Nondrug therapy for lipid modification
For patients with elevated low-density lipoprotein cholesterol (LDL-C) concentrations, promote dietary modification at the time of diagnosis, and continue to do so even after drug therapy has started. Effective dietary changes for improving lipid concentrations include:
- reducing alcohol intake
- reducing intake of saturated and trans fats
- replacing saturated fats with monounsaturated and polyunsaturated fats
- increasing intake of fibre (particularly soluble fibre)
- introducing plant sterol–enriched milk, margarine or cheese products (this can reduce LDL-C concentration by 10 to 15%, but at the time of writing no studies with clinical endpoints have been performed)Visseren, 2021.
For patients with elevated triglyceride concentrations, effective dietary changes for improving triglyceride concentrations include:
- cutting out soft drinks and reducing intake of other added sugars
- reducing alcohol intake
- reducing intake of fats, particularly saturated and trans fats (reduction of fat intake to less than 15% of total energy intake may be beneficial)
- reducing intake of carbohydrates, particularly heavily refined carbohydrates
- increasing intake of fibre (particularly soluble fibre).
A study of a Mediterranean diet for primary prevention in patients at high risk of cardiovascular events (more than two-thirds of whom had dyslipidaemia) found that a diet supplemented with extra-virgin olive oil or nuts significantly reduced cardiovascular events (although this was not specifically a trial of diet-induced cholesterol reduction)1 Estruch, 2018.
Losing weight (if overweight or obese) and increasing physical activity also improve lipid concentrations. Increasing physical activity and losing weight are the most effective interventions for increasing high-density lipoprotein cholesterol (HDL-C) concentrations. Lifestyle interventions can also improve cardiovascular outcomes beyond their effect on lipids.
For more information on lifestyle modification, see Modifiable lifestyle risk factors for atherosclerotic cardiovascular disease.