Adherence to lifestyle advice and its related cardiovascular disease risk among US adults with high cholesterol

Little is known about adherence to lifestyle advice from health professionals among people with high blood cholesterol, and its relationship with cardiovascular disease (CVD). We aimed to examine the proportion of adherence to lifestyle advice and its effect on lipid profile and CVD among people with high cholesterol. Within the National Health and Nutrition Examination Survey 1999–2010, the study included adults aged ≥20 years who were recommended to improve lifestyles in diet (N = 6645), bodyweight (N = 4797), or exercise (N = 5594) due to their high cholesterol. Adherent status was self-reported through questionnaires. Lipid measurements were collected from laboratory tests. 10-year Atherosclerotic CVD (ASCVD) risk was estimated by using pooled cohort risk equations for participants aged 40–79 years. CVD mortality up to December 31, 2019 was obtained from the National Death Index. The percentages of adherents were 80.9%, 80.7%, and 72.7% for eating less fat, controlling weight, and increasing exercise, respectively. The percentages of adherents for controlling weight and increasing exercise significantly increased from 1999 to 2000 to 2009–2010 (both Pₜᵣₑₙd <0.05). Adherents had a higher high-density lipoprotein cholesterol (HDL-C) and lower total cholesterol/HDL-C ratio than non-adherents (Pfₒᵣ dᵢffₑᵣₑₙcₑ <0.05 for all). Participants adhering to increasing exercise had a lower odds ratio of 10-year intermediate-to-high ASCVD risk (Odd ratio 0.73, 95% confidence interval [CI] 0.56–0.95) and a lower CVD mortality (Hazard ratio 0.70, 95% CI 0.51–0.97) than non-adherents. Lifestyle advice from health staff obtained relatively high and increasing acceptability. Given the better lipid profile and lower CVD risk of adherents, health professionals should be encouraged to recommend lifestyle modifications for adults with high cholesterol in clinical practice.