How do lifestyle changes factor into whether or not you should start someone on a statin?

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As previously discussed, starting someone on a statin should not be a knee-jerk reaction. There’s a lot of room for tailoring therapy to the individual patient.

One component of individual tailoring is what one of my preceptors calls “TLC,” or therapeutic lifestyle changes. These are all the things we know are good for us but don’t often do: better diet, exercise.

These changes can benefit people with a medium cardiovascular risk of 6-15%. The key elements are:

  • Reduce saturated fat
  • Reduce simple carbs
  • Increase soluble fiber
  • Eat fish!
  • Exercise increases HDL (1 hour per day increases HDL 20%, equivalent to strongest drug). Also decreases triglycerides.
  • Drink only modest amounts of alcohol
  • Stop smoking!

After 6-12 weeks, check their LDL. If it’s still higher than 190, continue TLC for another 6-12 weeks. If this cycle fails twice, strongly consider a statin (and continue TLC no matter what!).


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