appendix Table 2 ) ) . Second , 1 week after inclusion , the dietitian delivered a 1-hour group session with up to 20 participants , with separate sessions for each Mediterranean diet group . Each group session consisted of informative talks and provision of written material s with elaborate descriptions of typical Mediterranean foods and seasonal shopping lists , meal plans , and cooking recipes . Throughout the study , all participants had free and continuous access to their center dietitian for advice and consultation . Measurements Trained personnel measured weight and height by using calibrated scales and a wall-mounted stadiometer , respectively ; waist circumference midway between the lowest rib and the iliac crest by using an anthropometric tape ; and blood pressure in triplicate with a vali date d semiautomatic oscillometer ( Omron HEM-705CP , Hoofddorp , the Netherl and s ) . We calculated energy and nutrient intake from Spanish food composition tables ( 23 ) . At the 3-month visit and when consulted by participants , dietitians assessed any adverse effects from the interventions by administering a checklist of symptoms and gave advice on how to remedy them . The checklist included mouth symptoms ; bloating , fullness , or indigestion ; altered bowel Efficacy of a new patented proprietary combination of natural nutraceuticals ( PN ) containing natural hypolipidemic as red yeast , policosanol and berberine was tested in a large study on dyslipidemic patients in clinical practice . A parallel , controlled , r and omized , multicenter study was design ed . After 2 weeks on a stable dietary regimen , the patients were r and omized to PN 1 tablet/day associated with diet ( PN + D ) or diet alone ( D ) for 16 weeks . Entry criteria were : Tot-Chol > 200 mg/dL or LDL-Chol > 150 mg/dL without a clear indication for statins , or plasma triglycerides > 150 mg/dL.  Lipid pattern and CV parameters were evaluated at baseline and monthly . 1,751 patients were enrolled in 248 Italian units , 933 patients on PN + D and 818 on D. The baseline lipid values were : Tot-Chol 255.4 versus 243.1 mg/dL , LDL-Chol 170.1 versus 162.2 mg/dL , HDL-Chol 50.0 versus 48.8 mg/dL , and TG 190.5 versus 184.4 mg/dL. PN constantly and significantly improved lipid parameters versus D group : at 16 weeks −19.1 versus −9.4 % for Tot-Chol ( p < 0.001 ) , −23.5 versus −10.8 % for LDL-Chol ( p < 0.001 ) , + 11.6 versus + 4.0 % for HDL-Chol ( p < 0.001 ) , −17.9 versus −11.3 % for TG ( p < 0.001 ) . In conclusions , PN plus diet allows an effective improvement of blood lipids with a significant reduction of global CV risk , suggesting a role for PN in CHD prevention BACKGROUND Restricted intakes of saturated and trans-fatty acids is emphasized in heart-healthy diets , and replacement with poly- and monounsaturated fatty acids is encouraged . OBJECTIVE To compare the effects of polyunsaturated fatty acid-rich corn oil ( CO ) and monounsaturated fatty acid-rich extra-virgin olive oil ( EVOO ) on plasma lipids in men and women ( N = 54 ) with fasting low-density lipoprotein cholesterol ( LDL-C ) ≥130 mg/dL and < 200 mg/dL and triglycerides ( TG ) ≤350 mg/dL. METHODS In a double-blind , r and omized , crossover design ( 21-day treatments , 21-day washout between ) , 4 tablespoons/day CO or EVOO were provided in 3 servings study product/day ( muffin , roll , yogurt ) as part of a weight-maintenance diet ( ∼35 % fat , < 10 % saturated fat , < 300 mg cholesterol ) . Subjects ate breakfast at the clinic every weekday throughout the study . Lunches , dinners , and snacks ( and breakfasts on weekends ) were provided for consumption away from the clinic . RESULTS Baseline mean ( st and ard error ) lipids in mg/dL were : LDL-C 153.3 ( 3.5 ) , total cholesterol ( total-C ) 225.7 ( 3.9 ) , non-high-density lipoprotein (non-HDL)-C 178.3 ( 3.7 ) , HDL-C 47.4 ( 1.7 ) , total-C/HDL-C 5.0 ( 0.2 ) , and TG 124.8 ( 7.2 ) . CO result ed in significantly larger least-squares mean % changes ( all P < .001 vs EVOO ) from baseline in LDL-C -10.9 vs -3.5 , total-C -8.2 vs -1.8 , non-HDL-C -9.3 vs -1.6 , and total-C/HDL-C -4.4 vs 0.5 . TG rose a smaller amount with CO , 3.5 vs 13.0 % with EVOO ( P = .007 ) . HDL-C responses were not significantly different between conditions ( -3.4 vs -1.7 % ) . CONCLUSION Consumption of CO in a weight-maintenance , low saturated fat and cholesterol diet result ed in more favorable changes in LDL-C and other atherogenic lipids vs EVOO We previously found no difference in healthy young adults '  plasma cholesterols between palmolein and olive oil as the major dietary lipid , although the former is high in palmitic acid ( 16:0 ) but the latter in oleic acid ( 18:1 cis ) . In the experiment reported here we compared the effects of palmolein against another monounsaturated oil , highly oleic sunflower oil ( HOSO ) , on plasma cholesterol in both young and middle-aged healthy adults . The test oils were provided as frying oil of potato crisps ( 150 g/day in men ; 100 g/day in women ) against low-fat background diets in free-living motivated volunteers . The design was a r and omised double-blind 4-week/3-week crossover trial . Compliance was monitored with continuous dietary diaries and by measuring ( fasting ) plasma lipid fatty-acid pattern . Plasma lipids and vitamin-E compounds were measured at the start and twice at the end of each test period . In combined young plus older subjects ( n = 42 )  mean plasma total and low-density-lipoprotein cholesterol ( LDL-c ) values were both 7 % ( significantly ) lower on HOSO than on palmolein , but because high-density-lipoprotein cholesterol ( HDL-c ) was also 5 % lower , the LDL-c/HDL-c ratio was only 3 % lower on HOSO than on palmolein . The difference between the present results with HOSO and previous results with olive oil both compared against palmolein suggest that olive oil is associated with higher plasma cholesterols than other monounsaturated oils . In both the young and older subgroup , LDL-c was lower on HOSO but because HDL-c moved down too in the young subgroup , the LDL-c/HDL-c ratio was lower on HOSO only in the older subjects . Palmolein has an unusual pattern of E vitamins , with a high content of tocotrienols , notably the gamma-isomer . Unlike alpha-tocopherol however , there was no sign of these tocotrienols in subjects ' plasmas Sixty-four male , healthy volunteers aged 35 - 45 y were r and omly assigned to receive ( as 1-g capsules ) either 14 g fish-oil concentrate/d ( 55 % n-3 fatty acids ) or 14 g olive oil/d for 6 wk . Plasma fibrinogen was reduced by 13 % and serum triglycerides by 22 % after fish-oil supplementation ended . Three weeks after supplementation ended both variables were back to baseline values . An appreciable increase in the ratio of eicosapentaenoic acid to arachidonic acid ( EPA : AA ) in plasma eicosapentaenoic acid to arachidonic acid ( EPA : AA ) in plasma and red blood cell phospholipids occurred during the fish-oil intake . High-density-lipoprotein ( HDL ) cholesterol and HDL2 activity tended to be lowered by fish-oil supplementation . Systolic and diastolic blood pressures , serum cholesterol , gamma-glutamyltransferase , blood glucose , and monocyte low-density-lipoprotein receptor activity did not differ significantly between the two groups . The reduction in plasma fibrinogen concentration seems of special interest because this variable in several recent studies emerges as a separate cardiovascular risk factor with a high predictive value The effects of two strictly controlled diets , one rich in complex carbohydrates , the other rich in olive oil , on serum lipids were studied in healthy men and women .  Serum cholesterol levels fell on average by 0.44 mmol/l in the carbohydrate group and 0.46 mmol/l in the olive oil group . HDL cholesterol levels fell by 0.19 mmol/l in the carbohydrate group and rose by 0.03 mmol/l in the olive oil group . Serum triglycerides rose by 0.19 mmol/l in the carbohydrate group and fell by 0.06 mmol/l in the olive oil group . The changes in both HDL and triglycerides were larger in men than in women . These results clearly show that the olive-oil-rich diet , unlike the complex-carbohydrate-rich diet , caused a specific fall in non-HDL cholesterol while leaving serum triglyceride levels virtually unchanged Consumption of diets high in hydrogenated fat/trans fatty acids has been shown to have an adverse affect on lipoprotein profiles with respect to cardiovascular disease risk . Dietary fat and cholesterol play an important role in the regulation of immune and inflammatory responses shown to be involved in atherogenesis . We investigated the effects of diets containing hydrogenated fat on cellular immune response and production of inflammatory cytokines in human subjects with moderately elevated cholesterol levels ( LDL cholesterol > 130 mg/dl ) . In a double blind cross-over study , 19 subjects consumed three diets  , 30 % of calories as fat , of which two thirds were provided as soybean oil , soybean oil-based stick margarine , or butter for 32 days , each in a r and omized order . Production of proinflammatory mediators , prostagl and in (PG)E(2 ) , interleukin (IL)-1beta , IL-6 , and tumor necrosis factor alpha ( TNF-alpha ) ; delayed type hypersensitivity ( DTH ) response , in vitro lymphocyte proliferation , and production of IL-2 were determined . Production of IL-6 and TNF-alpha was significantly higher after consumption of stick margarine diet compared with soybean oil diet .  IL-1beta and TNF-alpha production correlated positively with ratios of total cholesterol to HDL cholesterol ( r = 0.499 , P < 0.001 and r = 0.291 , P = 0.04 , respectively ) . There was no significant difference in DTH response , lymphocyte proliferation , or levels of IL-2 and PGE(2 ) produced among three groups . Our results indicate that consumption of a diet high in hydrogenated fat does not adversely affect cellular immunity but increases production of inflammatory cytokines that have been associated with the pathophysiology of atherosclerosis BACKGROUND & AIMS The aim of this study was to compare the in vivo effects of a diet rich in virgin olive oil or sunflower oil on the lipid profile and on LDL susceptibility to oxidative modification in free-living Spanish male patients with peripheral vascular disease . METHODS A total of 20 Spanish male subjects diagnosed with peripheral vascular disease were r and omly divided into two groups ( n = 10 ) receiving different supplements , virgin olive oil and sunflower oil for 4 months . RESULTS The adaptation of patients to the experimental supplements was demonstrated since plasma and LDL fatty acids composition reflected dietary fatty acids . No differences in triglycerides , total cholesterol , LDL-cholesterol or HDL-cholesterol concentrations were found between the groups of patients . A significantly higher LDL susceptibility to oxidation was observed after sunflower oil intake in comparison with virgin olive oil , in spite of an increase in LDL alpha-tocopherol concentration in sunflower oil group . CONCLUSIONS The results of the present study provide further evidence that sunflower-oil-enriched diets does not protect LDL against oxidation as virgin olive oil does in patients with peripheral vascular disease Plant sterols ( PS ) and MUFA are well-documented cholesterol lowering agents . We aim ed to determine the effect of PS esterified to olive oil fatty acids ( PS-OO ) on blood lipid profile and lipid peroxidation in hypercholesterolaemic subjects . Twenty-one moderately overweight , hypercholesterolaemic subjects consumed three consecutive treatment diets , each lasting 28 d and separated by 4-week washout periods , using a r and omized crossover design . Diets contained 30 % energy as fat , 70 % of which was provided by olive oil ( OO ) , and differed only in the treatment oils : OO , PS esterified to sunflower oil fatty acids ( PS-SO ) , and PS-OO . Both PS-SO and PS-OO treatments provided 1.7 g PS /d . PS-OO and PS-SO consumption result ed in a decrease ( P = 0.0483 ) in LDL-cholesterol ( LDL-C ) concentrations compared with the OO diet . Although total cholesterol and apo B-100 levels were not significantly affected , PS-SO and , to some extent , PS-OO reduced the total : HDL-cholesterol ( HDL-C ) ratio ( P = 0.0142 ) and the apo B-100:apo A-I ratio ( P = 0.0168 ) compared with the OO diet . There were no differences across diets in lipoprotein(a ) ( Lp(a ) ) and lipid peroxidation levels . However , following consumption of OO and PS-SO , Lp(a ) concentrations increased ( P = 0.0050 and 0.0421 , respectively ) , while PS-OO treatment did not affect Lp(a ) levels . Furthermore , there was a decrease ( P = 0.0097 ) in lipid peroxidation levels with PS-OO treatment during the supplementation phase . Our results suggest that supplementing an OO-rich diet with PS-OO favourably alters the plasma lipid profile and may decrease the susceptibility of LDL-C to lipid peroxidation in hypercholesterolaemic subjects Introduction High dietary saturated fat intake is associated with higher blood concentrations of low-density lipoprotein cholesterol ( LDL-C ) , an established risk factor for coronary heart disease . However , there is increasing interest in whether various dietary oils or fats with different fatty acid profiles such as extra virgin coconut oil may have different metabolic effects but trials have reported inconsistent results . We aim ed to compare changes in blood lipid profile , weight , fat distribution and metabolic markers after four weeks consumption of 50 g daily of one of three different dietary fats , extra virgin coconut oil , butter or extra virgin olive oil , in healthy men and women in the general population . Design R and omised clinical trial conducted over June and July 2017 . Setting General community in Cambridgeshire , UK . Participants Volunteer adults were recruited by the British Broadcasting Corporation through their websites . Eligibility criteria were men and women aged 50–75 years , with no known history of cancer , cardiovascular disease or diabetes , not on lipid lowering medication , no contraindications to a high-fat diet and willingness to be r and omised to consume one of the three dietary fats for 4 weeks . Of 160 individuals initially expressing an interest and assessed for eligibility , 96 were r and omised to one of three interventions ; 2 individuals subsequently withdrew and 94 men and women attended a baseline assessment . Their mean age was 60 years , 67 % were women and 98 % were European Caucasian . Of these , 91 men and women attended a follow-up assessment 4 weeks later . Intervention Participants were r and omised to extra virgin coconut oil , extra virgin olive oil or unsalted butter and asked to consume 50 g daily of one of these fats for 4 weeks , which they could incorporate into their usual diet or consume as a supplement . Main outcomes and measures The primary outcome was change in serum LDL-C ; secondary outcomes were change in total and high-density lipoprotein cholesterol ( TC and HDL-C ) , TC/HDL-C ratio and non-HDL-C ; change in weight , body mass index ( BMI ) , waist circumference , per cent body fat , systolic and diastolic blood pressure , fasting plasma glucose and C reactive protein . Results LDL-C concentrations were significantly increased on butter compared with coconut oil ( + 0.42 , 95 % CI 0.19 to 0.65 mmol/L , P<0.0001 ) and with olive oil ( + 0.38 , 95 % CI 0.16 to 0.60 mmol/L , P<0.0001 ) , with no differences in change of LDL-C in coconut oil compared with olive oil ( −0.04 , 95 % CI −0.27 to 0.19 mmol/L , P=0.74 ) . Coconut oil significantly increased HDL-C compared with butter ( + 0.18 , 95 % CI 0.06 to 0.30 mmol/L ) or olive oil ( + 0.16 , 95 % CI 0.03 to 0.28 mmol/L ) . Butter significantly increased TC/HDL-C ratio and non-HDL-C compared with coconut oil but coconut oil did not significantly differ from olive oil  for TC/HDL-C and non-HDL-C. There were no significant differences in changes in weight , BMI , central adiposity , fasting blood glucose , systolic or diastolic blood pressure among any of the three intervention groups . Conclusions and relevance Two different dietary fats ( butter and coconut oil ) which are predominantly saturated fats , appear to have different effects on blood lipids compared with olive oil , a predominantly monounsaturated fat with coconut oil more comparable to olive oil with respect to LDL-C. The effects of different dietary fats on lipid profiles , metabolic markers and health outcomes may vary not just according to the general classification of their main component fatty acids as saturated or unsaturated but possibly according to different profiles in individual fatty acids , processing methods as well as the foods in which they are consumed or dietary patterns . These findings do not alter current dietary recommendations to reduce saturated fat intake in general but highlight the need for further elucidation of the more nuanced relationships between different dietary fats and health . Trial registration number NCT03105947 ; Results Background Observational cohort studies and a secondary prevention trial have shown inverse associations between adherence to the Mediterranean diet and cardiovascular risk . Methods In a multicenter trial in Spain , we assigned 7447 participants ( 55 to 80 years of age , 57 % women ) who were at high cardiovascular risk , but with no cardiovascular disease at enrollment , to one of three diets : a Mediterranean diet supplemented with extra‐virgin olive oil , a Mediterranean diet supplemented with mixed nuts , or a control diet ( advice to reduce dietary fat ) . Participants received quarterly educational sessions and , depending on group assignment , free provision of extra‐virgin olive oil , mixed nuts , or small nonfood gifts . The primary end point was a major cardiovascular event ( myocardial infa rct ion , stroke , or death from cardiovascular causes ) . After a median follow‐up of 4.8 years , the trial was stopped on the basis of a prespecified interim analysis . In 2013 , we reported the results for the primary end point in the Journal . We subsequently identified protocol deviations , including enrollment of household members without r and omization , assignment to a study group without r and omization of some participants at 1 of 11 study sites , and apparent inconsistent use of r and omization tables at another site . We have withdrawn our previously published report and now report revised effect estimates based on analyses that do not rely exclusively on the assumption that all the participants were r and omly assigned . Results A primary end‐point event occurred in 288 participants ; there were 96 events in the group assigned to a Mediterranean diet with extra‐virgin olive oil ( 3.8 % ) , 83 in the group assigned to a Mediterranean diet with nuts ( 3.4 % ) , and 109 in the control group ( 4.4 % ) . In the intention‐to‐treat analysis including all the participants and adjusting for baseline characteristics and propensity scores , the hazard ratio was 0.69 ( 95 % confidence interval [ CI ] , 0.53 to 0.91 ) for a Mediterranean diet with extra‐virgin olive oil and 0.72 ( 95 % CI , 0.54 to 0.95 ) for a Mediterranean diet with nuts , as compared with the control diet . Results were similar after the omission of 1588 participants whose study ‐group assignments were known or suspected to have departed from the protocol . Conclusions In this study involving persons at high cardiovascular risk , the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra‐virgin olive oil or nuts than among those assigned to a reduced‐fat diet . ( Funded by Instituto de Salud Carlos III , Spanish Ministry of Health , and others ; Current Controlled Trials number , IS RCT N35739639 .
The results of this systematic review indicate that the dietary supplementation with red yeast rice , bergamot , artichoke , and virgin olive oil has promising effects on the increase of HDL-C serum levels .
The artichoke leaf extract and virgin olive oil appear to be particularly interesting , while bergamot extract needs further research and the effect of red yeast rice seems to be limited to patients with previous myocardial infa rct ion .
Various MediterrAsian diet products or natural extracts may represent a potential intervention treatment to raise HDL-C in dyslipidemic subjects
Background .
High HDL-cholesterol ( HDL-C ) values are negatively correlated with cardiovascular diseases .
This review analyses the effect of the supplementation with various Mediterranean diet products ( artichoke , bergamot , and olive oil ) and Asian diet products ( red yeast rice ) on the  HDL-C value in dyslipidemic subjects .