Are the current European Society of Cardiology nutrition recommendations most effective in the treatment of cardiovascular disease? Review article
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Published:
Jun 30, 2013
Keywords:
guidelines, low fat diet, atherogenesis
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Abstract
The latest guidelines describe behavioral treatment of cardiovascular diseases. A part of the guidelines that refers to the behavioral treatment of patients burdened with cardiovascular diseases focus on benefits of the mediterranean diet. This paper points out the benefits and advantages of the vegan diet (Ornish Diet), as an alternative for today’s guidelines.
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Desmond , M., & Śliż , D. (2013). Are the current European Society of Cardiology nutrition recommendations most effective in the treatment of cardiovascular disease?. Cardiology in Practice, 7(2), 31-36. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1568
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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4. Ornish D., Brown S.E., Scherwitz L.W., Billings J.H. et al.: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336(8708): 129-33.
5. Ornish D., Scherwitz L.W., Billings J.H. et al.: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23): 2001-7.
6. Key T.J., Fraser G.E., Thorogood M. et al.: Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am. J. Clin. Nutr. 1999; 70(suppl.): 516S-24S.
7. Crowe F.L., Appleby P.N., Travis R.C., Key T.J.: Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am. J. Clin. Nutr. 2013; 97(3): 597-603.
8. Tang J.L., Armitage J.M., Lancaster T., Silagy C.A., Fowler G.H., Neil H.A.: Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. BMJ 1998; 316(7139): 1213-20.
9. Yu-Poth S., Zhao G., Etherton T., Naglak M., Jonnalagadda S., Kris-Etherton P.M.: Effects of the National Cholesterol Education Program‘s Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am. J. Clin. Nutr. 1999; 69(4): 632-46.
10. Jenkins D.J., Kendall C.W., Marchie A., Faulkner D.A., Wong J.M., de Souza R., Emam A., Parker T.L., Vidgen E., Lapsley K.G., Trautwein E.A., Josse R.G., Leiter L.A., Connelly P.W.: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003; 290(4): 502-10.
11. Jenkins D.J., Jones P.J., Lamarche B., Kendall C.W. 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(8): 831-9.
12. Fraser G.E.: Diet and the risk of coronary heart disease. W: Diet, life expectancy and chronic disease. Studies of Seventh day Adventists and other vegetarians. Fraser G.E. (red.). Oxford University Press, New York 2003: 59-84.
13. Appleby P.N., Thorogood M., Mann J.I., Key T.J.A.: The Oxford Vegetarian Study: an overview. Am. J. Clin. Nutr. 1999; 70(suppl): 525S-31S.
14. Sacks F.M., Svetkey L.P., Vollmer W.M., Appel L.J., Bray G.A., Harsha D., Obarzanek E., Conlin P.R., Miller E.R. 3rd, Simons-Morton D.G., Karanja N., Lin P.H.; DASH-Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N. Engl. J. Med. 2001; 344(1): 3-10.
15. Svetkey L.P., Simons-Morton D., Vollmer W.M., Appel L.J., Conlin P.R., Ryan D.H., Ard J., Kennedy B.M.: Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch. Intern. Med. 1999; 159(3): 285-93.
16. Vogt T.M., Appel L.J., Obarzanek E., Moore T.J., Vollmer W.M., Svetkey L.P., Sacks F.M., Bray G.A., Cutler J.A., Windhauser M.M., Lin P.H., Karanja N.M.: Dietary Approaches to Stop Hypertension: rationale, design, and methods. DASH Collaborative Research Group. J. Am. Diet. Assoc. 1999; 99(8 suppl.): S12-8.
17. Heun E.: [Vegetarian fruit juices in therapy in obesity and hypertension]. Forsch. Ther. 1936; 12: 403-411.
18. Masarei J.R., Rouse I.L., Lynch W.J., Robertson K., Vandongen R., Beilin L.J.: Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL-C, HDL2-C, HDL3-C, apoprotein-B, and Lp(a). Am. J. Clin. Nutr. 1984; 40(3): 468-78.
19. Rouse I.L., Beilin L.J., Mahoney D.P., Margetts B.M., Armstrong B.K., Record S.J., Vandongen R., Barden A.: Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with a lacto-ovo-vegetarian diet. J. Hypertens. 1986; 4(2): 241-50.
20. Lindahl O., Lindwall L., Spångberg A., Stenram A., Ockerman P.A.: A vegan regimen with reduced medication in the treatment of hypertension. Br. J. Nutr. 1984; 52(1): 11-20.
21. Rouse I.L., Beilin L.J., Armstrong B.K., Vandongen R.: Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983; 1(8314-5): 5-10.
22. Margetts B.M., Beilin L.J., Armstrong B.K., Vandongen R.: Vegetarian diet in mild hypertension: effects of fat and fiber. Am. J. Clin. Nutr. 1988; 48(3 suppl.): 801-5.
23. Fraser G.E.: Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am. J. Clin. Nutr. 1999; 70(3 suppl): 532S-538S.
24. Fraser G.E.: Vegetarian diets: what do we know of their effects on common chronic diseases? Am. J. Clin. Nutr. 2009; 89(5): 1607S-1612S.
25. Appleby P.N., Davey G.K., Key T.J.: Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutr. 2002; 5(5): 645-54.
26. The Look AHEAD Research Group: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care 2007; 30: 1374-1383.
27. Ong K.L., Cheung B.M., Man Y.B., Wong L.Y., Wat N.M., Tan K.C., Lam K.S.: Treatment and control of diabetes mellitus in the United States National Health and Nutrition Examination Survey, 1999-2002. J. Cardiometab. Syndr. 2006; 1(5): 301-7.
28. [online: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices.html].
29. Barnard N.D., Cohen J., Jenkins D.J., Turner-McGrievy G., Gloede L., Jaster B., Seidl K., Green A.A., Talpers S.: A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006; 29(8): 1777-83.
30. Kahleova H., Matoulek M., Malinska H., Oliyarnik O., Kazdova L., Neskudla T., Skoch A., Hajek M., Hill M., Kahle M., Pelikanova T.: Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet. Med. 2011; 28(5): 549-59.
31. Anderson J.W., Ward K.: High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am. J. Clin. Nutr.1979; 32(11): 2312-21.
32. Barnard R.J., Jung T., Inkeles S.B.: Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care 1994; 17(12): 1469-72.
33. Crane M.G., Sample C.: Regression of diabetic neuropathy with total vegetarian (vegan) diet. J. Nut. Med. 1994; 4: 431-9.
34. Jenkins D.J., Kendall C.W., Marchie A., Jenkins A.L., Augustin L.S., Ludwig D.S., Barnard N.D., Anderson J.W.: Type 2 diabetes and the vegetarian diet. Am. J. Clin. Nutr. 2003; 78(3 suppl.): 610S-616S.
35. Tonstad S., Stewart K., Oda K., Batech M., Herring R.P., Fraser G.E.: Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr. Metab. Cardiovasc. Dis. 2013; 23(4): 292-9.
36. Anderson J.W., Smith B.M., Gustafson N.J.: Health benefits and practical aspects of high-fiber diets. Am. J. Clin. Nutr. 1994; 59(5 suppl.): 1242S-1247S.
37. Pérez-Escamilla R., Obbagy J.E., Altman J.M., Essery E.V. et al.: Dietary energy density and body weight in adults and children: a systematic review. J. Acad. Nutr. Diet. 2012; 112(5): 671-84.
38. Tonstad S., Butler T., Yan R., Fraser G.E.: Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009; 32(5): 791-796.
39. Spencer E.A., Appleby P.N., Davey G.K., Key T.J.: Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int. J. Obes. Relat. Metab. Disord. 2003; 27(6): 728-34.
40. Witmanowski H., Herzig K.H., Przyslawski J., Wadolowska L., Piątek J., Walkowiak J.M.: Short-Term Vegetarian Diet Reduces Oxidative Stress and Increases Antioxidant Defense in Healthy Volunteers. Gastroenterology 2005; 129(3): 1206.
41. Jenkins D.J., Kendall C.W., Marchie A., Faulkner D.A., Wong J.M., de Souza R., Emam A., Parker T.L., Vidgen E., Lapsley K.G., Trautwein E.A., Josse R.G., Leiter L.A., Connelly P.W.: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003; 290(4): 502-10.
42. Dod H.S., Bhardwaj R., Sajja V., Weidner G. et al.: Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am. J. Cardiol. 2010; 105(3): 362-7.
43. Blacklock C.J., Lawrence J.R., Wiles D., Malcolm E.A. et al.: Salicylic acid in the serum of subjects not taking aspirin. Comparison of salicylic acid concentrations in the serum of vegetarians, non-vegetarians, and patients taking low dose aspirin. J. Clin. Pathol. 2001; 54(7): 553-5.
44. Craig W.J., Mangels A.R.: Position of the American Dietetic Association: vegetarian diets. J. Am. Diet. Assoc. 2009; 109: 1266-82.
45. Barnard N.D., Scialli A.R., Turner-McGrievy G., Lanou A.J.: Acceptability of a low-fat vegan diet compares favorably to a step II diet in a randomized, controlled trial. J. Cardiopulm. Rehabil. 2004; 24(4): 229-35.
46. Barnard N.D., Gloede L., Cohen J., Jenkins D.J., Turner-McGrievy G., Green A.A., Ferdowsian H.: A low-fat vegan diet elicits greater macronutrient changes, but is comparable in adherence and acceptability, compared with a more conventional diabetes diet among individuals with type 2 diabetes. J. Am. Diet. Assoc. 2009; 109(2): 263-72.
47. Ornish D., Denke M.: Dietary treatment of hyperlipidemia. J. Cardiovasc. Risk 1994; 1(4): 283-6.
2. [online: http://www.upmchealthplan.com/pdf/PandP/PAY_059_LifestyleModificationProgramHeartDiseaseMay10.pdf] (dostęp: 9.02.2013 r.).
3. [online: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R125NCD.pdf] (dostęp: 9.02.2013 r.).
4. Ornish D., Brown S.E., Scherwitz L.W., Billings J.H. et al.: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336(8708): 129-33.
5. Ornish D., Scherwitz L.W., Billings J.H. et al.: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23): 2001-7.
6. Key T.J., Fraser G.E., Thorogood M. et al.: Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am. J. Clin. Nutr. 1999; 70(suppl.): 516S-24S.
7. Crowe F.L., Appleby P.N., Travis R.C., Key T.J.: Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am. J. Clin. Nutr. 2013; 97(3): 597-603.
8. Tang J.L., Armitage J.M., Lancaster T., Silagy C.A., Fowler G.H., Neil H.A.: Systematic review of dietary intervention trials to lower blood total cholesterol in free-living subjects. BMJ 1998; 316(7139): 1213-20.
9. Yu-Poth S., Zhao G., Etherton T., Naglak M., Jonnalagadda S., Kris-Etherton P.M.: Effects of the National Cholesterol Education Program‘s Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am. J. Clin. Nutr. 1999; 69(4): 632-46.
10. Jenkins D.J., Kendall C.W., Marchie A., Faulkner D.A., Wong J.M., de Souza R., Emam A., Parker T.L., Vidgen E., Lapsley K.G., Trautwein E.A., Josse R.G., Leiter L.A., Connelly P.W.: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003; 290(4): 502-10.
11. Jenkins D.J., Jones P.J., Lamarche B., Kendall C.W. 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(8): 831-9.
12. Fraser G.E.: Diet and the risk of coronary heart disease. W: Diet, life expectancy and chronic disease. Studies of Seventh day Adventists and other vegetarians. Fraser G.E. (red.). Oxford University Press, New York 2003: 59-84.
13. Appleby P.N., Thorogood M., Mann J.I., Key T.J.A.: The Oxford Vegetarian Study: an overview. Am. J. Clin. Nutr. 1999; 70(suppl): 525S-31S.
14. Sacks F.M., Svetkey L.P., Vollmer W.M., Appel L.J., Bray G.A., Harsha D., Obarzanek E., Conlin P.R., Miller E.R. 3rd, Simons-Morton D.G., Karanja N., Lin P.H.; DASH-Sodium Collaborative Research Group: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N. Engl. J. Med. 2001; 344(1): 3-10.
15. Svetkey L.P., Simons-Morton D., Vollmer W.M., Appel L.J., Conlin P.R., Ryan D.H., Ard J., Kennedy B.M.: Effects of dietary patterns on blood pressure: subgroup analysis of the Dietary Approaches to Stop Hypertension (DASH) randomized clinical trial. Arch. Intern. Med. 1999; 159(3): 285-93.
16. Vogt T.M., Appel L.J., Obarzanek E., Moore T.J., Vollmer W.M., Svetkey L.P., Sacks F.M., Bray G.A., Cutler J.A., Windhauser M.M., Lin P.H., Karanja N.M.: Dietary Approaches to Stop Hypertension: rationale, design, and methods. DASH Collaborative Research Group. J. Am. Diet. Assoc. 1999; 99(8 suppl.): S12-8.
17. Heun E.: [Vegetarian fruit juices in therapy in obesity and hypertension]. Forsch. Ther. 1936; 12: 403-411.
18. Masarei J.R., Rouse I.L., Lynch W.J., Robertson K., Vandongen R., Beilin L.J.: Effects of a lacto-ovo vegetarian diet on serum concentrations of cholesterol, triglyceride, HDL-C, HDL2-C, HDL3-C, apoprotein-B, and Lp(a). Am. J. Clin. Nutr. 1984; 40(3): 468-78.
19. Rouse I.L., Beilin L.J., Mahoney D.P., Margetts B.M., Armstrong B.K., Record S.J., Vandongen R., Barden A.: Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with a lacto-ovo-vegetarian diet. J. Hypertens. 1986; 4(2): 241-50.
20. Lindahl O., Lindwall L., Spångberg A., Stenram A., Ockerman P.A.: A vegan regimen with reduced medication in the treatment of hypertension. Br. J. Nutr. 1984; 52(1): 11-20.
21. Rouse I.L., Beilin L.J., Armstrong B.K., Vandongen R.: Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983; 1(8314-5): 5-10.
22. Margetts B.M., Beilin L.J., Armstrong B.K., Vandongen R.: Vegetarian diet in mild hypertension: effects of fat and fiber. Am. J. Clin. Nutr. 1988; 48(3 suppl.): 801-5.
23. Fraser G.E.: Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am. J. Clin. Nutr. 1999; 70(3 suppl): 532S-538S.
24. Fraser G.E.: Vegetarian diets: what do we know of their effects on common chronic diseases? Am. J. Clin. Nutr. 2009; 89(5): 1607S-1612S.
25. Appleby P.N., Davey G.K., Key T.J.: Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutr. 2002; 5(5): 645-54.
26. The Look AHEAD Research Group: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care 2007; 30: 1374-1383.
27. Ong K.L., Cheung B.M., Man Y.B., Wong L.Y., Wat N.M., Tan K.C., Lam K.S.: Treatment and control of diabetes mellitus in the United States National Health and Nutrition Examination Survey, 1999-2002. J. Cardiometab. Syndr. 2006; 1(5): 301-7.
28. [online: http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices.html].
29. Barnard N.D., Cohen J., Jenkins D.J., Turner-McGrievy G., Gloede L., Jaster B., Seidl K., Green A.A., Talpers S.: A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006; 29(8): 1777-83.
30. Kahleova H., Matoulek M., Malinska H., Oliyarnik O., Kazdova L., Neskudla T., Skoch A., Hajek M., Hill M., Kahle M., Pelikanova T.: Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type 2 diabetes. Diabet. Med. 2011; 28(5): 549-59.
31. Anderson J.W., Ward K.: High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am. J. Clin. Nutr.1979; 32(11): 2312-21.
32. Barnard R.J., Jung T., Inkeles S.B.: Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care 1994; 17(12): 1469-72.
33. Crane M.G., Sample C.: Regression of diabetic neuropathy with total vegetarian (vegan) diet. J. Nut. Med. 1994; 4: 431-9.
34. Jenkins D.J., Kendall C.W., Marchie A., Jenkins A.L., Augustin L.S., Ludwig D.S., Barnard N.D., Anderson J.W.: Type 2 diabetes and the vegetarian diet. Am. J. Clin. Nutr. 2003; 78(3 suppl.): 610S-616S.
35. Tonstad S., Stewart K., Oda K., Batech M., Herring R.P., Fraser G.E.: Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr. Metab. Cardiovasc. Dis. 2013; 23(4): 292-9.
36. Anderson J.W., Smith B.M., Gustafson N.J.: Health benefits and practical aspects of high-fiber diets. Am. J. Clin. Nutr. 1994; 59(5 suppl.): 1242S-1247S.
37. Pérez-Escamilla R., Obbagy J.E., Altman J.M., Essery E.V. et al.: Dietary energy density and body weight in adults and children: a systematic review. J. Acad. Nutr. Diet. 2012; 112(5): 671-84.
38. Tonstad S., Butler T., Yan R., Fraser G.E.: Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009; 32(5): 791-796.
39. Spencer E.A., Appleby P.N., Davey G.K., Key T.J.: Diet and body mass index in 38000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int. J. Obes. Relat. Metab. Disord. 2003; 27(6): 728-34.
40. Witmanowski H., Herzig K.H., Przyslawski J., Wadolowska L., Piątek J., Walkowiak J.M.: Short-Term Vegetarian Diet Reduces Oxidative Stress and Increases Antioxidant Defense in Healthy Volunteers. Gastroenterology 2005; 129(3): 1206.
41. Jenkins D.J., Kendall C.W., Marchie A., Faulkner D.A., Wong J.M., de Souza R., Emam A., Parker T.L., Vidgen E., Lapsley K.G., Trautwein E.A., Josse R.G., Leiter L.A., Connelly P.W.: Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 2003; 290(4): 502-10.
42. Dod H.S., Bhardwaj R., Sajja V., Weidner G. et al.: Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am. J. Cardiol. 2010; 105(3): 362-7.
43. Blacklock C.J., Lawrence J.R., Wiles D., Malcolm E.A. et al.: Salicylic acid in the serum of subjects not taking aspirin. Comparison of salicylic acid concentrations in the serum of vegetarians, non-vegetarians, and patients taking low dose aspirin. J. Clin. Pathol. 2001; 54(7): 553-5.
44. Craig W.J., Mangels A.R.: Position of the American Dietetic Association: vegetarian diets. J. Am. Diet. Assoc. 2009; 109: 1266-82.
45. Barnard N.D., Scialli A.R., Turner-McGrievy G., Lanou A.J.: Acceptability of a low-fat vegan diet compares favorably to a step II diet in a randomized, controlled trial. J. Cardiopulm. Rehabil. 2004; 24(4): 229-35.
46. Barnard N.D., Gloede L., Cohen J., Jenkins D.J., Turner-McGrievy G., Green A.A., Ferdowsian H.: A low-fat vegan diet elicits greater macronutrient changes, but is comparable in adherence and acceptability, compared with a more conventional diabetes diet among individuals with type 2 diabetes. J. Am. Diet. Assoc. 2009; 109(2): 263-72.
47. Ornish D., Denke M.: Dietary treatment of hyperlipidemia. J. Cardiovasc. Risk 1994; 1(4): 283-6.