What are the strategies to reduce Low-Density Lipoprotein (LDL) and total cholesterol through dietary and lifestyle modifications?

From the Guidelines

Reducing LDL and total cholesterol effectively requires a combination of specific dietary changes and lifestyle modifications, focusing on consuming a diet rich in soluble fiber, replacing saturated and trans fats with heart-healthy unsaturated fats, limiting dietary cholesterol intake, and incorporating plant sterols and stanols, as well as regular physical activity and weight management, as recommended by the American Heart Association 1. To achieve this, consider the following strategies:

• Focus on consuming a diet rich in soluble fiber from foods like oats, beans, fruits, and vegetables, which can bind to cholesterol in the digestive system and help eliminate it 1.
• Replace saturated and trans fats with heart-healthy unsaturated fats found in olive oil, avocados, nuts, and fatty fish like salmon 1.
• Aim to limit dietary cholesterol intake to under 200mg daily by reducing consumption of egg yolks, organ meats, and high-fat dairy 1.
• Plant sterols and stanols, found naturally in plants or in fortified foods, can block cholesterol absorption; consuming 2 grams daily can lower LDL by 5-15% 1.
• Regular physical activity of at least 150 minutes of moderate exercise weekly helps raise HDL cholesterol while lowering LDL 1.
• Weight management is crucial as losing just 5-10% of body weight can significantly improve cholesterol levels 1.
• Limit alcohol consumption to moderate levels and completely avoid tobacco products, as smoking damages blood vessels and lowers HDL cholesterol 1. These approaches work by reducing cholesterol production in the liver, enhancing cholesterol elimination, and improving overall metabolic health, often producing noticeable improvements within 3-6 weeks of consistent implementation 1.

From the FDA Drug Label

Although in man, cholestyramine resin produces an increase in hepatic synthesis of cholesterol, plasma cholesterol levels fall In a large, placebo-controlled, multi-clinic study, LRC-CPPT1, hypercholesterolemic subjects treated with cholestyramine resin had mean reduction in total and low-density lipoprotein cholesterol (LDL-C) which exceeded those for diet and placebo treatment by 7.2% and 10. 4%, respectively. In the St. Thomas Atherosclerosis Regression Study (STARS)3,90 hypercholesterolemic men with CAD were randomized to three blinded treatments: usual care, lipid-lowering diet and lipid-lowering diet plus cholestyramine resin To reduce LDL and total cholesterol through dietary and lifestyle modifications, the following strategies can be considered:

• Lipid-lowering diet: As seen in the St. Thomas Atherosclerosis Regression Study, a lipid-lowering diet can help reduce the progression of coronary artery disease and promote regression of atherosclerotic lesions.
• Combination therapy: Using a combination of diet and medication, such as cholestyramine resin, can be effective in reducing LDL and total cholesterol levels, as well as slowing the progression of coronary artery disease 2.

From the Research

Dietary and Lifestyle Modifications to Reduce LDL and Total Cholesterol

To reduce LDL and total cholesterol, several dietary and lifestyle modifications can be implemented. These include:

• Increasing physical activity to at least 150 minutes of moderate-intensity aerobic exercise per week 3
• Eating a healthy diet that is low in saturated and trans fats, added sugars, and refined carbohydrates
• Incorporating plant-based foods, such as fruits, vegetables, and whole grains, into the diet
• Choosing lean protein sources, such as poultry, fish, and legumes
• Limiting dietary cholesterol to less than 300 milligrams per day

Pharmacological Interventions

In addition to dietary and lifestyle modifications, pharmacological interventions may be necessary to reduce LDL and total cholesterol. These include:

• Statins, such as rosuvastatin, which inhibit the production of cholesterol in the liver 4, 5, 6
• Ezetimibe, which inhibits the absorption of cholesterol in the intestine 4, 5, 7, 6, 3
• Combination therapy with rosuvastatin and ezetimibe, which has been shown to be effective in reducing LDL and total cholesterol 4, 5, 6

Benefits of Combination Therapy

Combination therapy with rosuvastatin and ezetimibe has been shown to have several benefits, including:

• Greater reductions in LDL and total cholesterol compared to monotherapy with either agent 4, 5, 7, 6
• Improved attainment of LDL goals, including LDL < 100 mg/dL and LDL < 70 mg/dL 7, 3
• A similar safety profile to monotherapy with either agent 5, 6