Effectiveness of Altering Serum Cholesterol Levels Without Drugs (Disease/Disorder Overview‪)‬

Drug therapy with statins and other agents can result in dramatic lipid-lowering effects. Despite the wealth of data supporting the beneficial effects of pharmacologic therapy on cardiovascular risk, patients often express a desire to accomplish similar goals with diet alone. And, except for patients with extreme cholesterol elevations, consensus panels all promote dietary therapy as an initial step in the treatment of hyperlipidemia. This review examines a variety of dietary strategies designed to lower lipid levels, including the American Heart Association diet, the Ornish diet, the Mediterranean diet, exercise, phytosterols, fiber, soy products, and fish oil. Though the declines in low-density lipoprotein cholesterol levels with these methods range from 0% to 37%, cardiovascular risk may be more significantly impacted than would be predicted from these changes alone. Significant benefits can be reaped from nonpharmacologic measures. Despite all of the positive research and trial data about statins and other pharmacologic interventions for treating elevated cholesterol, patients do not take these drugs. In my practice, patients, even those with very high lipids and known heart disease, ask if they could try to lower their cholesterol with diet alone. Or, if they have already started a statin, they want to stop it because of side effects or cost. Drug companies note that upwards of 30% of patients initiated on statins do not continue their prescriptions. These reasons warrant a review of the efficacy of dietary and nonpharmacologic measures to lower cholesterol compared with pharmacologic therapy.