What are the recommended lifestyle modifications for patients with hyperlipidaemia before initiating pharmacotherapy?

Recommended lifestyle modifications for patients with hyperlipidaemia before initiating pharmacotherapy include:

• Adopt a diet where total fat intake is 30% or less of total energy intake, with saturated fats making up less than 7-10% of total energy intake, and dietary cholesterol less than 300 mg/day. Replace saturated fats with monounsaturated and polyunsaturated fats such as olive oil or rapeseed oil.
• Consume at least 5 portions of fruit and vegetables daily, and at least 2 portions of fish per week, including one portion of oily fish (pregnant women should limit oily fish to 2 portions per week).
• Engage in physical activity consistent with national guidelines for the general population, including aerobic and muscle-strengthening activities; if moderate-intensity activity is not possible due to comorbidities, exercise at the maximum safe capacity is encouraged. Recommended activities include brisk walking, stair climbing, and cycling.
• Manage weight appropriately, offering advice and support to achieve and maintain a healthy weight if overweight or obese.
• Limit alcohol consumption to recommended levels (men up to 3-4 units/day, women up to 2-3 units/day) and avoid binge drinking.
• Advise smoking cessation and provide support to stop smoking.
• Exclude secondary causes of dyslipidaemia such as excess alcohol intake, uncontrolled diabetes, hypothyroidism, liver disease, and nephrotic syndrome before considering pharmacotherapy.
• Offer support or referral to lifestyle change programmes such as exercise referral schemes or smoking cessation services as needed.

These lifestyle modifications should be attempted and optimised before initiating pharmacotherapy, with reassessment of cardiovascular risk after lifestyle changes. Pharmacotherapy, such as statins, is offered if lifestyle modification is ineffective or inappropriate.

References: ¹,²,⁵,⁶