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01-11-2009 | Cardiometabolic | Article

Non-drug therapies prevalent, effective in hypercholesterolemia


Free abstract

MedWire News: Most people with high cholesterol levels use non-drug diet and lifestyle measures as advised by their doctors, a Spanish population survey shows.

Importantly, individuals who use non-pharmacologic approaches to lower their cholesterol showed lower mortality over 6 years of follow-up than those who did not, underscoring the importance of “lifestyle” adjuncts to lipid-lowering drug therapy.

The study involved 4008 adults aged 60 years who were representative of the elderly noninstitutionalized Spanish population. They were interviewed and examined in 2001, at which time 24.8% had a diagnosis of hypercholesterolemia.

In the subset of 918 hypercholesterolemic individuals, 83.8% reported using at least one specific nonpharmacologic measure to reduce their cholesterol – defined as weight control/loss, increased physical activity, or reduced dietary intake of saturated fat/cholesterol – in accordance with advice from their doctor.

Nearly one-third (29.5%) of hypercholesterolemic participants used all three measures.

Between 2001 and 2007, 145 hypercholesterolemic individuals died. There was a significant linear correlation between use of nondrug measures and mortality, such that mortality was highest among those who used no non-drug measures and lowest among those who used all three measures (60% vs 41%).

More detailed analysis revealed that increasing physical activity was independently associated with reduced mortality (hazard ratio 0.55), after adjusting for confounders.

By contrast, neither weight control nor dietary changes were independently associated with significant reductions in mortality.

Writing in the Journal of the American Geriatric Society, José Banegas (Universidad Autónoma de Madrid) and team say their results “show that the large majority of older adults with known hypercholesterolemia reported adherence to some nonpharmacologic measure specifically to control high plasma cholesterol.”

Although increased physical activity was the only measure that was independently associated with lower mortality 6 years later, they write: “Nonetheless, this study showed that the more nonpharmacologic measures that subjects reported adherence to, the lower the risk of mortality and that adherence to all three measures is associated with a substantial reduction in mortality in this population.”

The team concludes: “These findings are especially important in older persons, who bear most of the burden of cardiovascular disease and would therefore derive greatest benefit from the recommendations.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Joanna Lyford