How healthy lifestyle behavior can improve cholesterol profiles

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According to a study published on February 9 in eLife, combining interventions for a healthy lifestyle reduced heart disease through beneficial effects on various lipoproteins and associated cholesterols.

Healthy lifestyles have long been linked to lower risk of heart disease. The new study provides more detailed information on how a healthy lifestyle improves cholesterol and suggests that the combination of cholesterol-lowering drugs and lifestyle interventions may bring the greatest benefits to heart health.

Cholesterol-lowering drugs like statins help reduce heart risk by lowering levels of low-density lipoprotein (LDL) cholesterol, also known as “bad” cholesterol. Healthy lifestyle interventions, including regular exercise, healthy eating, lowering alcohol consumption, and maintaining a healthy weight, have also been shown to lower LDL and increase “healthy” high density lipoprotein (HDL) cholesterol.

“To date, no studies have compared the lipid-lowering effects of cholesterol-lowering drugs and healthy lifestyle interventions side by side,” says lead author Jiahui Si, a postdoctoral fellow in the Epidemiology Department at Harvard TH Chan School of Public Health. Boston, Massachusetts, USA.

To fill this gap, Si and colleagues used a technique called nuclear magnetic resonance targeted spectroscopy to measure 61 different lipid markers in blood samples from 4,681 participants in the China Kadoorie Biobank, including cases of stroke, coronary artery disease, and healthy individuals. They examined lipid markers in the blood of participants with several healthy habits and compared them to those of participants with less healthy habits. They found 50 lipid markers associated with a healthy lifestyle.

When the team examined a subset of 927 people with coronary artery disease over the next 10 years and 1,513 healthy people, they found 35 lipid markers that showed statistically significant mediation effects on the path from healthy lifestyle to reduction in heart disease. Taken together, the combined beneficial effects of lipid changes associated with a healthy lifestyle were associated with a 14% reduced risk of heart disease. In particular, very low density lipoprotein (VLDL) and HDL levels in the blood have been linked to the heart protective benefits of a healthy lifestyle.

“Using a genetic assessment technique, we were able to compare the effects of cholesterol-lowering drugs with the effects of lifestyle in the study participants,” says co-senior author Liming Liang, associate professor of statistical genetics in the Department of Epidemiology at Harvard TH Chan School of Public Health . “Our analysis confirmed that cholesterol lowering drugs would have the expected effect in lowering LDL cholesterol, but this is much weaker than the effect of healthy behavior on VLDL cholesterol, which also increases the risk of heart disease.”

Overall, they found that taking cholesterol-lowering drugs and participating in multiple healthy lifestyles would likely help to achieve the greatest cardioprotective benefits due to the complementary effects of the drugs and healthy behavior.

“Lifestyle interventions and lipid lowering drugs can affect different components of the lipid profile, suggesting that they are not redundant strategies but could be combined for enhanced benefit,” concludes co-senior author Jun Lv, professor at the Department of Epidemiology and Biostatistics at School of Public Health, Beijing University Health Science Center, Beijing, China.

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