title: Decline in low-density lipoprotein cholesterol concentration: lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study.
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.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  The Whitehall II study.
  
  
  METHODS
  4469 British civil servants (72% men) aged 39-62 years at baseline.
  
  
  METHODS
  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.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK. kim.bouillon.09@ucl.ac.uk
authors.forename: Kim
authors.initials: K
authors.lastname: Bouillon
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: G David
authors.initials: GD
authors.lastname: Batty
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Brunner
authors.forename: Séverine
authors.initials: S
authors.lastname: Sabia
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tabák
authors.forename: Tasnime
authors.initials: T
authors.lastname: Akbaraly
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000328:Adult; D008078:Cholesterol, LDL / Q000378:metabolism*; D004032:Diet; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000628:therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008131:London; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents