title: Decreasing cholesterol levels in the community--lifestyle change with statin?
abstract: BACKGROUND
  The Lapinlahti 2005-2010 study was carried out to explore cardiovascular disease risk factors and changes in lifestyle in Lapinlahti residents in eastern Finland. Our aim was to analyse factors influencing the level of cholesterol in the community.
  
  
  METHODS
  In 2005, 480 subjects aged 30-65 years underwent a complete health survey (baseline study) that consisted of a structured questionnaire and a health examination. The follow-up was carried out five years later in 2010. The present study population included 326 individuals who did not use lipid-lowering medication at the baseline. A trained research nurse measured weight, height, waist circumference and blood pressure at the baseline and follow-up. Respectively, lifestyle factors (nutrition, exercise, smoking and alcohol use) were examined with a structured questionnaire. Each lifestyle item was valued as -1, 0 or 1, depending on how closely it fitted to the recommendations. Cholesterol level analyses at the baseline and follow-up were performed according to the protocol of the Kuopio University Hospital's medical laboratory. Based on their baseline cholesterol levels, the participants were divided into tertiles. The age- and sex-adjusted linear trend between the tertiles was tested.
  
  
  RESULTS
  The change in cholesterol level was associated with lipid-lowering medication (P < 0.001). Lifestyle improvement was associated with the cholesterol level change but did not reach statistical significance (P = 0.061), although the interaction of lipid-lowering medication and lifestyle change was associated with the change in cholesterol level (P = 0.018). In multivariate analysis, a favourable change in fat consumption (P = 0.007) and lipid-lowering medication (P < 0.001) were associated with decreasing cholesterol levels.
  
  
  CONCLUSIONS
  At the population level, dyslipidaemia is one of the most easily modifiable risk factors of CHD. Lipid-lowering medication may have the most significant impact on cholesterol level in communities with primary health care with good coverage. On the other hand, the potential of health-promoting and population-based prevention strategies may be underused.
authors: Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland. Jorma.Savolainen@uef.fi.|Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI-72009 KYS, Kuopio, Finland. Jorma.Savolainen@uef.fi.
authors: Jorma
authors: J
authors: Savolainen
authors: Department of General Practice, Helsinki University Central Hospital, Unit of Primary Health Care and University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland. Hannu.Kautiainen@medcare.fi.
authors: Hannu
authors: H
authors: Kautiainen
authors: Endocrinology, Abdominal Center, Helsinki University Central Hospital, P.O. Box 55, FI- 00014, Helsinki, Finland. Leo.Niskanen@hus.fi.
authors: Leo
authors: L
authors: Niskanen
authors: Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland. Pekka.Mantyselka@uef.fi.|Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI-72009 KYS, Kuopio, Finland. Pekka.Mantyselka@uef.fi.
authors: Pekka
authors: P
authors: Mäntyselkä
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D002784:Cholesterol / Q000097:blood*; D050171:Dyslipidemias / Q000188:drug therapy*; D015444:Exercise; D005260:Female; D005387:Finland; D006293:Health Promotion; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol