title: Evidence of lifestyle modification in the management of hypercholesterolemia.
abstract: BACKGROUND
  Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. The growth of ageing populations in developing countries with progressively urbanized lifestyles are major contributors. The key risk factors for CHD such as hypercholesterolemia, diabetes mellitus, and obesity are likely to increase in the future. These risk factors are modifiable through lifestyle.
  
  
  OBJECTIVE
  To review current literature on the potential benefit of cholesterol lowering in CHD risk reduction with a particular focus on the evidence of non-pharmacological/lifestyle management of hypercholesterolemia.
  
  
  METHODS
  Medline/PubMed systematic search was conducted using a two-tier approach limited to all recent English language papers. Primary search was conducted using key words and phrases and all abstracts were subsequently screened and relevant papers were selected. The next tier of searching was conducted by (1) reviewing the citation lists of the selected papers and (2) by using PubMed weblink for related papers. Over 3600 reports were reviewed.
  
  
  RESULTS
  Target cholesterol levels set out in various guidelines could be achieved by lifestyle changes, including diet, weight reduction, and increased physical activity with the goal of reducing total cholesterol to <200 mg/dL and LDL-C<100 mg/dL. Various dietary constituents such as green tea, plant sterols, soy protein have important influences on total cholesterol. Medical intervention should be reserved for those patients who have not reached this goal after 3 months of non-pharmacological approach.
  
  
  CONCLUSIONS
  CHD remains as a leading cause of death worldwide and hypercholesterolemia is an important cause of CHD. Non-pharmacological methods provide initial as well as long-term measures to address this issue.
authors.affiliation: Medicine and Biochemistry, C/o Level 2, MFE Offices, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK. Gurdeepmannu@gmail.com
authors.forename: G S
authors.initials: GS
authors.lastname: Mannu
authors.forename: M J S
authors.initials: MJ
authors.lastname: Zaman
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: H U
authors.initials: HU
authors.lastname: Rehman
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D004032:Diet; D015444:Exercise; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control*; D008019:Life Style; D012307:Risk Factors; D015431:Weight Loss