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May 8, 1996

Very Low-Fat Diets for Coronary Heart Disease: Perhaps, But Which One?-Reply

Author Affiliations

Preventive Medicine Research Institute Sausalito, Calif

JAMA. 1996;275(18):1403. doi:10.1001/jama.1996.03530420030030

In Reply.  —Unlike the patient described by Dr Siguel and colleagues, almost all of the patients in the experimental group of the Lifestyle Heart Trial1 and in an earlier study2 described improvements in well-being, energy, stamina, and concentration. Also, these patients reported a 91% reduction in frequency of angina after 1 year and a 71% reduction after 5 years.High-density lipoprotein cholesterol decreased and triglycerides increased slightly, although not significantly. However, HDL-C and triglycerides are only risk factors, not diseases. These patients showed some overall regression in percent diameter stenosis after 1 year and even more regression after 5 years. There was a dose-response correlation between adherence to the lifestyle program and changes in atherosclerosis at 1 year and at 5 years. Cardiac positron emission tomography scans showed overall improvement in myocardial perfusion in these patients after 5 years. Dr Gould's analyses indicated that the progression of disease