From the Guidelines
A reasonable trial period for lifestyle modifications to lower high LDL cholesterol is typically 3-6 months before considering medication. During this time, focus on a heart-healthy diet low in saturated fats and trans fats, high in fiber (especially soluble fiber from oats, beans, and fruits), and incorporate plant sterols/stanols 1. Aim for at least 150 minutes of moderate-intensity exercise weekly, lose weight if overweight (even 5-10% weight loss can help), quit smoking, limit alcohol consumption, and manage stress. Regular follow-up cholesterol testing (usually at 3 months) is important to assess progress. This timeframe allows sufficient opportunity for lifestyle changes to demonstrate effectiveness while not delaying appropriate medical treatment if needed. For those with very high LDL levels (>190 mg/dL) or existing cardiovascular disease, physicians may recommend starting medications alongside lifestyle changes rather than waiting, as suggested by recent clinical trials 2, 3. The effectiveness of lifestyle modifications varies by individual, with potential LDL reductions of 5-15% through diet alone and additional benefits from exercise and weight loss.
Some key points to consider when implementing lifestyle modifications include:
- Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management, with the potential to reduce cardiovascular risk through several mechanisms beyond LDL lowering 1
- Any person at high risk or moderately high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors regardless of LDL-C level 1
- When LDL-lowering drug therapy is employed in high-risk or moderately high-risk persons, it is advised that intensity of therapy be sufficient to achieve at least a 30% to 40% reduction in LDL-C levels 1
- Recent clinical trials provide greater rationale for more intensive LDL-lowering therapy, but they do not resolve all issues surrounding very low LDL levels, and clinical judgment is necessary to weigh patient risk and the efficacy, safety, and cost of different therapies 2, 3