TITLE

Decline in low-density lipoprotein cholesterol concentration: lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study

AUTHOR(S)
Bouillon, Kim; Singh-Manoux, Archana; Jokela, Markus; Shipley, Martin J.; Batty, G. David; Brunner, Eric J.; Sabia, S⇔(c)verine; Tabák, Adam G.; Akbaraly, Tasnime; Ferrie, Jane E.; Kivimäki, Mika
PUB. DATE
June 2011
SOURCE
Heart;Jun2011, Vol. 97 Issue 11, p923
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objective To examine the association of lipid-lowering drugs, change in diet and physical activity with a decline in low-density lipoprotein (LDL) cholesterol in middle age. Design A prospective cohort study. Setting The Whitehall II study. Participants 4469 British civil servants (72% men) aged 39-62⇔ years at baseline. Main Outcome Measure Change in LDL-cholesterol concentrations between the baseline (1991-3) and follow-up (2003-4). Results Mean LDL-cholesterol decreased from 4.38 to 3.52⇔ mmol/l over a mean follow-up of 11.3⇔ years. In a mutually adjusted model, a decline in LDL-cholesterol was greater among those who were taking lipid-lowering treatment at baseline (⇔'1.14⇔ mmol/l, n=34), or started treatment during the follow-up (⇔'1.77⇔ mmol/l, n=481) compared with untreated individuals (n=3954; p<0.001); among those who improved their diet-especially the ratio of white to red meat consumption and the ratio of polyunsaturated to saturated fatty acids intake- (⇔'0.07⇔ mmol/l, n=717) compared with those with no change in diet (n=3071; p=0.03) and among those who increased physical activity (⇔'0.10⇔ mmol/l, n=601) compared with those with no change in physical activity (n=3312; p=0.005). Based on these estimates, successful implementation of lipid-lowering drug treatment for high-risk participants (n=858) and favourable changes in diet (n=3457) and physical activity (n=2190) among those with non-optimal lifestyles would reduce LDL-cholesterol by 0.90 to 1.07⇔ mmol/l in the total cohort. Conclusions Both lipid-lowering pharmacotherapy and favourable changes in lifestyle independently reduced LDL-cholesterol levels in a cohort of middle-aged men and women, supporting the use of multifaceted intervention strategies for prevention.
ACCESSION #
61037817

 

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