Background: Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. The
growth of ageing populations in developing countries with progressively urbanized lifestyles are major contributors. The
key risk factors for CHD such as hypercholesterolemia, diabetes mellitus, and obesity are likely to increase in the future.
These risk factors are modifiable through lifestyle.
Objectives: To review current literature on the potential benefit of cholesterol lowering in CHD risk reduction with a particular
focus on the evidence of non-pharmacological/lifestyle management of hypercholesterolemia.
Methods: Medline/PubMed systematic search was conducted using a two-tier approach limited to all recent English language
papers. Primary search was conducted using key words and phrases and all abstracts were subsequently screened
and relevant papers were selected. The next tier of searching was conducted by (1) reviewing the citation lists of the selected
papers and (2) by using PubMed weblink for related papers. Over 3600 reports were reviewed.
Results: Target cholesterol levels set out in various guidelines could be achieved by lifestyle changes, including diet,
weight reduction, and increased physical activity with the goal of reducing total cholesterol to <200 mg/dL and LDL-C
<100mg/dL. Various dietary constituents such as green tea, plant sterols, soy protein have important influences on total
cholesterol. Medical intervention should be reserved for those patients who have not reached this goal after 3 months of
Conclusion: CHD remains as a leading cause of death worldwide and hypercholesterolemia is an important cause of CHD.
Non-pharmacological methods provide initial as well as long-term measures to address this issue.