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To the Editor.—Dr Knopp and colleagues¹ state that "aggressive fat restriction compared with moderate fat restriction offers no further benefits in a number of parameters and adverse effects in others." This conclusion is misleading, since Knopp et al did not assess heart disease but only changes in lipid levels. In the Lifestyle Heart Trial,² reducing fat intake to 10% of energy consumed and dietary cholesterol to 10 mg/d resulted in a 37% decrease in low-density lipoprotein (LDL) after 1 year compared with only 6% in the control group on a Step II diet (and compared with 5%-13% in the lowest-fat category of the study by Knopp et al). Thus, "aggressive fat restriction" clearly offers further benefits in reducing LDL.

High-density lipoprotein (HDL) levels decreased and triglyceride levels increased somewhat in our experimental group patients—yet these same patients showed overall regression in coronary atherosclerosis as measured by quantitative coronary arteriography² . . . [Full Text of this Article]

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