Effect of lifestyle and drug interventions on lipid levels
| Type of study | TC (mmol/L) | LDL-C (mmol/L) | HDL-C (mmol/L) | TG (mmol/L) | Reference | |
| Lifestyle interventions | ||||||
| Weight loss | ||||||
| Any intervention | Meta-analysis | −0.09 (−0.42 to 0.24)* | −0.20 (−0.29 to −0.10) | NR | −0.13 (−0.22 to 0.03) | 48 |
| Lifestyle weight loss, OW+T2DM | Meta-analysis, <5% WL | 0.11 (−0.40 to 0.17) | 0.02 (−0.44 to 0.40) | 0.03 (−0.01 to 0.07) | −0.19 (−1.01 to 0.62) | 11 |
| Meta-analysis, ≥5% WL | −0.39 (−0.47 to −0.32) | −0.11 (−0.14 to −0.09) | 0.09 (0.07 to 0.10) | −0.33 (−0.37 to 0.29) | 11 | |
| Intermittent versus continuous fasting | Meta-analysis | 0.01 (−0.10 to 0.12) | −0.02 (−0.11 to 0.08) | 0.04 (−0.005 to 0.09) | −0.04 (−0.11 to 0.04) | 12 |
| Any weight loss drug | Meta-analysis | NR | −0.003 (−0.01 to −0.001) | 0.003 (0.004 to 0.007) | NR | 13 |
| Weight loss by Orlistat® | Meta-analysis | −0.30 (−0.34 to −0.25) | −0.27 (−0.32 to −0.22) | −0.034 (−0.04 to −0.02) | −0.09 (−0.12 to −0.06) | 14 |
| Smoking cessation | Prospective study | 0.140 | NR | 0.098 | NR | 17 |
| Prospective study | 0.121 | 0.077 | 0.045 | 0.021 | 16 | |
| RCT | NR | 0.013 | 0.062 | −0.134 | 18 | |
| Intervention study | −0.424† | −0.225† | 0.070† | 0.0† | 19 | |
| Intervention study | 0.173† | NR | 0.091† | 0.343† | 15 | |
| Intervention study | 0.01† | −0.04† | 0.06† | −0.29† | 49 | |
| Meta-analysis | 0.003 (−0.042 to 0.048) | −0.064 (−0.149 to 0.021) | 0.100 (0.07 to 0.127) | 0.028 (−0.014 to 0.071) | 50 | |
| Diet | ||||||
| Salt reduction | Meta-analysis | 0.146 (0.228 to 0.064) | 0.081 (−0.011 to 0.172) | −0.007 (−0.043 to 0.028) | 0.079 (0.125 to 0.034) | 23 |
| Fat replacement/reduction | Meta-analysis | −0.44 (−0.60 to −0.28) | −0.20 (−0.47 to 0.07) | −0.04 (−0.18 to 0.09) | −0.11 (−0.22 to 0) | 27 |
| Fat reduction | Meta-analysis | −0.10 (−0.14 to −0.05) | −0.10 (−0.14 to −0.05) | −0.01 (−0.02 to 0.01) | 0.0 (0.0 to 0.0) | 27 |
| SFA reduction | Meta-analysis | −0.24 (−0.36 to −0.13) | −0.19 (−0.33 to −0.05) | −0.01 (−0.02 to 0.01) | −0.08 (−0.21 to 0.04) | 51 |
| Increased omega-6 intake | Meta-analysis | −0.33 (−0.50 to −0.16) | −0.04 (−0.21 to 0.14) | −0.01 (−0.03 to 0.02) | −0.01 (−0.23 to 0.21) | 28 |
| Increased omega-3 intake | Meta-analysis | −0.01 (−0.05 to 0.04) | 0.01 (−0.01 to 0.03) | 0.02 (0 to 0.04) | −0.24 (−0.31 to −0.16) | 52 |
| Increased nut intake | Meta-analysis | −0.122 (−0.137 to −0.103) | −0.124 (−0.142 to −0.109) | −0.007 (−0.022 to 0.009) | −0.025 (−0.043 to −0.006) | 30 |
| Decreased sugar intake | Meta-analysis | −0.16 (−0.24 to −0.10) | −0.12 (−0.19 to −0.05) | −0.02 (−0.03 to 0) | −0.11 (−0.15 to −0.07) | 31 |
| Low glycaemic diet | Meta-analysis | −0.22 (−0.43 to −0.02) | −0.24 (−0.44 to −0.05) | NR | 0.08 (−0.11 to 0.27) | 32 |
| Meta-analysis | −0.032 (−0.145 to 0.082) | −0.007 (−0.115 to 0.100) | 0.019 (−0.006 to 0.044) | −0.010 (−0.064 to 0.044) | 53 | |
| Increased fibre intake | Meta-analysis | −0.20 (−0.34 to −0.06) | −0.14 (−0.22 to −0.06) | −0.03 (−0.06 to −0.01) | 0.00 (−0.04 to 0.05) | 33 |
| Advice to eat more fruits and vegetables | Meta-analysis | −0.01 (−0.11 to 0.09) | −0.17 (−0.38 to 0.03) | −0.01 (−0.10 to 0.08) | 0.10 (−0.06 to 0.27) | 34 |
| Vitamin D supplementation | Meta-analysis | NR | 0.34 (0.07 to 0.61) | 0.11 (−0.06 to 0.28) | −0.24 (−0.50 to 0.03) | 37 |
| Increased EPA intake | Meta-analysis | NR | −0.046 (−0.048 to 0.139) | NR | NR | 54 |
| Increased DHA intake | Meta-analysis | NR | 0.187 (0.103 to 0.272) | NR | NR | 54 |
| Increased phytosterol intake | Meta-analysis | NR | −0.47 (−0.56 to −0.37) | NR | NR | 55 |
| Red yeast rice | Meta-analysis | −0.97 (−1.13 to −0.80) | −0.87 (−1.03 to −0.71) | 0.08 (−0.02 to 0.19) | −0.23 (−0.31 to −0.14) | 56 |
| Mediterranean diet | Meta-analysis | NR | NR | 0.030 (0.010 to 0.051) | −0.069 (−0.117 to −0.022) | 39 |
| Nordic diet | Meta-analysis | −0.38 (−0.76 to −0.01) | −0.30 (−0.54 to −0.06) | −0.07 (−0.16 to 0.02) | −0.01 (−0.13 to 0.12) | 41 |
| DASH diet | Meta-analysis | −0.20 (−0.31 to −0.10) | −0.10 (−0.20 to −0.01) | 0.003 (−0.05 to 0.05) | −0.005 (−0.06 to 0.05) | 42 |
| High-intensity dietary counselling | Meta-analysis | −0.12 (−0.16 to −0.07) | −0.09 (−0.14 to −0.04) | 0.02 (0 to 0.04) | −0.10 (−0.16 to −0.04) | 44 |
| Exercise | ||||||
| Any type | Meta-analysis, T2DM | −0.11 (−0.41 to 0.18) | 0.12 (−0.29 to 0.53) | −0.02 (−0.10 to 0.06) | −0.25 (−0.48 to −0.02) | 61 |
| Meta-analysis | 0.030 (−0.240 to 0.310) | 0.100 (−0.210 to 0.010) | 0.060 (0.030 to 0.100) | −0.060 (−0.120 to −0.010) | 62 | |
| Resistance training | Meta-analysis | −0.142 (−0.621 to 0.336) | −0.158 (−0.747 to 0.424) | 0.018 (−0.230 to 0.269) | −0.091 (−0.390 to 0.207) | 63 |
| Aerobic exercise | Meta-analysis, OW | −0.055 (−0.228 to 0.118) | −0.013 (−0.206 to 0.179) | 0.034 (−0.004 to 0.072) | NR | 64 |
| Hypolipidaemic drugs | ||||||
| Rosuvastatin | Meta-analysis | NR | −46% to −55% | 7% | NR | 95 |
| Fluvastatin | Meta-analysis | −11% to −25% | −15% to −33% | No effect | −3% to −17.5% | 96 |
| Simvastatin | Meta-analysis | NR | −18% to −56% | 0% to 13% | −48% to +1% | 97 |
| Atorvastatin | Meta-analysis | −27% to −38.1% | −37% to −52% | 1.8% to 4.7% | −17.8% to −27.7% | 98 |
Results are expressed as value and (95% CI) whenever available. Lifestyle interventions with significant effects are indicated in bold font. Omega-3 and omega-6 fatty acids are polyunsaturated fatty acids characterised by the presence of a cis-double bond located three (respectively six) atoms away from the terminal group of their carbon chain. EPA is an omega-3 fatty acid found in fatty fish such as salmon; it is composed of a carbon chain made of 20 atoms and has five cis-double bonds. DHA is an omega-3 fatty acid found in fish oil; it is composed of a carbon chain made of 22 atoms and has six cis-double bonds.
*Effect at 12–24 months.
†Relative to people who continued smoking.
DASH, Dietary Approach to Stop Hypertension; DHA, docosahexaenoic acid ; EPA, eicosapentaenoic acid ; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; NR, not reported; OW, overweight or obese subjects; RCT, randomised controlled trial; SFA, saturated fatty acid; TC, total cholesterol; T2DM, type 2 diabetes mellitus; TG, triglyceride; WL, weight loss.