Step I and step II diets

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1. Dietary therapy should be initiated in patients who have borderline-high LDL cholesterol levels (130 to 159 mg/dL) and two or more risk factors for coronary heart disease and in patients who have LDL levels of 160 mg/dL or greater. The objective of dietary therapy in primary prevention is to decrease the LDL cholesterol level to 160 mg/dL if only one risk factor for coronary heart disease is present and to less than 130 mg/dL if two or more risk factors are identified. In the presence of documented coronary heart disease, dietary therapy is indicated in patients who have LDL values exceeding 100 mg/dL, with the aim of lowering the LDL level to 100 mg/dL or less.

2. Step I diet limits calories derived from saturated fats to 8 to 10 percent of total calories and cholesterol to less than 300 mg/day.

3. Step II diet further restricts calories from saturated fats to less than 7 percent of total calories and restricts cholesterol intake to less than 200 mg/day.

4. In primary prevention of coronary heart disease (without evidence of coronary heart disease), dietary therapy should be maintained for six months before drug therapy is initiated. In patients with coronary heart disease and an LDL cholesterol value above 100 mg/dL, therapy should begin with the step II diet.

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