What lifestyle recommendations are suggested for managing hypercholesterolemia?

Lifestyle Recommendations for High Cholesterol

To effectively manage hypercholesterolemia, implement a comprehensive diet and lifestyle modification plan that includes limiting saturated fat to less than 7% of daily calories, reducing dietary cholesterol to less than 200 mg/day, increasing physical activity to at least 30 minutes daily, and maintaining a healthy weight. 1

Dietary Modifications

• Limit saturated fat intake to less than 7% of total daily calories and trans-fatty acids to less than 1% of energy by choosing lean meats and low-fat dairy products 1
• Reduce dietary cholesterol to less than 200 mg/day 1
• Consume a diet rich in vegetables, fruits, and whole grains to increase fiber intake 1
• Include 10-25 g/day of viscous (soluble) fiber to enhance LDL cholesterol lowering 1
• Add plant stanols/sterols (2 g/day) to further reduce LDL cholesterol 1
• Consume fish, especially oily fish, at least twice a week for omega-3 fatty acids 1
• Choose whole-grain, high-fiber foods instead of refined carbohydrates 1
• Minimize intake of beverages and foods with added sugars 1
• Limit salt intake to less than 2,400 mg/day (6,000 mg of sodium chloride) 1
• If you consume alcohol, do so in moderation (≤2 drinks/day for men, ≤1 drink/day for women) 1

Physical Activity

• Engage in at least 30 minutes of moderate-intensity physical activity on most (preferably all) days of the week 1
• For additional benefits, consider vigorous-intensity activity (≥60% of maximum capacity) for 20-40 minutes, 3-5 days per week 1
• Include resistance training with 8-10 different exercises, 1-2 sets per exercise, and 10-15 repetitions at moderate intensity twice weekly 1
• Incorporate flexibility training and increase daily lifestyle activities 1
• Regular physical activity helps reduce plasma triglycerides and improve insulin sensitivity 1

Weight Management

• Achieve and maintain a healthy body weight (BMI 18.5-24.9 kg/m²) 1
• For overweight/obese individuals, aim to reduce body weight by 10% in the first year of therapy 1
• Target a waist circumference of less than 40 inches (102 cm) for men and less than 35 inches (88.9 cm) for women 1
• Even modest weight loss can improve lipid profiles, particularly by increasing HDL-C and decreasing triglycerides 2

Additional Recommendations

• Avoid tobacco products completely and minimize exposure to secondhand smoke 1
• When eating food prepared outside the home, continue to follow heart-healthy dietary guidelines 1
• Consider monitoring blood pressure and blood glucose levels regularly, as these conditions often coexist with hypercholesterolemia 1
• For those with diabetes and hypercholesterolemia, more aggressive lifestyle modifications may be needed 1, 3

Expected Benefits

• Combined lifestyle interventions (healthy diet, weight loss, and physical activity) can increase HDL-C by 10-13% 2
• Dietary modifications can lower LDL-C by 5-15% depending on adherence and individual response 4
• Regular physical activity can reduce triglycerides by 20-30% 1
• These lifestyle changes, when maintained consistently, can significantly reduce cardiovascular disease risk 1, 4

Common Pitfalls to Avoid

• Focusing only on total fat rather than the type of fat (saturated vs. unsaturated) 1
• Substituting saturated fat with refined carbohydrates instead of healthy unsaturated fats or whole grains 1
• Neglecting physical activity while only focusing on dietary changes 1
• Setting unrealistic goals that lead to poor adherence 4
• Failing to address all modifiable risk factors simultaneously (diet, exercise, smoking, etc.) 1
• Very low-fat diets (<15% of energy as fat) may adversely affect HDL cholesterol levels 1

If these lifestyle modifications do not achieve target cholesterol levels after 3 months, medical intervention with cholesterol-lowering medications should be considered, particularly for those at higher cardiovascular risk 4.