Usual care dietary practice, achievement and implications for medication in the management of hypercholesterolaemia

Abstract

Aims: To evaluate long-term responses to cholesterol-lowering diets in usual care and their associations with responses to lipid medication. Methods: Analysis of paired data from the U.K. Lipid Clinics Programme computerized database for lipid responses, and associations of weight loss with later response to medication, plus analysis of a questionnaire on clinic dietary practice. Results: Cholesterol, predominantly as low density lipoprotein was reduced in 60% of 2508 patients entered, and maintained long-term. Moderate 5-7% average responses incorporated reductions of at least 0.6 mmol . 1-1 in 40% of patients, consistent with a 25% fall in the risk of cardiac events if maintained for 2 years. Responses to medication were greater for up to 2194 patients who previously lost weight on diet, an effect not apparent for 291 patients on statins alone. Physicians worked with dieticians in most clinics, and with individually tailored diets but with incomplete appreciation of the differences between available dietary protocols. Conclusions: Usual care dietary advice can be effective in lipid management, weight loss is important and associates with greater responses to lipid medication although statin monotherapy may not be affected. However, average responses are modest and physicians are not well informed of the dietary principles involved.