Showing how to optimally manage cholesterol & blood lipid nutrition- Medical nutrition therapy

Cholesterol & CVD

Expert Cholesterol Dietitian Melbourne

Optimise your heart health- Reduce heart attack and stroke risk with personally tailored health and nutrition strategies with an expert Melbourne Dietitian

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Improving your cholesterol is not impossible

Happy family middle aged and senior in good health with good blood glucose levels and well managed cholesterol

Whether you are an optimiser or just looking to improve your health and cholesterol management, we’re here to provide expert support.

Heart health can be complicated and difficult to manage. With our Accredited Practising Dietitians (APD), our consultations are designed to:

Optimise cholesterol 

 

Increase confidence in management

Reduce health stress

 

Reduce risk of heart attacks, stroke and Dementia

Instead of just focusing on what to stop doing, we focus on what to add. By increasing your intake of fibre-rich plants, high-quality proteins, and healthy fats, we can help slow down the absorption of glucose into your bloodstream, all while still enjoying some of your favourite foods!

We don’t use cookie-cutter meal plans. We work with your lifestyle to find a way of eating that you can sustain for 50 years, not just 5 weeks.

Why Choose REAL Health & Nutrition To Optimise Your Cholesterol

At REAL Health & Nutrition, we believe in giving you back the ability to take control of your heart health.

Our Accredited Practising Dietitians (APD) use evidence-based Medical Nutrition Therapy to help you stabilise your energy, protect your long-term health, and feel in control of your body again.

Realistic nutrition solutions

REAL Health & Nutrition was founded in Melbourne by Matthew Rigoni alongside a passionate team that provides evidence-based nutrition strategies that fit into your busy life.

Our diverse clientele includes individuals seeking to manage chronic diseases, enhance their sports performance, and those aiming to improve their healthspan and longevity through sustainable health and nutrition strategies.

Matthew Rigoni, expert Dietitian and sports dietitian- REAL Health & Nutrition

Practitioners

Meet the team

Highly skilled and qualified Dietitians and Sport Nutritionists

  • Matthew Rigoni Accredited Practising Dietitian (APD), sport Nutritionist, Accredited Sport Dietitian (ASD)

    Matthew Rigoni

    Head Dietitian (APD) & Sports Nutritionist

    Matthew Rigoni is an Accredited Practising Dietitian and Sports Nutritionist supporting clients across Eltham, Diamond Creek and Melbourne’s North-East. He specialises in weight management, chronic disease care, IBS/low-FODMAP nutrition, and sports-performance nutrition. His approach focuses on evidence-based, realistic strategies tailored to each client’s health goals. Matthew also brings experience in strength training and rehabilitation, helping clients build long-term, sustainable habits.

  • Max Dennehy Dietitian, body building coach

    Max Dennehy

    Dietitian and Bodybuilding Coach

    Max Dennehy is a qualified Dietitian with strong expertise in sports nutrition, weight loss, muscle gain and body recomposition. He has more than seven years of hands-on experience in bodybuilding and strength training, blending clinical nutrition with practical performance coaching. Max supports clients managing chronic conditions, improving metabolic health, and achieving body-composition goals. His coaching style is structured and supportive, helping clients stay consistent and confident.

  • Emma Westlake Accredited Sports Nutritionist

    Emma Westlake

    Accredited Sports Nutritionist

    Emma Westlake is a Nutritionist and Accredited Sports Nutritionist with experience in athletic performance, endurance nutrition, injury recovery and rehabilitation. She brings a strong background in Biomedical Science and works with clients to improve energy, health and long-term wellbeing. Emma has supported athletes across AFL/AFLW, triathlon and running communities, offering clear and practical guidance. Her passion lies in helping active individuals optimise performance through personalised, evidence-based nutrition.

Learn more about our practitioners

Qualifcations, profesional interests and why they're unique!

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Happy family eating a nutricious meal after Dietitian consultation

An in-depth look

What is Cholesterol?

Cholesterol is a waxy, fat-like substance found in all the cells in your body.

We need it to live.

Without cholesterol, you wouldn’t be able to produce essential hormones (like testosterone and estrogen), synthesize vitamin D, or maintain the structure of your cell walls.

Buckle up, because the old “Good vs. Bad” cholesterol story is dead.

Good vs bad Cholesterol” is outdated and oversimplified

For decades, we were told LDL is the "bad" cholesterol and HDL is the "good" cholesterol. That is a massive oversimplification. Cholesterol itself is just cargo.

Because oil and water don’t mix, cholesterol cannot float freely in your blood. It has to be carried around in microscopic transport boats called lipoproteins.

When we assess your risk for heart disease, we shouldn't just be looking at the cargo (the cholesterol). We need to look at the boats carrying it, how many there are, and what size they are.

1. Apolipoprotein B (ApoB): The Number of Dangerous boats

Standard lipid panels measure the total mass of cholesterol inside your LDL particles (LDL-C). But modern science tells us that the total amount of cholesterol isn’t the primary driver of arterial plaque, it’s the number of particles (or number of “boats”) carrying it.

Enter Apolipoprotein B (ApoB).

  • What is it? ApoB is a structural protein attached to every single atherogenic (plaque-building) particle in your blood. This includes LDL, VLDL, IDL particles and chylomicrons.
  • The Rule: There is exactly one ApoB protein per particle.
  • Why it matters: By measuring your ApoB, we get an exact head-count of the dangerous “boats” traveling through your bloodstream. You could have “normal” LDL cholesterol levels, but if that cholesterol is packed into a massive number of tiny, dangerous boats, your ApoB will be high and your risk for cardiovascular disease will be high.
  • The REAL Goal: We want ApoB as low as reasonably possible. Less traffic on the highway means fewer crashes into your artery walls (endothelial damage).

Apo-B Reference ranges:

  • Optimal: <0.8g/L
  • Suboptimal: 0.81-0.99g/L
  • Danger zone: >1.0g/L

2. Lipid Subfractions: Particle Size Matters

2. Lipid Subfractions: Particle Size Matters

Not all LDL particles are created equal. Subfraction testing breaks down your lipoproteins by their size and density. While this is not necessary in most cases, it can be valuable if you have familial hypercholesterolemia (genetically high cholesterol).

Think of your LDL particles like sports equipment going through a highway

  1. Pattern A (Large, Buoyant LDL): These are like beach balls. They are large, fluffy, and generally “bounce” off the walls of your blood vessels. They are considered less harmful than other LDL particles and carry a lower risk of causing cardiovascular disease.
  2. Pattern B (Small, Dense LDL – sdLDL): These are like golf balls. Because they are small and heavy, they easily penetrate the delicate inner lining of your blood vessels (the endothelium). Once inside, they oxidise, trigger an immune response, and begin forming the plaque that leads to heart attacks.

The Metabolic Connection: If you have high triglycerides and low HDL (a classic sign of insulin resistance and Type 2 Diabetes), you are highly likely to have a dangerous “Pattern B” profile. Improving your blood sugar control directly shifts your cholesterol profile to the safer “Pattern A.”

LDL reference ranges:

  • Optimal: <2.5mmol/L
  • Suboptimal: 2.6mmol/L-mmol/L
  • Danger zone: >3mmol/L

3. Lipoprotein(a) [Lp(a)]: The Genetic Wildcard

 

If small, dense LDL is a golf ball, Lipoprotein(a), pronounced “Lp little a”, is a golf ball wrapped in barbed wire and superglue.

What is it? Lp(a) is an LDL particle with an extra, highly sticky protein attached to it called Apolipoprotein(a).

The Triple Threat:

    1. It builds plaque: It drives cholesterol into the artery walls just like normal LDL.
    2. It promotes clotting: It mimics blood-clotting proteins, making your blood more prone to forming dangerous clots.
    3. It drives inflammation: It carries oxidised lipids that severely inflame the blood vessels.

The Catch: Unlike regular LDL or triglycerides, Lp(a) levels are almost entirely dictated by your genetics (about 80-90%). Diet and exercise have almost zero impact on lowering it.

Lp(a) Reference ranges:

  • Optimal: <0.3g/L
  • Suboptimal: 0.31-0.49g/L
  • Danger zone: >0.5g/L

What you need to do: Everyone should have their Lp(a) tested at least once in their life, especially if your family history is unknown to you.

If it is elevated, it means you have a significant genetic risk factor. While we can’t lower the Lp(a) with food, it means we have to be incredibly aggressive about managing everything else (ApoB, blood pressure, blood sugar, polyphenols, micronutrients, body composition and more) to keep your total risk low.

To ensure optimal management, have an in-depth discussion with your REAL Dietitian

What we can do

How is high Cholesterol treated?
The REAL Approach

If your ApoB is high or you have a dangerous subfraction profile, here is how we target it from a lifestyle and nutrition perspective:

1. Crush Insulin Resistance

Image of BGL Lancet and measurement device

High blood sugar and high insulin drive the liver to produce VLDL and small, dense LDL (Pattern B).

By utilising the Low Glycaemic Index (GI) strategies and hypertrophy training we teach at REAL, you clear out triglycerides and shift your particles back to the safe “Pattern A” size.

This can, in turn, work towards optimising your mitochondrial efficiency and increasing the utilisation of fat for energy through beta oxidation.

Here is a hint, it’s not just through food where you see the biggest benefit to insulin sensitivity.

2. Optimise the fat matrix

Nutrient dense high polyphenol, high omega 3 foods to optimise fat matrix and improve beta oxidation while reducing whole body inflammation and CRP

We don’t fear fat, but we respect it.

Substituting highly refined saturated fats C14 and C16 (which down-regulate your liver’s LDL receptors, trapping ApoB in your blood) with monounsaturated fats (Extra Virgin Olive Oil, walnuts) and Omega-3s (Salmon, Sardines etc) helps your body clear ApoB particles more efficiently.

Getting enough can be tricky, that’s why we take the guesswork out of nutrition, whether it’s through food first approach or supplementation where appropriate.

3. Increase Soluble Fibre

Nutrient dense whole foods. Macronutrients and micronutrients (vitamins and minerals). Nutrients for deficiencies

Foods like oats, psyllium husk, and legumes bind to bile acids in your gut.

Your liver is forced to pull ApoB particles out of your bloodstream to make more bile, effectively lowering your circulating cholesterol.

Even if you are supplementing with fibre, it is very common for people to not be consuming enough to reach optimal levels of intake.

 

 

4. Optimising muscle mass and body composition

Middle aged and seniour couple exercising together to improve their longevity, body composition and support health, osteoprosis, cholesterol and blood glucose levels

Exceeding your genetic limit on safe fat storage causes fat to “spill over” into your organs, specifically the liver. This ectopic fat causes insulin resistance, which panics the liver and forces it to pump out VLDL and dangerous “Pattern B” LDL particles. 

By focusing on building muscle and improving insulin resistance, you can drastically improve your insulin sensitivity. This dual approach of losing visceral fat while expanding your muscle “sink” effectively stops your liver from overproducing atherogenic cholesterol particles

5. Micronutrient optimisation and appropriate supplementation

Nutrient dense whole foods. Macronutrients and micronutrients (vitamins and minerals)

Plant sterols structurally mimic human cholesterol, allowing them to hijack your gut’s absorption pathways and force your body to excrete excess cholesterol instead.

Combine this with targeted micronutrients, like high-dose Omega-3s to slash liver triglyceride production and specific antioxidants to stop LDL particles from oxidizing.

This dual defence is targeted at reducing vascular damage and actively lowering your circulating ApoB count.

Learn more about our Glycaemic Index

And what the glycaemic index is of common foods

Can you cure plaque buildup & Cardiovascular Disease (CVD)?

There currently is no cure for purely genetic lipid disorders (like Familial Hypercholesterolemia or elevated Lipoprotein(a)), however, they can be managed exceptionally well with minimal impact on your long-term health.

While it is technically possible to reverse lifestyle-driven atherosclerosis (arterial plaque buildup), it is very rare and incredibly difficult to do once the plaques have hardened.

Cardiovascular disease is a condition that usually occurs after decades of prolonged exposure to high ApoB particles, poor nutrition, inflammation, and physical inactivity. This often means that strong habitual routines have already been established that work against making meaningful changes, decreasing the likelihood of treating the root cause effectively.

To clarify, there are two concepts that are critical to understand when discussing reversing or “curing” Cardiovascular Disease:

Stabilisation (a band aid)

When an individual drastically reduces their ApoB (the particle count of dangerous cholesterol) to optimal, low-risk levels (often below 60-80 mg/dL).

This halts the progression of the disease and turns dangerous, unstable “soft” plaque into stable, calcified plaque that is less likely to rupture and cause a heart attack.

Regression/ reversal (the goal)

When an individual actively shrinks their total arterial plaque volume and restores full endothelial function (the health and flexibility of the blood vessels), maintaining optimal ApoB and inflammatory markers without the need for intensive medical intervention.

The REAL Approach to Regression

1. Optimal Pathology (The Bloodwork Targets)

You cannot manage what you do not measure.

To enable plaque regression, we want to starve the plaque of its building blocks and completely eliminate vascular inflammation.

  • Cholesterol- Apolipoprotein B (ApoB): <0.8g/L
  • Inflammation- High-Sensitivity C-Reactive Protein (hs-CRP): Target < 1.0 mg/L.
  • Blood sugar- HbA1c & Fasting Insulin: Target HbA1c < 5.5% and fasting insulin < 5 mU/L.
  • Blood Pressure: < 110/80 mmHg.
Heart anatomy, Left Anterior Descending (LAD) artery and Circumflex artery Photo by Robina Weermeijer on Unsplash

2. Lifestyle Strategies (The Action Plan)

While medication is frequently required to push ApoB low enough to achieve regression, lifestyle is the engine that heals the endothelium and corrects the underlying metabolism.

  • Strategic Fat Substitution: Swapping saturated fats that down-regulate liver LDL receptors for monounsaturated and polyunsaturated fats forces your body to pull atherogenic ApoB particles out of circulation.

 

  • Hypertrophy & Zone 2 Training: Combining heavy resistance training to expand your glucose-absorbing muscle “sink” with steady-state Zone 2 cardio builds new mitochondria and heals your blood vessels through increased nitric oxide production.

 

  • Viscous Soluble Fibre & Plant Sterols: Consuming viscous fibre and plant sterols creates a dual gut-level blockade that stops dietary cholesterol absorption and forces your liver to extract circulating ApoB to manufacture new bile.
  • Polyphenols: Consuming high-polyphenol foods like berries, extra virgin olive oil, and green tea provides powerful antioxidants that specifically prevent LDL particles from oxidizing, halting the exact trigger for arterial plaque formation.

 

  • Toxin Elimination (Alcohol & Smoking): Eliminating smoking and minimising alcohol is non-negotiable for regression, as these toxins actively destroy the delicate endothelial lining of your arteries and severely spike systemic inflammation.

 

  • Stress Management: Chronically elevated cortisol from unmanaged stress directly increases blood pressure and blood glucose, acting as a mechanical and chemical pressure washer that damages your artery walls.

 

  • Sleep Optimisation: Consistently getting 7-9 hours of quality sleep acts as your body’s primary nightly repair phase, which is crucial for healing endothelial damage, regulating insulin sensitivity, and lowering inflammatory markers.

 

  • Micronutrient Optimisation: Targeted intake of specific micronutrients, such as high-dose Omega-3s (EPA/DHA) to slash liver triglyceride production,  magnesium and potassium to relax blood vessels, zinc, vitamin E and selenium for it’s antioxidant effects, all contribute to the chemical support needed to maintain a regenerative environment.

Stats

How common is high cholesterol and Cardiovascular Disease?

Cardiovascular disease (CVD) is caused by the narrowing of the arteries, often by cholesterol.
It is the leading cause of death and disability worldwide.

While it remains a compounding global health crisis, we at REAL believe it is largely preventable through the metabolic and lifestyle strategies that we teach and coach you through.

Here is a breakdown of the prevalence based on Global and Australian data (given your location).

Global Statistics (World Health Organization & World Heart Federation)

  • Total Cases: Over half a billion people (approximately 620 million) are currently living with high cholesterol, heart and circulatory diseases worldwide.
  • The Leading Cause: It is the number one killer globally, responsible for roughly 20 million deaths annually. This represents about 1 in every 3 deaths worldwide.
  • The “Silent” Threat: Millions of adults are living with undiagnosed severe risk factors (like elevated ApoB, high blood pressure, and genetic lipid disorders), meaning they are entirely unaware they are actively building arterial plaque until a heart attack or stroke occurs.

Australian Context (Australian Institute of Health and Welfare & Heart Foundation)

  • Total Prevalence: An estimated 4 million Australians, roughly 1 in 6 adults, are currently living with cardiovascular disease.
  • The Impact: It is a major cause of death, claiming the lives of over 40,000 Australians each year (approximately one life lost every 12 minutes). This has only recently been surpassed by Dementia.
  • The “Silent” Statistics: High cholesterol (the raw material for arterial plaque) affects millions of Australians, yet many have a false sense of security because standard lipid panels miss the true risk (particle number/ApoB). Furthermore, an estimated 1 in 250 Australians has Familial Hypercholesterolemia (FH), a genetic condition causing massive cholesterol levels, but over 90% of them remain dangerously undiagnosed

Further medical care

When should you see a Doctor?

You should see a Doctor (GP or Cardiologist) to handle your ongoing medical treatment, prescriptions, and complication checks.

Make an appointment if:

  • Your numbers are consistently off: You frequently see high blood pressure readings or elevated ApoB/LDL cholesterol levels on your blood tests despite taking your medication as prescribed.
  • You feel “burnout”: You are feeling overwhelmed, anxious, or experiencing “pill fatigue” from managing your cardiovascular health and taking multiple medications.
  • New symptoms appear:
    • Occasional chest tightness or discomfort that goes away with rest (signs of stable angina).
    • Mild shortness of breath during normal daily activities or an unexplained drop in your exercise capacity.
    • Swelling in your lower legs, ankles, or feet (signs of fluid retention/edema).
    • Pain or cramping in your calves when walking that stops when you rest (signs of peripheral artery disease).
  • Life changes: You are planning to get pregnant, have become pregnant, or have developed other metabolic conditions like Type 2 diabetes or insulin resistance.
  • Medication side effects: You experience unusual, unexplained muscle aches or weakness (a potential side effect of statins), a persistent dry cough, dizziness when standing up (common with blood pressure meds), or severe fatigue after starting a new medicine.

When should you call 000 or go to emergency?

Call 000 or go to the ER immediately if:

  • You experience chest pain or pressure: A sudden sensation of squeezing, heaviness, or tightness in the centre of your chest that lasts more than a few minutes (or goes away and comes back).

 

  • The pain radiates: You feel pain or discomfort spreading to your left arm, both arms, neck, jaw, stomach, or back.

 

  • You have sudden, severe shortness of breath: Especially if accompanied by a cold sweat, nausea, vomiting, or extreme light-headedness/dizziness.

 

  • You show signs of a stroke (F.A.S.T.):
    • Face drooping (one side of the face is numb or drooping).
    • Arm weakness (inability to raise both arms evenly).
    • Speech difficulty (slurred speech or unable to speak coherently).
    • Time to call 000: If you observe any of these signs, even if they go away, call emergency services immediately.

When should you see a Dietitian?

Most standard advice tells you how to live with high cholesterol . At REAL Health & Nutrition we teach you how to live without the limitations .

If you are following the guidelines but not seeing the results, generic advice isn’t enough . You need a strategy engineered for plaque regression .

It is time to book your consultation if :

  • You want to break up with your medication: Your goal is to safely reduce or eliminate your reliance on statins or blood pressure meds under medical supervision .
  • You are stuck in the “Progressive Trap”: Your doctor says your numbers are “okay,” but you know “okay” isn’t good enough . You want optimal health, not just stable sickness .
  • You are ready for Curative Care: You aren’t looking for a diet; you’re looking for a metabolic reset . You want to target the root cause of atherogenic particles (ApoB) and endothelial dysfunction, not just treat the number.

The Result: A roadmap to optimal ApoB levels, clear arteries, and the freedom to eat without fear.

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This commitment ensures you always receive the most current, evidence-based nutrition guidance available.

Frequently Asked Cholesterol Questions

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    Sometimes, but you have to be realistic. If your cholesterol is driven purely by poor diet and excess visceral fat, lifestyle changes can cause massive drops.

    However, if your high ApoB is genetically driven, diet may not move the needle by enough to reduce the markers within optimal range. In those cases, medication may be worth considering.

    If you aggressively target your nutrition, increase your soluble fiber, and start resistance training, you can see significant improvements in your triglycerides and particle sizes in as little as 4 to 8 weeks.

    Cholesterol levels are heavily influenced by genetics and dietary intake.

    If you have an inherited condition like Familial Hypercholesterolemia or high Lipoprotein(a), your liver either overproduces cholesterol or cannot clear it effectively, regardless of how thin you are

    No. This is a decades-old myth. For the vast majority of people, dietary cholesterol (the cholesterol found in food) has a minimal impact on the cholesterol circulating in your blood.

    Your liver tightly regulates production. Poor metabolic health and high saturated fat intake are the real culprits, not eggs

    From a lipid perspective, yes. Butter, coconut oil and animal fats such as tallow are incredibly high in palmitic acid (C16) and mystiric acid (C14), specific saturated fatS that tells your liver to stop pulling dangerous ApoB particles out of your blood.

    Swapping these fats for extra virgin olive oil is one of the highest-ROI dietary changes you can make

    It depends entirely on the type of fat. High saturated fat foods (like those in processed meats, coconut oil and butter) down-regulate your liver’s ability to clear cholesterol, driving your numbers up.

    Monounsaturated fats (like extra virgin olive oil) can help your body clear cholesterol more efficiently

    Yes. Plant sterols are the plant kingdom’s version of cholesterol.

    They compete for the same absorption pathways in your gut. If your gut absorbs the plant sterols, it blocks the actual cholesterol, forcing your body to safely excrete it in your stool.

    Yes, but it requires aggressive, targeted action. You cannot just aim for “average” bloodwork.

    To shrink existing plaque (regression), you must drive your ApoB to extremely low levels (<0.8g/L) and almost completely eliminate systemic inflammation so the body can pull the cholesterol out of the artery wall. Even then, reversal is not garunteed and is further nuanced. 

    Not exactly. It is the number of particles (ApoB) and their size that dictate your risk.

    • Large, buoyant LDL particles (Pattern A) are less harmful.
    • Small, dense LDL particles (Pattern B) are the dangerous ones that penetrate your artery walls and cause plaque.

    However, if you have high LDL on your blood tests, it is usually safe to assume that there is work that is needed to be done

    We used to think pushing HDL (the “good” cholesterol) as high as possible would protect your heart. Modern science shows this isn’t true.

    While a normal HDL level is a great sign of overall metabolic health, artificially raising it doesn’t prevent heart attacks. We put more of a focus on lowering ApoB instead.

    Exercise has a modest direct impact on lowering your total LDL, but it does something arguably more important: it burns off visceral fat, lowers triglycerides, and shifts your dangerous “Pattern B” particles into safe “Pattern A” particles.

    Not only this but it supports systemic inflammation, sleep, stress management and blood glucose (sugar) management, all contributing to our heart health.

    Absolutely not. CVD is the leading cause of death for women, too.

    While women have a degree of protection from estrogen prior to menopause, their risk catches up to men’s rapidly once estrogen levels drop.

Extra reading & useful heart health resources

  1. Aramburu, A., Dolores-Maldonado, G., Curi-Quinto, K., Cueva, K., Alvarado-Gamarra, G., Alcalá-Marcos, K., Celis, C. R., & Lanata, C. F. (2024). Effect of reducing saturated fat intake on cardiovascular disease in adults: An umbrella review. Frontiers in Public Health, 12, 1396576. https://doi.org/10.3389/fpubh.2024.1396576
  2. Arnett, D. K., Khera, A., & Blumenthal, R. S. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Part 1, lifestyle and behavioral factors. JAMA Cardiology, 4(10), 1043–1044. https://doi.org/10.1001/jamacardio.2019.2604
  3. Clifton, P. M., & Keogh, J. B. (2017). A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease. Nutrition, Metabolism & Cardiovascular Diseases, 27(12), 1060–1080. https://doi.org/10.1016/j.numecd.2017.10.010
  4. Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., Graham, I. M., Halliday, A., Landmesser, U., Mihaylova, B., Pedersen, T. R., Riccardi, G., Richter, D. J., Sabatine, M. S., Taskinen, M.-R., Tokgozoglu, L., & Wiklund, O. (2020). 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. European Heart Journal, 41(1), 111–188. https://doi.org/10.1093/eurheartj/ehz455
  5. Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., et al. (2025). 2025 focused update of the 2019 ESC/EAS guidelines for the management of dyslipidaemias. European Heart Journal, 46(42), 4359–4378. https://doi.org/10.1093/eurheartj/ehaf190
  6. Genser, B. (2012). Plant sterols and cardiovascular disease: A systematic review and meta-analysis. European Heart Journal, 33(4), 444–451. https://doi.org/10.1093/eurheartj/ehr441
  7. Hooper, L., Martin, N., Jimoh, O. F., Kirk, C., Foster, E., & Abdelhamid, A. S. (2020). Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews, 2020(8), CD011737. https://doi.org/10.1002/14651858.CD011737.pub3
  8. Lichtenstein, A. H., Appel, L. J., Vadiveloo, M., Hu, F. B., Kris-Etherton, P. M., Rebholz, C. M., Sacks, F. M., Thorndike, A. N., Van Horn, L., & Wylie-Rosett, J. (2021). 2021 dietary guidance to improve cardiovascular health: A scientific statement from the American Heart Association. Circulation, 144(23), e472–e487. https://doi.org/10.1161/CIR.0000000000001031
  9. Lloyd-Jones, D. M., Morris, P. B., Ballantyne, C. M., Birtcher, K. K., Covington, A. M., DePalma, S. M., Minissian, M. B., Orringer, C. E., Smith, S. C., Jr., Waring, A. A., & Wilkins, J. T. (2022). 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk. Journal of the American College of Cardiology, 80(14), 1366–1418. https://doi.org/10.1016/j.jacc.2022.07.006
  10. Martínez-González, M. A., Gea, A., & Ruiz-Canela, M. (2019). The Mediterranean diet and cardiovascular health: A critical review. Circulation Research, 124(5), 779–798. https://doi.org/10.1161/CIRCRESAHA.118.313348
  11. Mozaffarian, D., Micha, R., & Wallace, S. (2010). Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: A systematic review and meta-analysis of randomized controlled trials. PLOS Medicine, 7(3), e1000252. https://doi.org/10.1371/journal.pmed.1000252
  12. Pirillo, A., Casula, M., & Catapano, A. L. (2023). European guidelines for the treatment of dyslipidaemias: New concepts and future challenges. Pharmacological Research, 196, 106936. https://doi.org/10.1016/j.phrs.2023.106936
  13. Schoeneck, M., & Iggman, D. (2021). The effects of foods on LDL cholesterol levels: A systematic review of systematic reviews and meta-analyses of randomized controlled trials. Nutrition, Metabolism & Cardiovascular Diseases, 31(5), 1325–1338. https://doi.org/10.1016/j.numecd.2020.12.032
  14. Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition, 91(3), 535–546. https://doi.org/10.3945/ajcn.2009.27725
  15. Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A. (2015). The Mediterranean diet, its components, and cardiovascular disease. American Journal of Medicine, 128(3), 229–238. https://doi.org/10.1016/j.amjmed.2014.10.014