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

Kim Bouillon, Archana Singh-Manoux, Markus Jokela, Martin J. Shipley, G. David Batty, Eric J. Brunner, Séverine Sabia, Adam G. Tabák, Tasnime Akbaraly, Jane E. Ferrie, Mika Kivimäki

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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.

Original languageEnglish
Pages (from-to)923-930
Number of pages8
JournalHeart
Volume97
Issue number11
DOIs
Publication statusPublished - Jun 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Bouillon, K., Singh-Manoux, A., Jokela, M., Shipley, M. J., Batty, G. D., Brunner, E. J., Sabia, S., Tabák, A. G., Akbaraly, T., Ferrie, J. E., & Kivimäki, M. (2011). Decline in low-density lipoprotein cholesterol concentration: Lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study. Heart, 97(11), 923-930. https://doi.org/10.1136/hrt.2010.216309