Heart 97:923-930 doi:10.1136/hrt.2010.216309
  • Epidemiology
  • Original article

Decline in low-density lipoprotein cholesterol concentration: lipid-lowering drugs, diet, or physical activity? Evidence from the Whitehall II study

Open Access
  1. Mika Kivimäki1,7
  1. 1Department of Epidemiology and Public Health, University College London, London, UK
  2. 2INSERM U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
  3. 3Hôpital Sainte Périne, Centre de Gérontologie, AP-HP, Paris, France
  4. 4Department of Psychology, University of Helsinki, Helsinki, Finland
  5. 5Semmelweis University Faculty of Medicine, 1st Department of Medicine, Budapest, Hungary
  6. 6INSERM U888, Université Montpellier I, Montpellier, France
  7. 7Finnish Institute of Occupational Health, Helsinki, Finland
  1. Correspondence to Dr Kim Bouillon, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; kim.bouillon.09{at}
  1. Contributors All authors contributed to the conception and design, and to analysis and interpretation of data; or wrote the first draft of the article and revised it critically for important intellectual content. All approved the final version to be published.

  • Accepted 11 February 2011
  • Published Online First 12 April 2011


Objective To examine the association of lipid-lowering drugs, change in diet and physical activity with a decline in low-density lipoprotein (LDL) cholesterol in middle age.

Design A prospective cohort study.

Setting The Whitehall II study.

Participants 4469 British civil servants (72% men) aged 39–62 years at baseline.

Main Outcome Measure Change in LDL-cholesterol concentrations between the baseline (1991–3) and follow-up (2003–4).

Results Mean LDL-cholesterol decreased from 4.38 to 3.52 mmol/l over a mean follow-up of 11.3 years. In a mutually adjusted model, a decline in LDL-cholesterol was greater among those who were taking lipid-lowering treatment at baseline (−1.14 mmol/l, n=34), or started treatment during the follow-up (−1.77 mmol/l, n=481) compared with untreated individuals (n=3954; p<0.001); among those who improved their diet—especially the ratio of white to red meat consumption and the ratio of polyunsaturated to saturated fatty acids intake—(−0.07 mmol/l, n=717) compared with those with no change in diet (n=3071; p=0.03) and among those who increased physical activity (−0.10 mmol/l, n=601) compared with those with no change in physical activity (n=3312; p=0.005). Based on these estimates, successful implementation of lipid-lowering drug treatment for high-risk participants (n=858) and favourable changes in diet (n=3457) and physical activity (n=2190) among those with non-optimal lifestyles would reduce LDL-cholesterol by 0.90 to 1.07 mmol/l in the total cohort.

Conclusions Both lipid-lowering pharmacotherapy and favourable changes in lifestyle independently reduced LDL-cholesterol levels in a cohort of middle-aged men and women, supporting the use of multifaceted intervention strategies for prevention.


  • Funding The Whitehall II study has been supported by grants from the Medical Research Council, UK, Economic and Social Research Council, UK, British Heart Foundation, UK, Health and Safety Executive, UK, Department of Health, UK, BUPA Foundation, UK, National Heart Lung and Blood Institute (R01HL036310), USA and NIH: National Institute on Aging (R01AG013196; R01AG034454), USA. GDB is a Wellcome Trust Fellow (WBS U.1300.00.006.00012.01), UK. MJS is supported by the British Heart Foundation. MK is supported by the BUPA Foundation, UK, the Academy of Finland, Finland, and the EU OSH ERA research programme.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University College London Medical School committee on the ethics of human research (London, UK).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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