Effect of Different Types of Whole Dietary Pulses on Established Therapeutic Lipid Targets for Cardiovascular Risk Reduction: An Updated Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Clinical Snapshot

Key Findings

• P Value: Statistically significant (CI excludes null)

• Effect Size: Mean difference -0.14 mmol/L for LDL-cholesterol

• Primary Outcome: LDL-cholesterol reduction of 0.14 mmol/L

• Nnt Or Sensitivity: Dose-response coefficient for beans: -0.25 mmol/L per 0.5 cup increase (95% CI -0.48 to -0.02)

• Confidence Interval: 95% CI -0.19 to -0.08 mmol/L

Clinical Application

Highly feasible - 130g/day (0.5-0.67 cup) is achievable through regular dietary incorporation Aligns with Australian Dietary Guidelines promoting legume consumption; supports PBS cholesterol management strategies; relevant for RACGP cardiovascular risk assessment protocols Adults seeking dietary approaches for cholesterol management and cardiovascular risk reduction

Abstract

BACKGROUND: Although dietary pulses are recognized by major clinical practice guidelines to reduce cholesterol and coronary heart disease risk, intake is low. There are no health claims for any pulse for cholesterol reduction, which could support uptake. We therefore conducted a systematic review and dose-response meta-analysis of randomized trials of the effect of different types of whole dietary pulses on lipid targets. METHODS: MEDLINE, Embase, and the Cochrane Library were searched through March 2025 for trials ≥3 weeks. The primary outcome was low-density lipoprotein-cholesterol. Secondary outcomes were other lipid targets. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Thirty-eight trials (52 trial comparisons, n=2095) with a median of 6 weeks and dose of 130 g/d (0.5-0.67 cup/d) showed that whole dietary pulses decreased low-density lipoprotein-cholesterol (mean difference, -0.14 mmol/L [95% CI, -0.19 to -0.08]), non-high-density lipoprotein-cholesterol (-0.22 mmol/L [95% CI, -0.30 to -0.14]), apoB (apolipoprotein B) (-0.08 g/L [95% CI, -0.13 to -0.03]) and high-density lipoprotein-cholesterol (-0.03 mmol/L [95% CI, -0.05 to -0.01]) with no effects on other lipids. Analyses by pulse type showed similar results. A linear inverse relationship was shown for beans up to 1 cup/d for low-density lipoprotein-cholesterol (coefficient, -0.25 mmol/L/0.5 cup [95% CI, -0.48 to -0.02]) and non-high-density lipoprotein-cholesterol (-0.45 mmol/L/0.5 cup [95% CI, -0.71 to -0.18]). Grading of Recommendations Assessment, Development, and Evaluation was moderate-to-high for all outcomes, except apoB (very low). CONCLUSIONS: Whole dietary pulses likely result in small important-to-moderate reductions in lipid targets and trivial reductions in high-density lipoprotein-cholesterol. Similar effects were observed across pulse types with an inverse dose-response gradient for beans up to 1 cup/d. Future studies on chickpeas, dried peas, and lentils are warranted. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023432826; Unique identifier: CRD42023432826.

References

1. 1.Back, S., Yang, S., Rossi, A., Ayoub-Charette, S., Grant, S. M., Chen, V., Lin, E. J., Haintz, L., Chen, Y.-T., Ahmad, E., Gahagan, J., Marinangeli, C. P. F., Ha, V., Khan, T. A., Blanco Meji, S., Zurbau, A., de Souza, R. J., Beyene, J., English, M. M., Vuksan, V., Josse, R. G., Leiter, L. A., Kendall, C. W. C., Jenkins, D. J. A., Sievenpiper, J. L., & Chiavaroli, L. (2026). Effect of Different Types of Whole Dietary Pulses on Established Therapeutic Lipid Targets for Cardiovascular Risk Reduction: An Updated Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.046659