Hypercholesterolemia and cardiovascular disease: What to do before initiating pharmacological therapy.

The availability of efficient lipid-lowering drugs has substantially reduced the incidence and mortality for cardiovascular disease (CVD). Despite that, CVD still represents a major cause of death and disability; efforts are thus required to prevent this disease, since reducing the established CV risk factors may slow or prevent the onset of cardiovascular events. Current guidelines recommend a healthier lifestyle for all CV risk categories, as it may have a beneficial impact on several risk factors; in individuals with a low-to-moderate hypercholesterolemia, which are not eligible for a pharmacological approach and are not far from the cholesterol target recommended for their risk category, functional foods or nutraceuticals may be considered as supplement to reduce their CV risk status. Of note, counseling and lifestyle intervention in people at moderate CV risk represents a major issue for both preventing a further risk increase and reducing the need for drugs. Studies on general populations have clearly indicated that lifestyle interventions translate into a clinical benefit, with reduction of the incidence of myocardial infarction and the risk of developing type 2 diabetes.
Competing Interests: Declaration of competing interest B.F. has received lecture fees from MEDA pharmaceuticals; C.J. and A.P. report no conflicts of interest; L.T. is Company consultant for Abbott, Amgen, Bayer, MSD, Mylan, Sanofi, and has received honorarium as speaker from Abbott, Actelion, Amgen, Astra, Bayer, Daiichi Sankyo MSD, Mylan, Novartis, Novo Nordisk, Sanofi, Servier, Pfizer, Recordati; M.P. reports no conflicts of interest; ALC reports grants from Amgen, Sanofi, Regeneron personal fees from Merck, Sanofi, Regeneron, AstraZeneca, Amgen, Novartis, outside the submitted work.
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