High Cholesterol

Health Condition

High Cholesterol

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

  • High-Fiber Diet

    Eating fiber-rich foods like whole grains, legumes, fruits, and vegetables can help reduce cholesterol levels.
    High-Fiber Diet
    ×

    Dietary fiber is categorized as soluble or insoluble. Soluble fiber interacts with water, often (but not always) forming a gel-like substance, and is fermentable by intestinal bacteria, while insoluble fiber does not interact with water and is usually not fermentable. Gel-forming soluble fiber (also called viscous fiber) sequesters dietary cholesterol (reducing its absorption) and alters the gut microbiome, leading to better cholesterol metabolism and lower cholesterol levels.214,215,216 Good sources of gel-forming soluble fiber include vegetables like sweet potatoes, carrots, artichokes, Brussels sprouts, broccoli, and other greens; fruits like apples, pears, berries, and bananas; legumes including lentils, peas, and beans; and whole grains like oats, rye, and barley.214Psyllium husks and flaxseeds are functional foods with high gel-forming soluble fiber content and have been shown in multiple clinical trials and meta-analyses to lower high LDL- and non-HDL-cholesterol levels. Typical amounts used in clinical trials were equivalent to two to three tablespoons for flaxseeds and about two to three teaspoons for psyllium husk.218,219 Insoluble fiber, found in high amounts in vegetables, whole wheat and other grain brans, and nuts and seeds, has important impacts on digestive function but is not likely to contribute as much to cholesterol lowering as soluble fiber.214,221

    Diets high in legume and whole-grain fiber (especially barley and oat) have been found in multiple studies to be associated with lower LDL-cholesterol levels.222,223 A meta-analysis of findings from 58 randomized controlled trials found beta-glucan from oats can reduce LDL- and non-HDL-cholesterol levels.224 One literature review determined that regular daily intake of 4–10 grams of soluble fiber can result in a 5–10% reduction in LDL-cholesterol.215 Furthermore, a growing body of evidence shows increasing dietary fiber intake, by increasing whole grains or adding psyllium husk for example, can enhance the effectiveness of widely used cholesterol-lowering drugs called statins.226,227

    The recommended daily allowance (RDA) for total dietary fiber is 38 grams in healthy adult men up to age 50 and 25 grams in healthy adult women up to age 50, but most Americans do not consume this amount.214 In fact, the average daily fiber intake in 2015–16 among US adults was found to be 17.33 grams.229 Randomized controlled trials show getting a minimum of 25–40 grams of total fiber, including a minimum of 7–13 grams of soluble fiber, per day can lower LDL-cholesterol by at least 5–10%.215 Dietary fiber has benefits beyond lowering cholesterol: A meta-analysis of data from 17 studies found the risk of death from any cause was 16% lower in those with the highest, versus lowest, daily fiber intake.231

  • Mediterranean Diet

    A Mediterranean-style diet has been associated with lower cholesterol levels and better cardiovascular, metabolic, and overall health.
    Mediterranean Diet
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    The foundation of the Mediterranean diet is a healthy, plant-based diet, high in whole grains, vegetables and fruits, legumes, and nuts and seeds. It also includes modest amounts of fish, low-fat dairy products, lean poultry, and red wine, and highlights olive oil as its main fat source.227 It is the most studied dietary pattern to date, and has been associated with a wide range of health benefits, including lower risks of heart disease, obesity, type 2 diabetes, and Alzheimer disease.228 Adherence to a Mediterranean diet has been shown to be associated with healthy lipid levels and reduced cardiovascular risk. In a large meta-analysis that included data from 57 controlled trials, participants assigned to a Mediterranean eating pattern experienced a reduction in LDL-cholesterol and increase in HDL-cholesterol levels compared with those assigned to other dietary changes or no dietary intervention.229 Another meta-analysis of 121 randomized controlled trials found a reduction in LDL-cholesterol levels was maintained after 12 months in subjects receiving a Mediterranean diet intervention, but not those receiving a low-fat, low-carbohydrate, or DASH diet interventions.230

  • Portfolio Diet

    The portfolio diet emphasizes four dietary components that lower cholesterol levels: phytosterols, viscous soluble fiber, soy protein, and nuts. Some research suggests this diet can be as effective as a widely used cholesterol-lowering drug.
    Portfolio Diet
    ×

    A diet emphasizing a portfolio of foods with evidence supporting their cholesterol-lowering effects has been developed and compared with other diets and cholesterol-lowering drugs. The goals of the portfolio diet are to consume, per 1,000 calories of daily energy intake:

    • ~1 gram of plant sterols from a sterol-enriched food
    • ~10 grams of viscous fiber from oats, barley, and psyllium
    • ~22 grams of soy protein from soymilk, tofu, or soy-based meat replacements
    • ~14–22 grams of almonds, other tree nuts, or peanuts

    In a randomized controlled trial with 46 participants who had high cholesterol levels, a portfolio diet was as effective as lovastatin (Mevacor®) and more effective than a low saturated fat diet, lowering LDL-cholesterol levels by 28.6% after one month.231 In a six-month controlled trial, 345 participants with high cholesterol levels ate either a low saturated fat or portfolio diet. The portfolio diet group had a reduction in LDL-cholesterol of more than 13%, while the low saturated fat group had a 3% reduction; levels of fat-soluble nutrients did not change with either diet.232,233 A meta-analysis of findings from seven trials found the portfolio diet, added to the Step II dietary recommendations of the National Cholesterol Education Program, lowered LDL-cholesterol levels by 17%, as well as total and non-HDL-cholesterol levels and other markers of cardiovascular risk.234 Furthermore, a large observational study that used data collected from more than 123,000 participants in the Women’s Health Initiative from 1993 through 2017 found higher scores reflecting adherence to the portfolio diet were correlated with lower risks of cardiovascular disease, coronary artery disease, and heart failure.235

  • Dietary Approaches to Stop Hypertension (DASH)

    The DASH eating pattern has been shown to lower LDL-cholesterol levels and improve cardiovascular and metabolic health.
    Dietary Approaches to Stop Hypertension (DASH)
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    The Dietary Approaches to Stop Hypertension (DASH) diet is predominantly plant based, is low in saturated fats and cholesterol, and emphasizes fruits, vegetables, whole grains, legumes, nuts, and low-fat dairy products.236 Although DASH was developed to lower high blood pressure, research has shown adherence to this dietary pattern also lowers non-HDL-cholesterol levels.237,238 One large review of 15 observational studies and 31 controlled trials found the DASH diet lowered LDL-cholesterol levels and improved other cardiovascular and metabolic health parameters.239

  • Coffee

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Coffee
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    While coffee consumption has been associated with decreased risks of cardiovascular disease, obesity, and diabetes, drinking coffee prepared without the use of a paper filter has been strongly linked to negative impacts on lipid profiles, including elevation of total and LDL-cholesterol levels.240,241

  • Fish

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Fish
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    A meta-analysis of 14 controlled trials found oily fish consumption raised HDL-cholesterol levels but did not impact levels of other forms of cholesterol. In addition, fish consumption lowered triglyceride levels.242

  • Garlic

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Garlic
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    According to a large analysis of findings from numerous controlled trials, adding garlic to the diet can lower cholesterol levels in as little as eight weeks.243 In one placebo-controlled trial with 80 participants with cardiovascular disease, 2 grams of garlic powder per day for 60 days lowered total and LDL-cholesterol and raised HDL-cholesterol levels.244

  • Olive Oil

    Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk.
    Olive Oil
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    The most studied dietary monounsaturated fatty acid is the omega-9 fatty acid oleic acid. Oleic acid is found mainly in olive oil but is also present in avocado and nut and seed oils. Multiple clinical trials have shown replacing saturated and trans fats with high-oleic acid oils can lower total and LDL-cholesterol levels without affecting HDL-cholesterol levels,245 and a growing body of evidence shows high intake of olive oil is associated with lower risk of cardiovascular events and death.246

  • Soy Foods

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Soy Foods
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    Soybeans are high in phytosterols and viscous soluble fiber, and have a relatively low ratio of omega-6 to omega-3 fatty acids, all of which may contribute to their cholesterol-lowering effects. Furthermore, soy protein fractions have been found to reduce dietary cholesterol absorption and cholesterol production by the liver. Soy proteins also decrease bile acid resorption, increasing the utilization of cholesterol to manufacture new bile acids.247 Preclinical and clinical trials show replacing animal protein with soy protein, and other plant-sourced proteins, substantially lowers total cholesterol, LDL-cholesterol, and non-HDL-cholesterol levels.248,249

  • Trans Fats

    Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk.
    Trans Fats
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    Trans fats are polyunsaturated fats that have been subjected to partial hydrogenation to increase their solid phase temperature range. Partially hydrogenated oils are used to make highly processed fat products such as shortening and margarine. Trans fats are also generated naturally as polyunsaturated fatty acids age but are found only in small amounts in unprocessed fats and oils. Trans fats are closely associated with cardiovascular disease and have been found to increase cholesterol synthesis in the liver.250

  • Saturated Fats

    Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk.
    Saturated Fats
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    Saturated fats are mainly found in animal foods, but coconut and palm oils are also rich sources. Higher intakes of saturated fatty acids appear to be associated with higher combined risk of heart disease and stroke.251 According to one analysis, replacing 10% of dietary saturated fat with polyunsaturated fatty acids could reduce cardiovascular events by 27%.252 The saturated fatty acids in coconut and palm oil differ from those in animal fat such as butter, and some clinical trials have found coconut oil has less negative impact on cholesterol metabolism than butter.253,254

  • Polyunsaturated Fats (PUFAs)

    Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk.
    Polyunsaturated Fats (PUFAs)
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    The most important dietary PUFAs are categorized, based on their structure, as either omega-6 or omega-3 fatty acids. Major dietary omega-6 fats include arachidonic acid (mainly from animal fats) and linoleic acid (mainly from plant fats); major dietary omega-3 fats include eicosapentaenoic acid and docosahexaenoic acid (EPA and DHA, mainly from fish fats) and alpha-linolenic acid (mainly from plant fats, especially flaxseed, hemp seed, and canola oils). Increasing omega-6 PUFA intake, particularly in the form of linoleic acid, can reduce total and LDL-cholesterol levels.255,256 However, one meta-analysis of data from eleven randomized controlled trials found replacing saturated fats with mostly omega-6 PUFAs does not lower risk of cardiovascular events or death.257 Omega-3 fatty acids appear to have varied effects on cholesterol metabolism: both alpha-linolenic acid and EPA have been found to reduce LDL-cholesterol and have no impact on HDL-cholesterol levels, but DHA appears to cause an increase in both LDL- and HDL-cholesterol levels.256 Although the average US adult diet provides 20–50 times more omega-6 than omega-3 fatty acids, some research suggests a lower ratio of omega-6 to omega-3 fat intake, such as 4–5:1, may be associated with lower risks of cardiovascular and other chronic inflammatory conditions.259

  • Monounsaturated Fats

    Replacing foods high in trans and saturated fats with foods rich in high-quality polyunsaturated and monounsaturated fats, like those in fish, nuts and seeds, and olive oil, can help lower cholesterol levels and reduce cardiovascular risk.
    Monounsaturated Fats
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    The most studied dietary monounsaturated fatty acid is the omega-9 fatty acid oleic acid. Oleic acid is found mainly in olive oil but is also present in avocado and nut and seed oils. Multiple clinical trials have shown replacing saturated and trans fats with high-oleic acid oils can lower total and LDL-cholesterol levels without affecting HDL-cholesterol levels,259 and a growing body of evidence shows high intake of olive oil is associated with lower risk of cardiovascular events and death.260

  • Nuts

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Nuts
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    People who eat nuts and seeds regularly have been found to have better lipid profiles and overall cardiovascular and metabolic health (including less overweight and obesity) than those who don’t eat nuts.261,262,263,264 In addition, a number of clinical trials have shown adding nuts and seeds to the diet is an effective strategy for lowering total, LDL-, and non-HDL cholesterol, as well as triglycerides.265 In particular, pecans,266 almonds,267 Brazil nuts,268 pistachios,269 hazelnuts,270 walnuts,270 and sunflower seeds272 have been found to improve cholesterol levels, while cashews have not shown these beneficial effects.273,274 Peanuts (which are technically in the legume family) have also failed to demonstrate beneficial effects on cholesterol levels.275

  • Seeds

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Seeds
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    People who eat nuts and seeds regularly have been found to have better lipid profiles and overall cardiovascular and metabolic health (including less overweight and obesity) than those who don’t eat nuts.275,276,277,278 In addition, a number of clinical trials have shown adding nuts and seeds to the diet is an effective strategy for lowering total, LDL-, and non-HDL cholesterol, as well as triglycerides.279 In particular, pecans,280 almonds,281 Brazil nuts,282 pistachios,283 hazelnuts,284 walnuts,284 and sunflower seeds286 have been found to improve cholesterol levels, while cashews have not shown these beneficial effects.287,288 Peanuts (which are technically in the legume family) have also failed to demonstrate beneficial effects on cholesterol levels.289

  • Cholesterol

    Replacing foods high in trans and saturated fats with those rich in high-quality fats, like omega-3 and omega-6 polyunsaturated and omega-9 monounsaturated fatty acids, can help lower cholesterol levels and reduce cardiovascular risk.
    Cholesterol
    ×

    It is increasingly evident that quality matters more than quantity when it comes to dietary fat. Low-fat diets have consistently been shown to have little impact on cardiovascular risk, but changes in dietary fatty acid composition may have meaningful effects.

    While diets associated with lower cholesterol levels and cardiovascular risk are often inherently low in cholesterol, dietary cholesterol intake has not been correlated with cholesterol levels, and reducing cholesterol intake has not been shown to be an effective way to reduce high cholesterol levels.289

  • Low-Sugar

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Low-Sugar
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    High consumption of sugar-sweetened foods and beverages, as well as refined carbohydrates (which are rapidly converted into glucose in the body), is strongly correlated with heart disease, although evidence linking sugars to high cholesterol levels is limited.290,291 Observational data from studies with almost 30,000 US adult participants found high intake of sugar-sweetened beverages in particular were associated with higher LDL-cholesterol and triglyceride levels and lower HDL-cholesterol levels.292 A meta-analysis of findings from 13 observational studies in children and youth also show links between increased sugar-sweetened beverage intake and worsening lipid profiles in this age group.293 However, a randomized controlled trial in 203 high consumers of sugar-sweetened beverages found switching to artificially-sweetened beverages did not improve lipid levels.294

  • Low-Carbohydrate

    Low-carbohydrate diets appear to slightly increase LDL-cholesterol levels but have positive impacts on HDL-cholesterol and triglyceride levels. It is unclear how these effects influence cardiovascular outcomes.
    Low-Carbohydrate
    ×

    Various degrees of carbohydrate restriction are sometimes used to manage metabolic disorders like type 2 diabetes and obesity. These diets can also affect lipid levels, having in particular a positive effect on triglyceride levels.295 One meta-analysis of findings from eight randomized controlled trials comparing low-carbohydrate to low-fat diets found these diets had similar effects on LDL-cholesterol levels, but adherence to low-carbohydrate diets resulted in lower triglyceride and higher HDL-cholesterol levels.296 Another meta-analysis that included 12 randomized controlled trials found that adhering to a low-carbohydrate diet raised LDL-cholesterol levels slightly, but all of the effects of the diet on lipid levels and other markers of cardiovascular risk disappeared within two years of monitoring.297 Furthermore, an analysis of 121 clinical trials with a combined total of almost 22,000 participants found neither low-carbohydrate nor low-fat diets led to lasting changes in cardiovascular risk factors, including cholesterol levels.298

    One analysis examined data from 37 clinical trials to compare the effects of diets with three different degrees of carbohydrate restriction: a very low-carbohydrate diet, in which less than 30% of daily calorie intake was from carbohydrates (a ketogenic diet); a low-carbohydrate diet, in which calories from carbohydrates ranged from 30% to less than 40% of total calories; and a moderately low-carbohydrate diet, in which carbohydrate calories ranged from 40% to less than 45% of daily calories. The analysis showed LDL-cholesterol and HDL-cholesterol levels increased more in those eating a very low-carbohydrate diet compared with those eating a moderately low-carbohydrate diet. The analysis also found substituting carbohydrate calories with saturated fat calories resulted in higher total and LDL-cholesterol levels.299 The effect of these differences on cardiovascular outcomes is still unknown, but some evidence has indicated a very low-carbohydrate diet, particularly one that includes high intake of animal (saturated) fat, may be associated with increased mortality.300

  • Vegetarian

    Vegetarian diets are generally rich in soluble fiber, phytosterols, and soy protein, all of which have been shown to lower LDL-cholesterol levels.
    Vegetarian
    ×
    A vegetarian diet excludes meat, poultry, and fish, while a vegan diet also excludes eggs and dairy products. These diets are generally low in saturated fat and excess calories and high in heart-protective foods like legumes, soy foods, nuts, seeds, vegetables, fruits, and whole grains.301,302 In addition to soluble fiber, vegetarian and vegan diets are high in phytosterols, plant lipids similar in structure and function to cholesterol. Phytosterols are found in all plant foods but are especially abundant in unrefined vegetable, nut and seed, and olive oils. When consumed in amounts of 600–3,300 mg per day, phytosterols have been found to improve lipid profiles by inhibiting dietary cholesterol absorption and stimulating cholesterol excretion.301 In addition, consuming about 25 grams of soy protein per day has been shown to lower LDL-cholesterol levels by 3–4%.304 A large review that included findings from 20 meta-analyses of observational studies and clinical trials determined vegetarian diets were associated with lower total and LDL-cholesterol levels, but had negative impacts on HDL-cholesterol levels and vitamin B12 status.305

  • Vegan

    Vegan diets are generally rich in soluble fiber, phytosterols, and soy protein, all of which have been shown to lower LDL-cholesterol levels.
    Vegan
    ×
    A vegetarian diet excludes meat, poultry, and fish, while a vegan diet also excludes eggs and dairy products. These diets are generally low in saturated fat and excess calories and high in heart-protective foods like legumes, soy foods, nuts, seeds, vegetables, fruits, and whole grains.305,306 In addition to soluble fiber, vegetarian and vegan diets are high in phytosterols, plant lipids similar in structure and function to cholesterol. Phytosterols are found in all plant foods but are especially abundant in unrefined vegetable, nut and seed, and olive oils. When consumed in amounts of 600–3,300 mg per day, phytosterols have been found to improve lipid profiles by inhibiting dietary cholesterol absorption and stimulating cholesterol excretion.305 In addition, consuming about 25 grams of soy protein per day has been shown to lower LDL-cholesterol levels by 3–4%.308 A large review that included findings from 20 meta-analyses of observational studies and clinical trials determined vegetarian diets were associated with lower total and LDL-cholesterol levels, but had negative impacts on HDL-cholesterol levels and vitamin B12 status.309

  • Alcohol Consumption

    Including specific foods and beverages, such as soy foods, nuts and seeds, fish, garlic, coffee, and alcohol, in your regular diet may improve cholesterol and other lipid levels.
    Alcohol Consumption
    ×

    Although certain specific foods have been studied for their effects on blood cholesterol levels, current research and recommendations mainly focus on overall dietary patterns. Nevertheless, some individual foods deserve mention.

    Regular light to moderate alcohol consumption is associated with increased HDL-cholesterol levels and decreased risk of atherosclerosis.309 Light to moderate alcohol intake is defined as a maximum of two drinks per day for men and one drink per day for women, with a drink being 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.310 In fact, two alcoholic drinks per day has been found to raise HDL-cholesterol by 12%.309

References

1. Aguilar-Ballester M, Herrero-Cervera A, Vinué Á, et al. Impact of Cholesterol Metabolism in Immune Cell Function and Atherosclerosis. Nutrients 2020;12:2021.

2. Ouimet M, Barrett TJ, Fisher EA. HDL and Reverse Cholesterol Transport. Circ Res 2019;124:1505–18.

3. Lorenzatti AJ, Toth PP. New Perspectives on Atherogenic Dyslipidaemia and Cardiovascular Disease. Eur Cardiol 2020;15:1–9.

4. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;139:e1082–143.

5. Atar D, Jukema JW, Molemans B, et al. New cardiovascular prevention guidelines: How to optimally manage dyslipidaemia and cardiovascular risk in 2021 in patients needing secondary prevention? Atherosclerosis 2021;319:51–61.

6. Fernández-Friera L, Fuster V, López-Melgar B, et al. Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors. J Am Coll Cardiol. 2017;70:2979–91.

7. Won KB, Park GM, Yang YJ, et al. Independent role of low-density lipoprotein cholesterol in subclinical coronary atherosclerosis in the absence of traditional cardiovascular risk factors. Eur Heart J Cardiovasc Imaging 2019;20:866–72.

8. Santos HO, Bueno AA, Mota JF. The effect of artichoke on lipid profile: A review of possible mechanisms of action. Pharmacol Res 2018;137:170–8.

9. Sahebkar A, Pirro M, Banach M, et al. Lipid-lowering activity of artichoke extracts: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2018;58:2549–56.

10. Rondanelli M, Castellazzi AM, Riva A, et al. Natural Killer Response and Lipo-Metabolic Profile in Adults with Low HDL-Cholesterol and Mild Hypercholesterolemia: Beneficial Effects of Artichoke Leaf Extract Supplementation. Evid Based Complement Alternat Med 2019;2019:2069701.

11. Rondanelli M, Giacosa A, Opizzi A, et al. Beneficial effects of artichoke leaf extract supplementation on increasing HDL-cholesterol in subjects with primary mild hypercholesterolaemia: a double-blind, randomized, placebo-controlled trial. Int J Food Sci Nutr 2013;64:7–15.

12. Rondanelli M, Opizzi A, Faliva M, et al. Metabolic management in overweight subjects with naive impaired fasting glycaemia by means of a highly standardized extract from Cynara scolymus: a double-blind, placebo-controlled, randomized clinical trial. Phytother Res 2014;28:33–41.

13. Ye Y, Liu X, Wu N, et al. Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol 2021;12:653887.

14. Ju J, Li J, Lin Q, Xu H. Efficacy and safety of berberine for dyslipidaemias: A systematic review and meta-analysis of randomized clinical trials. Phytomedicine 2018;50:25–34.

15. Kong WJ, Wei J, Zuo ZY, et al. Combination of simvastatin with berberine improves the lipid-lowering efficacy. Metabolism 2008;57:1029–37.

16. Zhang L, Zhang J, Feng R, et al. Efficacy and Safety of Berberine Alone or Combined with Statins for the Treatment of Hyperlipidemia: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Am J Chin Med 2019;47:751–67.

17. Formisano E, Pasta A, Cremonini AL, et al. Efficacy of Nutraceutical Combination of Monacolin K, Berberine, and Silymarin on Lipid Profile and PCSK9 Plasma Level in a Cohort of Hypercholesterolemic Patients. J Med food 2020;23:658–66.

18. Galletti F, Fazio V, Gentile M, et al. Efficacy of a nutraceutical combination on lipid metabolism in patients with metabolic syndrome: a multicenter, double blind, randomized, placebo controlled trial. Lipids health Dis 2019;18:66.

19. Bertuccioli A, Moricoli S, Amatori S, et al. Berberine and Dyslipidemia: Different Applications and Biopharmaceutical Formulations Without Statin-Like Molecules-A Meta-Analysis. J Med Food 2020;23:101–13.

20. Murphy E, Rezoagli E, Major I, et al. β-Glucan Metabolic and Immunomodulatory Properties and Potential for Clinical Application. J Fungi (Basel) 2020;6:356.

21. Joyce S, Kamil A, Fleige L, Gahan C. The Cholesterol-Lowering Effect of Oats and Oat Beta Glucan: Modes of Action and Potential Role of Bile Acids and the Microbiome. Front Nutr 2019;6:171.

22. Xu D, Liu H, Yang C, et al. Effects of different delivering matrices of β-glucan on lipids in mildly hypercholesterolaemic individuals: a meta-analysis of randomised controlled trials. Br J Nutr 2021;125:294–307.

23. Ms Wolever T, Rahn M, Dioum E, et al. An Oat β-Glucan Beverage Reduces LDL Cholesterol and Cardiovascular Disease Risk in Men and Women with Borderline High Cholesterol: A Double-Blind, Randomized, Controlled Clinical Trial. J Nutr 2021;151:2655–66.

24. Cicero AFG, Fogacci F, Veronesi M, et al. A randomized Placebo-Controlled Clinical Trial to Evaluate the Medium-Term Effects of Oat Fibers on Human Health: The Beta-Glucan Effects on Lipid Profile, Glycemia and inTestinal Health (BELT) Study. Nutrients. 2020;12:686.

25. Ying J, Zhang Y, Yu K. Phytosterol compositions of enriched products influence their cholesterol-lowering efficacy: a meta-analysis of randomized controlled trials. Eur J Clin Nutr 2019;73:1579–93.

26. Gylling H, Strandberg TE, Kovanen PT, et al. Lowering Low-Density Lipoprotein Cholesterol Concentration with Plant Stanol Esters to Reduce the Risk of Atherosclerotic Cardiovascular Disease Events at a Population Level: A Critical Discussion. Nutrients. 2020;12:2346.

27. Salehi B, Quispe C, Sharifi-Rad J, et al. Phytosterols: From Preclinical Evidence to Potential Clinical Applications. Front Pharmacol 2020;11:599959.

28. Cusack LK, Fernandez ML, Volek JS. The food matrix and sterol characteristics affect the plasma cholesterol lowering of phytosterol/phytostanol. Adv Nutr 2013;4:633–43.

29. Gylling H, Plat J, Turley S, et al. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 2014;232:346–60.

30. Babu S, Jayaraman S. An update on β-sitosterol: A potential herbal nutraceutical for diabetic management. Biomed Pharmacother 2020;131:110702.

31. Guan G, Azad M, Lin Y, et al. Biological Effects and Applications of Chitosan and Chito-Oligosaccharides. Front Physiol 2019;10:516.

32. Lütjohann D, Marinova M, Wolter K, et al. Influence of Chitosan Treatment on Surrogate Serum Markers of Cholesterol Metabolism in Obese Subjects. Nutrients. 2018;10:72.

33. Huang H, Zou Y, Chi H, et al. Lipid-Modifying Effects of Chitosan Supplementation in Humans: A Pooled Analysis with Trial Sequential Analysis. Mol Nutr Food Res 2018;62:e1700842.

34. Moraru C, Mincea MM, Frandes M, et al. A Meta-Analysis on Randomised Controlled Clinical Trials Evaluating the Effect of the Dietary Supplement Chitosan on Weight Loss, Lipid Parameters and Blood Pressure. Medicina (Kaunas) 2018 Dec;54:109.

35. Chen Z, Lei Y, Wang W, et al. Effects of Saponin from Trigonella Foenum-Graecum Seeds on Dyslipidemia. Iran J Med Sci 2017;42:577–85.

36. Khodamoradi K, Khosropanah MH, Ayati Z, et al. The Effects of Fenugreek on Cardiometabolic Risk Factors in Adults: A Systematic Review and Meta-analysis. Complement Ther Med 2020;52:102416.

37. Askarpour M, Alami F, Campbell MS, et al. Effect of fenugreek supplementation on blood lipids and body weight: A systematic review and meta-analysis of randomized controlled trials. J Ethnopharmacol 2020;253:112538.

38. Geberemeskel GA, Debebe YG, Nguse NA. Antidiabetic Effect of Fenugreek Seed Powder Solution (Trigonella foenum-graecum L.) on Hyperlipidemia in Diabetic Patients. J Diabetes Res 2019;2019:8507453.

39. Wan Q, Li N, Du L, et al. Allium vegetable consumption and health: An umbrella review of meta-analyses of multiple health outcomes. Food Sci Nutr 2019;7:2451–70.

40. Sun YE, Wang W, Qin J. Anti-hyperlipidemia of garlic by reducing the level of total cholesterol and low-density lipoprotein: A meta-analysis. Medicine 2018;97:e0255.

41. Ried K. Garlic lowers blood pressure in hypertensive individuals, regulates serum cholesterol, and stimulates immunity: an updated meta-analysis and review. J Nutr 2016;146:389S–96S.

42. Shabani E, Sayemiri K, Mohammadpour M. The effect of garlic on lipid profile and glucose parameters in diabetic patients: A systematic review and meta-analysis. Prim Care Diabetes 2019;13:28–42.

43. Sobenin IA, Myasoedova VA, Iltchuk MI, et al. Therapeutic effects of garlic in cardiovascular atherosclerotic disease. Chin J Nat Med 2019;17:721–8.

44. Devaraj R, Reddy C, Xu B. Health-promoting effects of konjac glucomannan and its practical applications: A critical review. Int J Biol Macromol 2019;126:273–81.

45. Ho HVT, Jovanovski E, Zurbau A, et al. A systematic review and meta-analysis of randomized controlled trials of the effect of konjac glucomannan, a viscous soluble fiber, on LDL cholesterol and the new lipid targets non-HDL cholesterol and apolipoprotein B. Am J Clin Nutr 2017;105:1239–47.

46. Landini L, Rebelos E, Honka MJ. Green Tea from the Far East to the Drug Store: Focus on the Beneficial Cardiovascular Effects. Curr Pharm Des 2021;27:1931–40.

47. Xu R, Yang K, Li S, et al. Effect of green tea consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Nutr J 2020;19:48.

48. Asbaghi O, Fouladvand F, Moradi S, et al. Effect of green tea extract on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Syndr 2020;14:293–301.

49. Yuan F, Dong H, Fang K, et al. Effects of green tea on lipid metabolism in overweight or obese people: A meta-analysis of randomized controlled trials. Mol Nutr Food Res 2018;62.

50. Momose Y, Maeda-Yamamoto M, Nabetani H. Systematic review of green tea epigallocatechin gallate in reducing low-density lipoprotein cholesterol levels of humans. Int J Food Sci Nutr 2016;67:606–13.

51. Eng QY, Thanikachalam PV, Ramamurthy S. Molecular understanding of Epigallocatechin gallate (EGCG) in cardiovascular and metabolic diseases. J Ethnopharmacol 2018;210:296–310.

52. Bocos C, Herrera E. Pantethine stimulates lipolysis in adipose tissue and inhibits cholesterol and fatty acid synthesis in liver and intestinal mucosa in the normolipidemic rat. Environ Toxicol Pharmacol 1998 6:59–66.

53. Evans M, Rumberger JA, Azumano I, et al. Pantethine, a derivative of vitamin B5, favorably alters total, LDL and non-HDL cholesterol in low to moderate cardiovascular risk subjects eligible for statin therapy: a triple-blinded placebo and diet-controlled investigation. Vasc Health Risk Manag 2014;10:89–100.

54. Rumberger JA, Napolitano J, Azumano I, et al. Pantethine, a derivative of vitamin B5 used as a nutritional supplement, favorably alters low-density lipoprotein cholesterol metabolism in low- to moderate-cardiovascular risk North American subjects: a triple-blinded placebo and diet-controlled investigation. Nutr Res 2011;31:608–15.

55. Binaghi P, Cellina G, Lo Cicero G, et al. Evaluation of the cholesterol-lowering effectiveness of pantethine in women in perimenopausal age. Minerva medica 1990 81:475–9.

56. Bertolini S, Donati C, Elicio N, et al. Lipoprotein changes induced by pantethine in hyperlipoproteinemic patients: adults and children. Int J Clin Pharmacol Ther Toxicol 1986;24:630–7.

57. Arsenio L, Bodria P, Magnati G, et al. Effectiveness of long-term treatment with pantethine in patients with dyslipidemia. Clin Ther 1986;8:537–45.

58. McRae M. Treatment of hyperlipoproteinemia with pantethine: A review and analysis of efficacy and tolerability. Nutrition Research - NUTR RES 2005;25:319–33.

59. McRae MP. Dietary Fiber Is Beneficial for the Prevention of Cardiovascular Disease: An Umbrella Review of Meta-analyses. J Chiropr Med 2017;16:289–99.

60. Schoeneck M, Iggman D. The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials. Nutr Metab Cardiovasc Dis 2021;31:1325–38.

61. Jovanovski E, Yashpal S, Komishon A, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2018;108:922–32.

62. Xiao Z, Chen H, Zhang Y, et al. The effect of psyllium consumption on weight, body mass index, lipid profile, and glucose metabolism in diabetic patients: A systematic review and dose-response meta-analysis of randomized controlled trials. Phytother Res 2020;34:1237–47.

63. Brum J, Ramsey D, McRorie J, et al. Meta-Analysis of Usefulness of Psyllium Fiber as Adjuvant Antilipid Therapy to Enhance Cholesterol Lowering Efficacy of Statins. Am J Cardiol 2018;122:1169–74.

64. Ribas SA, Cunha DB, Sichieri R, et al. Effects of psyllium on LDL-cholesterol concentrations in Brazilian children and adolescents: a randomised, placebo-controlled, parallel clinical trial. Br J Nutr 2015;113:134–41.

65. de Bock M, Derraik JG, Brennan CM, et al. Psyllium supplementation in adolescents improves fat distribution & lipid profile: a randomized, participant-blinded, placebo-controlled, crossover trial. PloS One. 2012;7:e41735.

66. Fukami H, Higa Y, Hisano T, et al. A Review of Red Yeast Rice, a Traditional Fermented Food in Japan and East Asia: Its Characteristic Ingredients and Application in the Maintenance and Improvement of Health in Lipid Metabolism and the Circulatory System. Molecules 2021;26:1619.

67. Cicero AFG, Fogacci F, Banach M. Red Yeast Rice for Hypercholesterolemia. Methodist JDeBakey Cardiovasc J. 2019;15:192–9.

68. Hachem R, Assemat G, Balayssac S, et al. Comparative Chemical Profiling and Monacolins Quantification in Red Yeast Rice Dietary Supplements by 1H-NMR and UHPLC-DAD-MS. Molecules 2020;25:317.

69. Farkouh A, Baumgärtel C. Mini-review: medication safety of red yeast rice products. Int J Gen Med 2019;12:167–71.

70. Hargreaves I, Heaton RA, Mantle D. Disorders of Human Coenzyme Q10 Metabolism: An Overview. Int J Mol Sci 2020;21:6695.

71. Wang TJ, Lien AS, Chen JL, et al. A Randomized Clinical Efficacy Trial of Red Yeast Rice (Monascus pilosus) Against Hyperlipidemia. Am J Chin Med 2019;47:323–35.

72. Puato M, Zambon A, Nardin C, et al. Lipid Profile and Vascular Remodelling in Young Dyslipidemic Subjects Treated with Nutraceuticals Derived from Red Yeast Rice. Cardiovasc Ther 2021;2021:5546800.

73. Mazza A, Lenti S, Schiavon L, et al. Effect of Monacolin K and COQ10 supplementation in hypertensive and hypercholesterolemic subjects with metabolic syndrome. Biomed Pharmacother 2018;105:992–6.

74. Ying J, Zhang Y, Yu K. Phytosterol compositions of enriched products influence their cholesterol-lowering efficacy: a meta-analysis of randomized controlled trials. Eur J Clin Nutr 2019;73:1579–93.

75. Gylling H, Strandberg TE, Kovanen PT, et al. Lowering Low-Density Lipoprotein Cholesterol Concentration with Plant Stanol Esters to Reduce the Risk of Atherosclerotic Cardiovascular Disease Events at a Population Level: A Critical Discussion. Nutrients. 2020;12:2346.

76. Salehi B, Quispe C, Sharifi-Rad J, et al. Phytosterols: From Preclinical Evidence to Potential Clinical Applications. Front Pharmacol 2020;11:599959.

77. Cusack LK, Fernandez ML, Volek JS. The food matrix and sterol characteristics affect the plasma cholesterol lowering of phytosterol/phytostanol. Adv Nutr 2013;4:633–43.

78. Gylling H, Plat J, Turley S, et al. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 2014;232:346–60.

79. Babu S, Jayaraman S. An update on β-sitosterol: A potential herbal nutraceutical for diabetic management. Biomed Pharmacother 2020;131:110702.

80. Carrol KK, Kurowska EM. Soy consumption and cholesterol reduction: review of animal and human studies. J Nutr 1995;125:594-7S.

81. Crouse JR 3rd, Morgan T, Terry JG, et al. A randomized trial comparing the effect of casein with that of soy protein containing varying amounts of isoflavones on plasma concentrations of lipids and lipoproteins. Arch Intern Med 1999;159:2070-6.

82. Nestel PJ, Yamashita T, Sasahara T, et al. Soy isoflavones improve systemic arterial compliance but not plasma lipids in menopausal and perimenopausal women. Arterioscler Thromb Vasc Biol 1997;17:3392-8.

83. Samman S, Lyons, Wall PM, et al. The effect of supplementation with isoflavones on plasma lipids and oxidisability of low density lipoprotein in premenopausal women. Atherosclerosis 1999;147:277-83.

84. Hoie LH, Morgenstern EC, Gruenwald J, et al. A double-blind placebo-controlled clinical trial compares the cholesterol-lowering effects of two different soy protein preparations in hypercholesterolemic subjects. Eur J Nutr 2005;44:65-71.

85. Mulet-Cabero AI, Wilde PJ. Role of calcium on lipid digestion and serum lipids: a review. Crit Rev Food Sci Nutr 2021:1–14.

86. Vinarova L, Vinarov Z, Tcholakova S, et al. The mechanism of lowering cholesterol absorption by calcium studied by using an in vitro digestion model. Food Funct 2016;7:151–63.

87. Chen C, Ge S, Li S, et al. The Effects of Dietary Calcium Supplements Alone or With Vitamin D on Cholesterol Metabolism: A Meta-Analysis of Randomized Controlled Trials.J Cardiovasc Nurs 2017;32:496–506.

88. Schnatz PF, Jiang X, Aragaki AK, et al. Effects of Calcium, Vitamin D, and Hormone Therapy on Cardiovascular Disease Risk Factors in the Women's Health Initiative: A Randomized Controlled Trial. Obstet Gynecol 2017;129:121–9.

89. Li S, Na L, Li Y, et al. Long-term calcium supplementation may have adverse effects on serum cholesterol and carotid intima-media thickness in postmenopausal women: a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2013;98:1353–9.

90. Pana TA, Dehghani M, Baradaran HR, et al. Calcium intake, calcium supplementation and cardiovascular disease and mortality in the British population: EPIC-norfolk prospective cohort study and meta-analysis.Eur J Epidemiol 2021;36:669–83.

91. Myung SK, Kim HB, Lee YJ, et al. Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials. Nutrients 2021;13:368.

92. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment: JACC Focus Seminar. J Am Coll Cardiol 2021;77:423–36.

93. Subih HS, Zueter Z, Obeidat BM, et al. A high weekly dose of cholecalciferol and calcium supplement enhances weight loss and improves health biomarkers in obese women.Nutr Res 2018 11;59:53–64.

94. Gerasimenko NV, Stavitskaia SS, Davydov VI. Adsorption of bile acids and cholesterol from model solutions and biological liquids modified with charcoal enterosorbents. Biokhimiia 1995;60:533–40.

95. Neuvonen PJ, Kuusisto P, Manninen V, et al. The mechanism of the hypocholesterolaemic effect of activated charcoal. Eur J Clin Invest 1989;19:251–4.

96. Neuvonen PJ, Kuusisto P, Vapaatalo H, Manninen V. Activated charcoal in the treatment of hypercholesterolaemia: dose-response relationships and comparison with cholestyramine. Eur J Clin Pharmacol 1989;37:225–30.

97. Park GD, Spector R, Kitt TM. Superactivated charcoal versus cholestyramine for cholesterol lowering: a randomized cross-over trial. J Clin Pharmacol 1988;28:416–9.

98. Kuusisto P, Vapaatalo H, Manninen V, et al. Effect of activated charcoal on hypercholesterolaemia. Lancet 1986;2:366–7.

99. Hoekstra JB, Erkelens DW. No effect of activated charcoal on hyperlipidaemia. A double-blind prospective trial. Neth J Med 1988;33:209–16.

100. Hollmann J, Schmidt A, von Bassewitz DB, et al. Relationship of sulfated glycosaminoglycans and cholesterol content in normal and arteriosclerotic human aorta. Arteriosclerosis 1989;9:154–8.

101. Izuka K, Murata K, Nakazawa K, et al. Effects of chondroitin sulfates on serum lipids and hexosamines in atherosclerotic patients: With special reference to thrombus formation time. Jpn Heart J 1968;9:453–60.

102. Nakazawa K, Murata K. Comparative study of the effects of chondroitin sulfate isomers on atherosclerotic subjects. Z Alternsforsch 1979;34:153–9.

103. Morrison LM, Enrick NL. Coronary heart disease: reduction of death rate by chondroitin sulfate A. Angiology 1973;24:269–87.

104. Rondanelli M, Miraglia N, Putignano P, et al. Short- and Long-Term Effectiveness of Supplementation with Non-Animal Chondroitin Sulphate on Inflammation, Oxidative Stress and Functional Status in Obese Subjects with Moderate Knee Osteoarthritis before and after Physical Stress: A Randomized, Double-Blind, Placebo-Controlled Trial. Antioxidants (Basel) 2020;9:1241.

105. Radhakrishnamurthy B, Ruiz HA, Srinivasan SR, et al. Studies of glycosaminoglycan composition and biologic activity of Vessel, a hypolipidemic agent. Atherosclerosis 1978;31:217–29.

106. Wegrowski J, Robert AM, Moczar M. The effect of procyanidolic oligomers on the composition of normal and hypercholesterolemic rabbit aortas. Biochem Pharmacol 1984;33:3491–7.

107. Arai H, Kashiwagi S, Nagasaka Y, et al. Oxidative modification of apolipoprotein E in human very-low-density lipoprotein and its inhibition by glycosaminoglycans. Arch Biochem Biophys 1999;367:1–8.

108. Xiao L, Zhou Y, Ma J, et al. The cross-sectional and longitudinal associations of chromium with dyslipidemia: A prospective cohort study of urban adults in China. Chemosphere 2019;215:362–9.

109. Lima KV, Lima RP, Gonçalves MC, et al. High frequency of serum chromium deficiency and association of chromium with triglyceride and cholesterol concentrations in patients awaiting bariatric surgery. Obes Surg 2014;24:771–6.

110. Tarrahi MJ, Tarrahi MA, Rafiee M, et al. The effects of chromium supplementation on lipidprofile in humans: A systematic review and meta-analysis ofrandomized controlled trials. Pharmacol Res 2021;164:105308.

111. Asbaghi O, Naeini F, Ashtary-Larky D, et al. Effects of chromium supplementation on lipid profile in patients with type 2 diabetes: A systematic review and dose-response meta-analysis of randomized controlled trials. J Trace Elem Med Biol 2021;66:126741.

112. Zhao F, Pan D, Wang N, et al. Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus: a Systematic Review and Meta-analysis. Biol Trace Elem Res 2022;200:516–25.

113. Zhao S, Liu H, Gu L. American cranberries and health benefits - an evolving story of 25 years. J Sci Food Agric 2020;100:5111–6.

114. Pourmasoumi M, Hadi A, Najafgholizadeh A, et al. The effects of cranberry on cardiovascular metabolic risk factors: A systematic review and meta-analysis. Clin Nutr 2020;39:774–88.

115. Chew B, Mathison B, Kimble L, et al. Chronic consumption of a low calorie, high polyphenol cranberry beverage attenuates inflammation and improves glucoregulation and HDL cholesterol in healthy overweight humans: a randomized controlled trial. Eur J Nutr. 2019;58(3):1223–35.

116. Lee IT, Chan YC, Lin CW, et al. Effect of cranberry extracts on lipid profiles in subjects with Type 2 diabetes. Diabet Med 2008;25:1473–7.

117. Novotny JA, Baer DJ, Khoo C, et al. Cranberry juice consumption lowers markers of cardiometabolic risk, including blood pressure and circulating C-reactive protein, triglyceride, and glucose concentrations in adults. J Nutr 2015;145:1185–93.

118. Moraes Rd, Van Bavel D, Moraes BS, et al. Effects of dietary creatine supplementation on systemic microvascular density and reactivity in healthy young adults. Nutr J 2014;13:115.

119. Arciero PJ, Hannibal NS, Nindl BC, et al. Comparison of creatine ingestion and resistance training on energy expenditure and limb blood flow. Metabolism 2001;50:1429–34.

120. Gualano B, Ugrinowitsch C, Artioli GG, et al. Does creatine supplementation improve the plasma lipid profile in healthy male subjects undergoing aerobic training? Int J Sport Nutr Exerc Metab 2008;5:16.

121. Volek JS, Duncan ND, Mazzetti SA, et al. No effect of heavy resistance training and creatine supplementation on blood lipids. Int J Sport Nutr Exerc Metab 2000;10:144–56.

122. Earnest CP, Almada AL, Mitchell TL. High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women. Clin Sci 1996;91:113–8.

123. Yamada T, Sugimoto K. Guggulsterone and Its Role in Chronic Diseases. Adv Exp Med Biol 2016;929:329–61.

124. Urizar NL, Moore DD. GUGULIPID: a natural cholesterol-lowering agent. Annu Rev Nutr 2003;23:303–13.

125. Nityanand S, Srivastava JS, Asthana OP. Clinical trials with Gugulipid—a new hypolipidemic agent. J Assoc Phys India 1989; 37:323–8.

126. Ulbricht C, Basch E, Szapary P, et al. Guggul for hyperlipidemia: a review by the Natural Standard Research Collaboration. Complement Ther Med 2005;Dec;13(4):279–90.

127. Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: an randomized controlled trial. JAMA 2003;290:765–72.

128. Nohr LA, Rasmussen LB, Straand J. Resin from the mukul myrrh tree, guggul, can it be used for treating hypercholesterolemia? A randomized, controlled study. Complement Ther Med 2009;17:16–22.

129. Cruz-Jentoft AJ. Beta-Hydroxy-Beta-Methyl Butyrate (HMB): From Experimental Data to Clinical Evidence in Sarcopenia. Curr Protein Pept Sci 2018;19:668–72.

130. Nissen S, Sharp RL, Panton L, et al. b-hydroxy-b-methylbutyrate (HMB) supplementation in humans is safe and may decrease cardiovascular risk factors. J Nutr 2000;130:1937–45.

131. Kim MG, Yang I, Lee HS, et al. Lipid-modifying effects of krill oil vs fish oil: a network meta-analysis. Nutr Rev 2020;78:699–708.

132. Sarkkinen ES, Savolainen MJ, Taurio J, et al. Prospective, randomized, double-blinded, placebo-controlled study on safety and tolerability of the krill powder product in overweight subjects with moderately elevated blood pressure. Lipids Health Dis 2018;17:287.

133. Ursoniu S, Sahebkar A, Serban MC, et al. Lipid-modifying effects of krill oil in humans: systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2017;75:361–73.

134. Fathizadeh H, Milajerdi A, Reiner Ž, et al. The Effects of L-Carnitine Supplementation on Serum Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Pharm Des 2019;25:3266–81.

135. Askarpour M, Hadi A, Symonds ME, et al. Efficacy of l-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2019;29:1151–67.

136. Asbaghi O, Kashkooli S, Amini MR, et al. The effects of L-carnitine supplementation on lipid concentrations inpatients with type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials. J Cardiovasc Thorac Res 2020;12:246–55.

137. Robert C, Couëdelo L, Vaysse C, et al. Vegetable lecithins: A review of their compositional diversity, impact on lipid metabolism and potential in cardiometabolic disease prevention. Biochimie 2020;169:121–32.

138. Mourad AM, de Carvalho Pincinato E, Mazzola PG, et al. Influence of soy lecithin administration on hypercholesterolemia. Cholesterol 2010;2010:824813.

139. Knuiman JT, Beynen AC, Katan MB. Lecithin intake and serum cholesterol. Am J Clin Nutr 1989;49:266–8.

140. Maleki V, Jafari-Vayghan H, Saleh-Ghadimi S, et al. Effects of Royal jelly on metabolic variables in diabetes mellitus: A systematic review. Complement Ther Med 2019;43:20–7.

141. Chiu HF, Chen BK, Lu YY, et al. Hypocholesterolemic efficacy of royal jelly in healthy mild hypercholesterolemic adults. Pharm Biol 2017;55:497–502.

142. Petelin A, Kenig S, Kopinč R, et al. Effects of Royal Jelly Administration on Lipid Profile, Satiety, Inflammation, and Antioxidant Capacity in Asymptomatic Overweight Adults. Evid Based Complement Alternat Med 2019;2019:4969720.

143. Guo H, Saiga A, Sato M, et al. Royal jelly supplementation improves lipoprotein metabolism in humans. J Nutr Sci Vitaminol (Tokyo) 2007;53:345–8.

144. Lambrinoudaki I, Augoulea A, Rizos D, et al. Greek-origin royal jelly improves the lipid profile of postmenopausal women. Gynecol Endocrinol 2016;32:835–9.

145. Shahidi F, de Camargo AC. Tocopherols and Tocotrienols in Common and Emerging Dietary Sources: Occurrence, Applications, and Health Benefits. Int J Mol Sci 2016;17:1745.

146. Zuo S, Wang G, Han Q, et al. The effects of tocotrienol supplementation on lipid profile: A meta-analysis of randomized controlled trials. Complement Ther Med 2020;52:102450.

147. Mathur P, Ding Z, Saldeen T, Mehta JL. Tocopherols in the Prevention and Treatment of Atherosclerosis and Related Cardiovascular Disease. Clin Cardiol 2015;38:570–6.

148. Mohammad A, Falahi E, Barakatun-Nisak MY, et al. Systematic review and meta-analyses of vitamin E (alpha-tocopherol) supplementation and blood lipid parameters in patients with diabetes mellitus. Diabetes Metab Syndr 2021;15:102158.

149. Vadarlis A, Antza C, Bakaloudi DR, et al. Systematic review with meta-analysis: The effect of vitamin E supplementation in adult patients with non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2021;36:311–9.

150. Sepidarkish M, Morvaridzadeh M, Akbari-Fakhrabadi M, et al. Effect of omega-3 fatty acid plus vitamin E Co-Supplementation on lipid profile: A systematic review and meta-analysis. Diabetes Metab Syndr 2019;13:1649–56.

151. Asbaghi O, Choghakhori R, Abbasnezhad A. Effect of Omega-3 and vitamin E co-supplementation on serum lipids concentrations in overweight patients with metabolic disorders: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2019;13:2525–31.

152. Asgary S, Naderi GH, Sarrafzadegan N, et al. Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii. Drugs Exp Clin Res 2000;26:89–93.

153. Serino E, Chahardoli A, Badolati N, et al. Salvigenin, a Trimethoxylated Flavone from Achillea Wilhelmsii C. Koch, Exerts Combined Lipid-Lowering and Mitochondrial Stimulatory Effects. Antioxidants (Basel) 2021;10:1042.

154. Kishimoto Y, Yoshida H, Kondo K. Potential Anti-Atherosclerotic Properties of Astaxanthin. Mar Drugs 2016;14:35.

155. Fanaee-Danesh E, Gali CC, Tadic J, et al. Astaxanthin exerts protective effects similar to bexarotene in Alzheimer's disease by modulating amyloid-beta and cholesterol homeostasis in blood-brain barrier endothelial cells. Biochim Biophys Acta Mol Basis Dis 2019;1865:2224–45.

156. Zou TB, Zhu SS, Luo F, et al. Effects of Astaxanthin on Reverse Cholesterol Transport and Atherosclerosis in Mice. Biomed Res Int 2017;2017:4625932.

157. Yoshida H, Yanai H, Ito K, et al. Administration of natural astaxanthin increases serum HDL-cholesterol and adiponectin in subjects with mild hyperlipidemia. Atherosclerosis. 2010;209:520–3.

158. Choi HD, Youn YK, Shin WG. Positive effects of astaxanthin on lipid profiles and oxidative stress in overweight subjects. Plant Foods Hum Nutr 2011;66:363–9.

159. Ursoniu S, Sahebkar A, Serban MC, et al. Lipid profile and glucose changes after supplementation with astaxanthin: a systematic review and meta-analysis of randomized controlled trials. Arch Med Sci 2015;11:253–66.

160. Kerkadi A, Alkudsi DS, Hamad S, et al. The Association between Zinc and Copper Circulating Levels and Cardiometabolic Risk Factors in Adults: A Study of Qatar Biobank Data. Nutrients 2021;13:2729.

161. Zhou J, Liu C, Francis M, et al. The Causal Effects of Blood Iron and Copper on Lipid Metabolism Diseases: Evidence from Phenome-Wide Mendelian Randomization Study. Nutrients 2020;12:3174.

162. Lee SH, Kim MJ, Kim YS, et al. Low hair copper concentration is related to a high risk of nonalcoholic fatty liver disease in adults. J Trace Elem Med Biol 2018;50:28–33.

163. Wang S, Wang N, Pan D, et al. Effects of Copper Supplementation on Blood Lipid Level: a Systematic Review and a Meta-Analysis on Randomized Clinical Trials. Biol Trace Elem Res 2021;199:2851–7.

164. Bügel S, Harper A, Rock E, et al. Effect of copper supplementation on indices of copper status and certain CVD risk markers in young healthy women. Br J Nutr 2005;94:231–6.

165. DiSilvestro RA, Joseph EL, Zhang W, et al. A randomized trial of copper supplementation effects on blood copper enzyme activities and parameters related to cardiovascular health. Metabolism 2012;61:1242–6.

166. Rojas-Sobarzo L, Olivares M,Brito A, et al. Copper supplementation at 8 mg neither affects circulating lipids nor liver function in apparently healthy Chilean men. Biol Trace Elem Res 2013;156:1–4.

167. Xian Z, Liu Y, Xu W, et al. The Anti-hyperlipidemia Effects of Raw Polygonum multiflorum Extract in Vivo. Biol Pharm Bull 2017;40:1839–45.

168. Wang W, He Y, Lin P, et al. In vitro effects of active components of Polygonum Multiflorum Radix on enzymes involved in the lipid metabolism. J Ethnopharmacol 2014;153:763–70.

169. Gao X, Hu YJ, Fu LC. [Blood lipid-regulation of stilbene glycoside from polygonum multiflorum]. Zhongguo Zhong Yao Za Zhi 2007;32:323–6.

170. Teka T, Wang L, Gao J, et al. Polygonum multiflorum: Recent updates on newly isolated compounds, potential hepatotoxic compounds and their mechanisms. J Ethnopharmacol 2021;271:113864.

171. Monograph: Inositol hexaniacinate. Altern Med Rev 1998;3:222–3.

172. Welsh AL, Ede M. Inositol hexanicotinate for improved nicotinic acid therapy. Int Record Med 1961;174:9–15.

173. Keenan JM. Wax-matrix extended-release niacin vs inositol hexanicotinate: a comparison of wax-matrix, extended-release niacin to inositol hexanicotinate "no-flush" niacin in persons with mild to moderate dyslipidemia. J Clin Lipidol 2013;7:14–23.

174. Ziliotto GR, Lamberti G, Wagner A, et al. Comparative studies of the response of normolipemic and dyslipemic aged subjects to 2 forms of delayed-action nicotinic acid polyesters. Pentaerythrotol tetranicotinate and inositol hexanicotinate. Arch Sci Med (Torino) 1977;134:359–94.

175. Dos Santos LR, Melo SRS, Severo JS, et al. Cardiovascular Diseases in Obesity: What is the Role of Magnesium? Biol Trace Elem Res 2021;199:4020–7.

176. Guerrero-Romero F, Jaquez-Chairez F, Rodriguez-Moran M. Magnesium in metabolic syndrome: a review based on randomized, double-blind clinical trials. Magnes Res 2016;29:146–53.

177. Asbaghi O, Moradi S, Nezamoleslami S, et al. The Effects of Magnesium Supplementation on Lipid Profile Among Type 2 Diabetes Patients: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Biol Trace Elem Res 2021;199:861–73.

178. Simental-Mendía LE, Simental-Mendía M, Sahebkar A, et al. Effect of magnesium supplementation on lipid profile: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2017;73:525–36.

179. Guo WL, Deng JC, Pan YY, et al. Hypoglycemic and hypolipidemic activities of Grifola frondosa polysaccharides and their relationships with the modulation of intestinal microflora in diabetic mice induced by high-fat diet and streptozotocin. Int J Biol Macromol 2020;153:1231–40.

180. Li L, Guo WL, Zhang W, et al. Grifola frondosa polysaccharides ameliorate lipid metabolic disorders and gut microbiota dysbiosis in high-fat diet fed rats. Food Funct 2019;10:2560–72.

181. Guo WL, Shi FF, Li L, et al. Preparation of a novel Grifola frondosa polysaccharide-chromium (III) complex and its hypoglycemic and hypolipidemic activities in high fat diet and streptozotocin-induced diabetic mice. Int J Biol Macromol 2019;131:81–8.

182. Ding Y, Xiao C, Wu Q, et al. The Mechanisms Underlying the Hypolipidaemic Effects of Grifola frondosa in the Liver of Rats. Front Microbiol 2016;7:1186.

183. Sahebkar A. A systematic review and meta-analysis of the effects of pycnogenol on plasma lipids. J Cardiovasc Pharmacol Ther 2014;19:244–55.

184. Janikula M. Policosanol: a new treatment for cardiovascular disease? Altern Med Rev 2002;7:203–17.

185. Gouni-Berthold I, Berthold HK. Policosanol: clinical pharmacology and therapeutic significance of a new lipid-lowering agent. Am Heart J 2002;143:356–65.

186. Varady KA, Wang Y, Jones PJ. Role of policosanols in the prevention and treatment of cardiovascular disease. Nutr Rev 2003;61:376–83.

187. Marinangeli CP, Jones PJ, Kassis AN, et al. Policosanols as nutraceuticals: fact or fiction. Crit Rev Food Sci Nutr 2010;50:259–67.

188. Barbagallo CM, Cefalù AB, Noto D, et al. Role of Nutraceuticals in Hypolipidemic Therapy. Front Cardiovasc Med 2015;2:22.

189. Barrios V, Escobar C, Cicero AF, et al. A nutraceutical approach (Armolipid Plus) to reduce total and LDL cholesterol in individuals with mild to moderate dyslipidemia: Review of the clinical evidence. Atheroscler Suppl 2017;24:1–15.

190. Olas B. Sea buckthorn as a source of important bioactive compounds in cardiovascular diseases. Food Chem Toxicol 201697:199–204.

191. Zhou F, Zhang J, Zhao A, et al. Effects of sea buckthorn puree on risk factors of cardiovascular disease in hypercholesterolemia population: a double-blind, randomized, placebo-controlled trial. Anim Biotechnol 2020:1–9.

192. Larmo PS, Yang B, Hurme SA, et al. Effect of a low dose of sea buckthorn berries on circulating concentrations of cholesterol, triacylglycerols, and flavonols in healthy adults. Eur J Nutr 2009;48:277–82.

193. Eccleston C, Baoru Y, Tahvonen R et al. Effects of an antioxidant-rich juice (sea buckthorn) on risk factors for coronary heart disease in humans. J Nutr Biochem 2002;13:346–54.

194. Larmo PS, Kangas AJ, Soininen P, et al. Effects of sea buckthorn and bilberry on serum metabolites differ according to baseline metabolic profiles in overweight women: a randomized crossover trial. Am J Clin Nutr 2013;98:941–51.

195. Vashishtha V, Barhwal K, Kumar A, et al. Effect of seabuckthorn seed oil in reducing cardiovascular risk factors: A longitudinal controlled trial on hypertensive subjects. Clin Nutr 2017;36:1231–8.

196. Hasani M, Djalalinia S, Sharifi F, et al. Effect of Selenium Supplementation on Lipid Profile: A Systematic Review and Meta-Analysis. Horm Metab Res 2018;50:715–27.

197. Tabrizi R, Akbari M, Moosazadeh M, et al. The Effects of Selenium Supplementation on Glucose Metabolism and Lipid Profiles Among Patients with Metabolic Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Horm Metab Res 2017;49:826–30.

198. Zhao M, Luo T, Zhao Z, et al. Food Chemistry of Selenium and Controversial Roles of Selenium in Affecting Blood Cholesterol Concentrations. J Agric Food Chem 2021;69:4935–45.

199. Sharma A, Madan N. Role of niacin in current clinical practice. Minerva Med 2019;110:79–83.

200. Dunbar RL, Goel H. Niacin Alternatives for Dyslipidemia: Fool's Gold or Gold Mine? Part I: Alternative Niacin Regimens. Curr Atheroscler Rep 2016;18:11.

201. Riaz H, Khan SU, Rahman H, et al. Effects of high-density lipoprotein targeting treatments on cardiovascular outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol 2019;26:533–43.

202. D'Andrea E, Hey SP, Ramirez CL, et al. Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open 2019;2:e192224.

203. Habibe M, Kellar J. Niacin Toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing, Copyright © 2021, StatPearls Publishing LLC.; 2021.

204. Zhang P, Xu X, Li X. Cardiovascular diseases: oxidative damage and antioxidant protection. Eur Rev Med Pharmacol Sci 2014;18:3091–6.

205. Doseděl M, Jirkovský E, Macáková K, et al. Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination. Nutrients 2021;13:615.

206. Morelli MB, Gambardella J, Castellanos V, et al. Vitamin C and Cardiovascular Disease: An Update. Antioxidants (Basel) 2020;9:1227.

207. Ashor AW, Brown R, Keenan PD, et al. Limited evidence for a beneficial effect of vitamin C supplementation on biomarkers of cardiovascular diseases: an umbrella review of systematic reviews and meta-analyses. Nutr Res 2019;61:1–12.

208. Ashor AW, Siervo M, van der Velde F, et al. Systematic review and meta-analysis of randomised controlled trials testing the effects of vitamin C supplementation on blood lipids. Clin Nutr 2016;35:626–37.

209. Tareke AA, Hadgu AA. The effect of vitamin C supplementation on lipid profile of type 2 diabetic patients: a systematic review and meta-analysis of clinical trials. Diabetol Metab Syndr 2021;13:24.

210. Namkhah Z, Ashtary-Larky D, Naeini F, et al. Does vitamin C supplementation exert profitable effects on serum lipid profile in patients with type 2 diabetes? A systematic review and dose-response meta-analysis. Pharmacol Res 2021;169:105665.

211. Mason SA, Keske MA, Wadley GD. Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care 2021;44:618–30.

212. Wu WH, Liu LY, Chung CJ, et al. Estrogenic effect of yam ingestion in healthy postmenopausal women. J Am Coll Nutr 2005;24:235–43.

213. Komesaroff PA, Black CV, Cable V, et al. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric 2001;4:144–50.

214. Soliman GA. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients 2019;11:1155.

215. Trautwein EA, McKay S. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients 2020;12:2671.

216. Henrion M, Francey C, Lê KA, et al. Cereal B-Glucans: The Impact of Processing and How It Affects Physiological Responses. Nutrients 2019;11:1729.

217. Sadat Masjedi M, Mohammadi Pour P, Shokoohinia Y, et al. Effects of Flaxseed on Blood Lipids in Healthy and Dyslipidemic Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Probl Car 2021:100931.

218. Jovanovski E, Yashpal S, Komishon A, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2018;108:922–32.

219. McRorie JW, McKeown NM. Understanding the Physics of Functional Fibers in the Gastrointestinal Tract: An Evidence-Based Approach to Resolving Enduring Misconceptions about Insoluble and Soluble Fiber. J Acad Nutr Diet 2017;117:251–64.

220. Schoeneck M, Iggman D. The effects of foods on LDL cholesterol levels: A systematic review of the accumulated evidence from systematic reviews and meta-analyses of randomized controlled trials. Nutr Metab Cardiovasc Dis 2021;31:1325–38.

221. Hollænder PL, Ross AB, Kristensen M. Whole-grain and blood lipid changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies. Am J Clin Nutr 2015;102:556–72.

222. Ho HV, Sievenpiper JL, Zurbau A, et al. The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials. Br J Nutr 2016;116:1369–82.

223. Wang H, Lichtenstein AH, Lamon-Fava S, et al. Association between statin use and serum cholesterol concentrations is modified by whole-grain consumption: NHANES 2003-2006. Am J Clin Nut 2014;100:1149–57.

224. Brum J, Ramsey D, McRorie J, et al. Meta-Analysis of Usefulness of Psyllium Fiber as Adjuvant Antilipid Therapy to Enhance Cholesterol Lowering Efficacy of Statins. Am J Cardiol 2018;122:1169–74.

225. Han S, Wu L, Wang W, et al. Trends in Dietary Nutrients by Demographic Characteristics and BMI among US Adults, 2003-2016. Nutrients 2019;11:2617.

226. Yang Y, Zhao LG, Wu QJ, et al. Association between dietary fiber and lower risk of all-cause mortality: a meta-analysis of cohort studies. Am J Epidemiol 2015;181:83–91.

227. Krznarić Ž, Karas I, Ljubas Kelečić D, et al. The Mediterranean and Nordic Diet: A Review of Differences and Similarities of Two Sustainable, Health-Promoting Dietary Patterns. Front Nutr 2021;8:683678.

228. Guasch-Ferré M, Willett WC. The Mediterranean diet and health: a comprehensive overview. J Intern Med 2021;290:549–66.

229. Papadaki A, Nolen-Doerr E, Mantzoros CS. The Effect of the Mediterranean Diet on Metabolic Health: A Systematic Review and Meta-Analysis of Controlled Trials in Adults. Nutrients 2020;12:3342.

230. Ge L, Sadeghirad B, Ball GDC, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ 2020;369:m696.

231. Jenkins DJ, Kendall CW, Marchie A, et al. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003;290:502-10.

232. Jenkins DJ, Jones PJ, Lamarche B, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA 2011;306:831–9.

233. Ramprasath VR, Jenkins DJ, Lamarche B, et al. Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds. Nutr J 2014;13:101.

234. Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis 2018;61:43–53.

235. Glenn AJ, Lo K, Jenkins DJA, et al. Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study. J Am Heart Assoc 2021;10:e021515.

236. Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, et al. Dietary Strategies for Metabolic Syndrome: A Comprehensive Review. Nutrients 2020;12:2983.

237. Glenn AJ, Hernández-Alonso P, Kendall CWC, et al. Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study. Clin Nutr 2021;40:2825–36.

238. Siervo M, Lara J, Chowdhury S, et al. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr 2015;113:1–15.

239. Chiavaroli L, Viguiliouk E, Nishi SK, et al. DASH Dietary Pattern and Cardiometabolic Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses. Nutrients 2019;11:338.

240. Farias-Pereira R, Park CS, Park Y. Mechanisms of action of coffee bioactive components on lipid metabolism. Food Sci Biotechnol 2019;28:1287–96.

241. Gökcen BB, Şanlier N. Coffee consumption and disease correlations. Crit Rev Food Sci Nutr 2019;59:336–48.

242. Alhassan A, Young J, Lean MEJ, et al. Consumption of fish and vascular risk factors: A systematic review and meta-analysis of intervention studies. Atherosclerosis 2017;266:87–94.

243. Wan Q, Li N, Du L, et al. Allium vegetable consumption and health: An umbrella review of meta-analyses of multiple health outcomes. Food Sci Nutr 2019;7:2451–70.

244. Zeb F, Safdar M, Fatima S, et al. Supplementation of garlic and coriander seed powder: Impact on body mass index, lipid profile and blood pressure of hyperlipidemic patients. Pak J Pharm Sci 2018;31:1935–41.

245. Huth PJ, Fulgoni VL, Larson BT. A systematic review of high-oleic vegetable oil substitutions for other fats and oils on cardiovascular disease risk factors: implications for novel high-oleic soybean oils. Adv Nutr 2015;6:674–93.

246. Katsiki N, Pérez-Martínez P, Lopez-Miranda J. Olive Oil Intake and Cardiovascular Disease Prevention: "Seek and You Shall Find". Curr Cardiol Rep 2021;23:64.

247. Caponio GR, Wang DQ, Di Ciaula A, et al. Regulation of Cholesterol Metabolism by Bioactive Components of Soy Proteins: Novel Translational Evidence. Int J Mol Sci 2020;22:227.

248. Chatterjee C, Gleddie S, Xiao CW. Soybean Bioactive Peptides and Their Functional Properties. Nutrients 2018;10:1211.

249. Li SS, Blanco Mejia S, Lytvyn L, et al. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2017;6:e006659.

250. Oteng AB, Kersten S. Mechanisms of Action of trans Fatty Acids. Adv Nutr 2020;11:697–708.

251. Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020;5:Cd011737.

252. Hooper L, Martin N, Abdelhamid A, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015:Cd011737.

253. Eyres L, Eyres MF, Chisholm A, et al. Coconut oil consumption and cardiovascular risk factors in humans. Nutr Rev 2016;74:267–80.

254. Khaw KT, Sharp SJ, Finikarides L, et al. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open 2018;8:e020167.

255. Abdelhamid AS, Martin N, Bridges C, et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018;7:Cd012345.

256. Djuricic I, Calder PC. Beneficial Outcomes of Omega-6 and Omega-3 Polyunsaturated Fatty Acids on Human Health: An Update for 2021. Nutrients 2021;13:2421.

257. Hamley S. The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials. Nutr J 2017;16:30.

258. Mariamenatu AH, Abdu EM. Overconsumption of Omega-6 Polyunsaturated Fatty Acids (PUFAs) versus Deficiency of Omega-3 PUFAs in Modern-Day Diets: The Disturbing Factor for Their "Balanced Antagonistic Metabolic Functions" in the Human Body. J Lipids 2021;2021:8848161.

259. Huth PJ, Fulgoni VL, Larson BT. A systematic review of high-oleic vegetable oil substitutions for other fats and oils on cardiovascular disease risk factors: implications for novel high-oleic soybean oils. Adv Nutr 2015;6:674–93.

260. Katsiki N, Pérez-Martínez P, Lopez-Miranda J. Olive Oil Intake and Cardiovascular Disease Prevention: "Seek and You Shall Find". Curr Cardiol Rep 2021;23:64.

261. Askari M, Daneshzad E, Jafari A, et al. Association of nut and legume consumption with Framingham 10 year risk of general cardiovascular disease in older adult men: A cross-sectional study. Clin Nutr ESPEN 2021;42:373–80.

262. Imran TF, Kim E, Buring JE, et al. Nut consumption, risk of cardiovascular mortality, and potential mediating mechanisms: The Women's Health Study. J Clin Lipidol 2021;15:266–74.

263. Julibert A, Del Mar Bibiloni M, Gallardo-Alfaro L, et al. Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study. J Nutr 2020;150:3161–70.

264. Kopčeková J, Lenártová P, Mrázová J, et al. The relationship between seeds consumption, lipid profile and body mass index among patients with cardiovascular diseases. Rocz Panstw Zakl Hig 2021;72:145–53.

265. Altamimi M, Zidan S, Badrasawi M. Effect of Tree Nuts Consumption on Serum Lipid Profile in Hyperlipidemic Individuals: A Systematic Review. Nutr Metab Insights 2020;13:1178638820926521.

266. Guarneiri LL, Paton CM, Cooper JA. Pecan-Enriched Diets Alter Cholesterol Profiles and Triglycerides in Adults at Risk for Cardiovascular Disease in a Randomized, Controlled Trial. J Nutr 2021;15:3091–101.

267. Asbaghi O, Moodi V, Hadi A, et al. The effect of almond intake on lipid profile: a systematic review and meta-analysis of randomized controlled trials. Food Funct 2021;12:1882–96.

268. Ferrari CKB. Anti-atherosclerotic and cardiovascular protective benefits of Brazilian nuts. Front Biosci (Schol Ed) 2020;12:38–56.

269. Liu K, Hui S, Wang B, et al. Comparative effects of different types of tree nut consumption on blood lipids: a network meta-analysis of clinical trials. Am J Clin Nutr 2020;111:219–27.

270. Adashek JJ, Redding D. A Pilot Study on the Effects of Nut Consumption on Cardiovascular Biomarkers. Cureus 2020;12:e8798.

271. Kaur G, Kaur N, Kaur A. Lipid profile of hyperlipidemic males after supplementation of multigrain bread containing sunflower (Helianthus annuus) seed flour. J Food Sci Technol 2021;58:2617–29.

272. Jalali M, Karamizadeh M, Ferns GA, et al. The effects of cashew nut intake on lipid profile and blood pressure: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2020;50:102387.

273. Morvaridzadeh M, Sepidarkish M, Farsi F, et al. Effect of Cashew Nut on Lipid Profile: A Systematic Review and Meta-Analysis. Complement Med Res 2020;27:348–56.

274. Jafari Azad B, Daneshzad E, Azadbakht L. Peanut and cardiovascular disease risk factors: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2020;60:1123–40.

275. Askari M, Daneshzad E, Jafari A, et al. Association of nut and legume consumption with Framingham 10 year risk of general cardiovascular disease in older adult men: A cross-sectional study. Clin Nutr ESPEN 2021;42:373–80.

276. Imran TF, Kim E, Buring JE, et al. Nut consumption, risk of cardiovascular mortality, and potential mediating mechanisms: The Women's Health Study. J Clin Lipidol 2021;15:266–74.

277. Julibert A, Del Mar Bibiloni M, Gallardo-Alfaro L, et al. Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study. J Nutr 2020;150:3161–70.

278. Kopčeková J, Lenártová P, Mrázová J, et al. The relationship between seeds consumption, lipid profile and body mass index among patients with cardiovascular diseases. Rocz Panstw Zakl Hig 2021;72:145–53.

279. Altamimi M, Zidan S, Badrasawi M. Effect of Tree Nuts Consumption on Serum Lipid Profile in Hyperlipidemic Individuals: A Systematic Review. Nutr Metab Insights 2020;13:1178638820926521.

280. Guarneiri LL, Paton CM, Cooper JA. Pecan-Enriched Diets Alter Cholesterol Profiles and Triglycerides in Adults at Risk for Cardiovascular Disease in a Randomized, Controlled Trial. J Nutr 2021;15:3091–101.

281. Asbaghi O, Moodi V, Hadi A, et al. The effect of almond intake on lipid profile: a systematic review and meta-analysis of randomized controlled trials. Food Funct 2021;12:1882–96.

282. Ferrari CKB. Anti-atherosclerotic and cardiovascular protective benefits of Brazilian nuts. Front Biosci (Schol Ed) 2020;12:38–56.

283. Liu K, Hui S, Wang B, et al. Comparative effects of different types of tree nut consumption on blood lipids: a network meta-analysis of clinical trials. Am J Clin Nutr 2020;111:219–27.

284. Adashek JJ, Redding D. A Pilot Study on the Effects of Nut Consumption on Cardiovascular Biomarkers. Cureus 2020;12:e8798.

285. Kaur G, Kaur N, Kaur A. Lipid profile of hyperlipidemic males after supplementation of multigrain bread containing sunflower (Helianthus annuus) seed flour. J Food Sci Technol 2021;58:2617–29.

286. Jalali M, Karamizadeh M, Ferns GA, et al. The effects of cashew nut intake on lipid profile and blood pressure: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2020;50:102387.

287. Morvaridzadeh M, Sepidarkish M, Farsi F, et al. Effect of Cashew Nut on Lipid Profile: A Systematic Review and Meta-Analysis. Complement Med Res 2020;27:348–56.

288. Jafari Azad B, Daneshzad E, Azadbakht L. Peanut and cardiovascular disease risk factors: A systematic review and meta-analysis. Crit Rev Food Sci Nutr 2020;60:1123–40.

289. Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation 2020;141:e39–53.

290. Temple NJ. Fat, Sugar, Whole Grains and Heart Disease: 50 Years of Confusion. Nutrients 2018;10:39.

291. Bergwall S, Johansson A, Sonestedt E, et al. High versus low-added sugar consumption for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2022;1:1002.

292. Haslam DE, Chasman DI, Peloso GM, et al. Sugar-sweetened Beverage Consumption and Plasma Lipoprotein Cholesterol, Apolipoprotein, and Lipoprotein Particle Size Concentrations in U.S. Adults. J Nutr 2022:1093.

293. Nikniaz L, Abbasalizad-Farhangi M, Vajdi M, et al. The association between Sugars Sweetened Beverages (SSBs) and lipid profile among children and youth: A systematic review and dose-response meta-analysis of cross-sectional studies. Pediatr Obes 2021;16:2782.

294. Ebbeling CB, Feldman HA, Steltz SK, et al. Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial. J Am Heart Assoc 2020;9:e015668.

295. Schwingshackl L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet 2013;113:1640–61.

296. Gjuladin-Hellon T, Davies IG, Penson P, et al. Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis. Nutr Rev 2019;77:161–80.

297. Dong T, Guo M, Zhang P, et al. The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis. PloS One 2020;15:e0225348.

298. Ge L, Sadeghirad B, Ball GDC, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ 2020;369:m696.

299. Fechner E, Smeets ETHC, Schrauwen P, et al. The Effects of Different Degrees of Carbohydrate Restriction and Carbohydrate Replacement on Cardiometabolic Risk Markers in Humans-A Systematic Review and Meta-Analysis. Nutrients 2020;12:991.

300. Seidelmann S, Claggett B, Cheng S, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018;3:e419–28.

301. Trautwein EA, McKay S. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients 2020;12:2671.

302. Bowman SA. A Vegetarian-Style Dietary Pattern Is Associated with Lower Energy, Saturated Fat, and Sodium Intakes; and Higher Whole Grains, Legumes, Nuts, and Soy Intakes by Adults: National Health and Nutrition Examination Surveys 2013-2016. Nutrients 2020;12:2668.

303. Blanco Mejia S, Messina M, Li SS, et al. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr 2019;149:968–81.

304. Oussalah A, Levy J, Berthezène C, et al. Health outcomes associated with vegetarian diets: An umbrella review of systematic reviews and meta-analyses. Clin Nutr 2020;39:3283–307.

305. Trautwein EA, McKay S. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients 2020;12:2671.

306. Bowman SA. A Vegetarian-Style Dietary Pattern Is Associated with Lower Energy, Saturated Fat, and Sodium Intakes; and Higher Whole Grains, Legumes, Nuts, and Soy Intakes by Adults: National Health and Nutrition Examination Surveys 2013-2016. Nutrients 2020;12:2668.

307. Blanco Mejia S, Messina M, Li SS, et al. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr 2019;149:968–81.

308. Oussalah A, Levy J, Berthezène C, et al. Health outcomes associated with vegetarian diets: An umbrella review of systematic reviews and meta-analyses. Clin Nutr 2020;39:3283–307.

309. Rosales C, Gillard BK, Gotto AM, et al. The Alcohol-High-Density Lipoprotein Athero-Protective Axis. Biomolecules 2020;10:987.

310. USDHHS. US Department of Health and Human Services. 2015–2020 Dietary Guidelines. Available at https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015 . Last updated 12/29/20. Accessed 08/18/21.

311. Ferraz-Bannitz R, Beraldo RA, Coelho PO, et al. Circadian Misalignment Induced by Chronic Night Shift Work Promotes Endoplasmic Reticulum Stress Activation Impacting Directly on Human Metabolism. Biology (Basel) 2021;10:197.

312. Garrido ALF, Duarte AS, Santana PT, et al. Eating habits, sleep, and a proxy for circadian disruption are correlated with dyslipidemia in overweight night workers. Nutrition 2021;83:111084.

313. Hoopes EK, Witman MA, D'Agata MN, et al. Rest-activity rhythms in emerging adults: implications for cardiometabolic health. Chronobiol Int 2021;38:543–56.

314. Lucassen EA, Zhao X, Rother KI, et al. Evening chronotype is associated with changes in eating behavior, more sleep apnea, and increased stress hormones in short sleeping obese individuals. PLoS One 2013;8:e56519.

315. Kwon YJ, Chung TH, Lee HS, et al. Association between circadian preference and blood lipid levels using a 1:1:1 propensity score matching analysis. J Clin Lipidol 2019;13:645–53.

316. Tomizawa A, Nogawa K, Watanabe Y, et al. Effect of circadian rhythm type on serum lipid levels in shift workers: A 5-year cohort study. Chronobiol Int 2019;36:751–7.

317. Maugeri A, Vinciguerra M. The Effects of Meal Timing and Frequency, Caloric Restriction, and Fasting on Cardiovascular Health: an Overview. J Lipid Atheroscler 2020;9:140–52.

318. Allison KC, Hopkins CM, Ruggieri M, et al. Prolonged, Controlled Daytime versus Delayed Eating Impacts Weight and Metabolism. Curr Biol 2021;31:650–7.

319. Wood G, Taylor E, Ng V, et al. Determining the effect size of aerobic exercise training on the standard lipid profile in sedentary adults with three or more metabolic syndrome factors: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2021.

320. Tian Q, Corkum AE, Moaddel R, et al. Metabolomic profiles of being physically active and less sedentary: a critical review. Metabolomics 2021;17:68.

321. Chau JPC, Leung LYL, Liu X, et al. Effects of Tai Chi on health outcomes among community-dwelling adults with or at risk of metabolic syndrome: A systematic review. Complement Ther Clin Pract 2021;44:101445.

322. Fikenzer K, Fikenzer S, Laufs U, et al. Effects of endurance training on serum lipids. Vascul Pharmacol 2018;101:9–20.

323. He N, Ye H. Exercise and Hyperlipidemia. Adv Exp Med Biol 2020;1228:79–90.

324. Moholdt T, Parr EB, Devlin BL, et al. The effect of morning vs evening exercise training on glycaemic control and serum metabolites in overweight/obese men: a randomised trial. Diabetologia 2021;64:2061–76.

325. Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015;25:s1–72.

326. Chen HJ, Li GL, Sun A, et al. Age Differences in the Relationship between Secondhand Smoke Exposure and Risk of Metabolic Syndrome: A Meta-Analysis. Int J Environ Res Public Health 2019;16:1409.

327. Rhee EJ, Kim HC, Kim JH, et al. 2018 Guidelines for the management of dyslipidemia. Korean J Intern Med 2019;34:723–71.

328. Smaardijk VR, Lodder P, Kop WJ, et al. Sex- and Gender-Stratified Risks of Psychological Factors for Incident Ischemic Heart Disease: Systematic Review and Meta-Analysis. J Am Heart Assoc 2019;8:e010859.

329. Sahoo S, Padhy SK, Padhee B, et al. Role of personality in cardiovascular diseases: An issue that needs to be focused too! Indian heart journal! Indian Heart J 2018;70:S471–7.

330. Pascoe MC, Thompson DR, Ski CF. Yoga, mindfulness-based stress reduction and stress-related physiological measures: A meta-analysis. Psychoneuroendocrinology 2017;86:152–68.

331. Yadav R, Yadav RK, Sarvottam K, et al. Framingham Risk Score and Estimated 10-Year Cardiovascular Disease Risk Reduction by a Short-Term Yoga-Based LifeStyle Intervention. J Altern Complement Med 2017;23:730–7.

332. Mehra P, Anand A, Nagarathna R, et al. Role of Mind-Body Intervention on Lipid Profile: A Cross-sectional Study. Int J Yoga 2021;14:168–72.

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