What lifestyle modifications should I advise to patients with familial hypercholesterolaemia in addition to pharmacological treatment?

Patients with familial hypercholesterolaemia should be advised to undertake physical activity in line with national guidance, including aerobic and muscle-strengthening activities, such as brisk walking, using stairs, and cycling, or exercising at their maximum safe capacity if unable to perform moderate activity ¹.

They should be encouraged to consume a diet where total fat intake is 30% or less of total energy, saturated fats are less than 7% of total energy, and dietary cholesterol is less than 300 mg/day, replacing saturated fats with monounsaturated and polyunsaturated fats like olive or rapeseed oil ¹.

Patients should eat at least 5 portions of fruit and vegetables daily and at least 2 portions of fish weekly, with pregnant women advised to limit oily fish to 2 portions per week ¹.

They should be advised that food products containing stanols and sterols need to be taken consistently to be effective if they wish to consume them ¹.

It is recommended that they do not routinely take omega-3 fatty acid supplements ¹.

Patients should be supported to achieve and maintain a healthy weight if overweight or obese, and to limit alcohol intake to up to 3-4 units per day for men and 2-3 units for women, avoiding binge drinking ¹.

Strong encouragement should be given to avoid smoking, and support should be offered to stop smoking, including referral to support services or pharmacotherapy if needed ¹.