Grant: Operating Grant

29% of deaths in Canada are due to cardiovascular disease (CVD), costing $20.9 billion annually. Conventional diet and lifestyle changes have failed to show CVD benefits (i.e. did not greatly reduce heart attacks and strokes). Therefore, we will undertake a pilot study to demonstrate feasibility prior to assessing the effects, in a large study, of our combined intensive therapeutic dietary approach and our Laval exercise program on incidence of cardiovascular disease (heart attacks and strokes). The concepts we will use in combination are those of our CIHR funded studies that have been demonstrated individually to have one or more of the following attributes: reduce LDL-C (bad cholesterol); raise HDL-C (good cholesterol); lower blood pressure; reduce CRP (inflammation); and in diabetes improve HbA1c (blood sugar) (JAMA 2008, CMAJ 2010, JAMA 2011, Arch Intern Med 2012). Together with the successful exercise and weight reduction program, established by our Laval collaborators, we believe we will have an uniquely powerful lifestyle tool for preventing CVD. We plan to conduct a pilot study with 200 participants at high risk for heart disease including those who cannot take cholesterol lowering drugs (statins), for medical reasons, or those who are reluctant to use drugs. They will be recruited for an initial 1 year trial of either the low glycemic index dietary portfolio of cholesterol lowering foods and the exercise program or a healthy low saturated fat diet with basic exercise advice. If one year recruitment and retention numbers are satisfactory, we will apply for the full trial to include additional centres and raise funds in other jurisdictions to fund sites internationally to be run by our collaborating colleagues. We believe the future results of the large study will influence guidelines and practice in the prevention and treatment of CVD internationally.