TLC vs Simvastatin vs Simvastatin and TLC in hypercholesterolemia

Purpose National Health and Morbidity Survey of Malaysia 2011 revealed that hypercholesterolemia (35.1 per cent, 6.2 million) was the primary leading causes of cardiovascular disease in Malaysia. Currently, three established recommended approaches such as therapeutic lifestyle change (TLC) diet, pharmacotherapy (simvastatin) and TLC + simvastatin are available to the public but, to our knowledge, have never been compared in Malaysia Primary Health Care setting. Hence, this paper aims to compare the lipid lowering effects of these three approaches in a primary health care clinic. Design/methodology/approach This randomized trial enrolled 180 patients with hypercholesterolemia who met adult treatment panel III (ATP III) criteria. All participants were randomized to TLC diet, simvastatin (10-20 mg/d) or TLC + simvastatin diets. The TLC group was enrolled in a 12-week multidisciplinary lifestyle program that involved monthly 45 minutes to hour meetings. The simvastatin group received medication, and traditional counseling was conducted by registered medical officer. Another group was enrolled into TLC + simvastain treatment. The primary outcome measure was the percentage change in low-density lipoprotein-cholesterol. Secondary measures were changes in weight loss, blood pressure and dietary changes. Assessments were repeated at three-month interval. Findings Lifestyle changes combined with simvastatin had a better lipid lowering effect compared to the other two treatments. However, TLC had a better weight and blood pressure reduction compared to the other two treatments. Nevertheless, TLC group showed reduction proportions similar to standard therapy with simvastatin or TLC + simvastatin. TLC has proven as an alternative approach to hyperlipidemia for a subset of patients unwilling or unable to take statins especially in a community-based, primary health care setting. Research limitations/implications Weight loss was not recorded for simvastatin participants, and this was the major drawback of this study, and there was no comparable weight loss reduction with other groups. Originality/value In Malaysia, the efficacy of hypocholesterolemic therapies among patients who are receiving the most common lipid-lowering drug, simvastatin, in primary health care setting has not been clearly defined. There is also a lack of research on the efficacy of TLC conducted by registered dietitian in a primary health care setting in Malaysia.