Other measures have mixed results
High-quality RCTs (N=267) with yoga or tai chi as the exercise intervention showed a statistically significant decrease in LDL-C over 12 to 14 weeks.12 Two RCTs investigated the effect of meditation on LDL-C with mixed results. One (N=16) showed a significant decrease in LDL-C over 8 weeks, while a second (N=60) showed no difference in LDL-C. A high-quality RCT (N=91) with a combined intervention (counseling, exercise, and meditation over 1 year) showed a significant decrease in LDL-C.
In cross-sectional surveys, LDL-C does not appear to differ between smokers and nonsmokers. One meta-analysis found a dose-dependent relationship between smoking and LDL-C, with overall LDL-C 1.7% higher for smokers compared with nonsmokers.13 Two RCTs investigated the effect of smoking cessation on LDL-C with mixed results. One (N=935) showed a decrease in nonfasting LDL-C while a second (N=140) showed no difference in LDL-C.
Recommendations from others
According to ATP III guidelines,3 all adults with LDL-C above goal should be treated with therapeutic lifestyle changes for primary and secondary prevention of CHD. These include a diet intervention, increased physical activity, and weight loss. Physicians are encouraged to refer patients to a nutritionist. If LDL-C is not at goal after 6 weeks, changes are intensified; physicians should consider pharmacologic therapy if a patient is still unable to attain his or her goal. ACP III guidelines recommend an office visit every 4 to 6 months to monitor adherence.
American Heart Association guidelines recommend that physicians counsel smokers at every office visit to stop smoking. The American College of Cardiology recommends abstinence from alcohol for patients with suspected alcoholic cardiomyopathy. For patients with heart failure from any other cause, alcohol consumption is usually limited to 1 drink per day.