Diet and exercise are the cornerstones of treatment for asymptomatic patients with dyslipidemia (Stefanick, 1998 [A]). Patients with an elevated LDL-cholesterol level should begin the Therapeutic Lifestyle Changes program and an individualized program of regular exercise. A diet low in saturated and transfats, and high in soluble fiber, consideration given to adding 2 grams plant sterol/stanol is recommended.
• Patients who are overweight should be advised to reduce their calorie intake to achieve weight loss. • Patients should follow the diet and exercise program for a reasonable amount of time to determine whether their LDL-cholesterol level is lowered to the target range. For many asymptomatic patients, a diet and exercise program is sufficient. Lifestyle modifications include diet; aerobic exercise; weight management; smoking cessation; evaluation of alcohol consumption; and a nutritional supplement containing sitostanol ester, a saturated derivative of a plant seed oil (EPA-DHA). The addtion of two grams plant sterol/stanol can effectively lower LDL. To avoid unintended toxic effects from vitamins, patients should be cautioned not to exceed recommended doses. Vitamin E supplements should not be used. Studies have shown no benefit in preventing clinical outcomes, and smaller studies suggest a blunting of the benefit from antidyslipidemic medications on HDL-C and angiographic progression of vascular disease (Brown, 2001 [A]; Cheung, 2001 [A]). Please refer to Appendix A, "Omega-3 Fatty Acids," and Appendix C, "Drug Companion Document," for additional information.Other management strategies, therapeutic lifestyle change (TLC), may include the following. |