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Nutrients
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Nutrition, Lifestyle and Treatment in Patients with Hypercholesterolemia
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Nutrition, Lifestyle and Treatment in Patients with Hypercholesterolemia

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Metabolism".

Deadline for manuscript submissions: 5 February 2026 | Viewed by 2709

Special Issue Editor

Dr. Christina Antza

E-Mail Website
Guest Editor
3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, 564 03 Thessaloniki, Greece
Interests: hypertension; diabetes mellitus; metabolic syndrome; obesity; early vascular aging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Reducing hypercholesterolemia is crucial for preventing cardiovascular diseases, one of the leading causes of morbidity and mortality worldwide. Elevated cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, contribute to the buildup of plaque in the arteries, narrowing them and restricting blood flow, which can lead to heart attacks, strokes, and peripheral artery disease. By managing cholesterol levels, individuals can significantly lower their risk of developing these severe health issues. Therefore, addressing high cholesterol is a key preventive measure that promotes long-term wellness and longevity.

The role of lifestyle, nutrition, and treatment in managing hypercholesterolemia is essential for developing effective strategies to combat this widespread health issue. Lifestyle factors, including physical activity and nutrition, play a significant role in controlling cholesterol levels and improving heart health. Nutritional research, in particular, provides insights into how specific foods—like those rich in fibre, healthy fats, and antioxidants—can lower low-density lipoprotein (LDL) cholesterol and support cardiovascular health. Additionally, treatment research, encompassing both pharmacological approaches (such as statins and PCSK9 inhibitors) and alternative therapies, helps determine the most effective interventions for individuals who may not achieve optimal cholesterol levels through lifestyle changes alone. Understanding how each of these areas contributes to cholesterol management enables healthcare providers to create personalized, holistic plans that address the root causes of hypercholesterolemia and prevent the progression of cardiovascular diseases. Hence, for this Special Issue, we wish to receive original data, meta-analyses, or systematic reviews showing the effects of lifestyle (nutrition, exercise and treatment) on hypercholesterolemia or on cardiometabolic risk factors in patients with hypercholesterolemia.

Dr. Christina Antza
Guest Editor

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Keywords

  • nutrition
  • diet
  • lifestyle
  • exercise
  • obesity
  • cardiovascular risk
  • hypercholesterolemia

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Published Papers (2 papers)

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Research

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19 pages, 971 KB  
Article
Impact of Dietary Patterns on the Lipidemic Profile and the Cardiovascular Risk in Stage 1 Hypertension: A Post Hoc Analysis of the HINTreat Trial
by Anastasios Vamvakis, Antonios Lazaridis, Maria G. Grammatikopoulou, Anastasia Malliora, Kyriaki Tsiroukidou, Christos Tzimos, Andrea Di Blasio, Pascal Izzicupo and Eugenia Gkaliagkousi
Nutrients 2025, 17(16), 2632; https://doi.org/10.3390/nu17162632 - 14 Aug 2025
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Abstract
Background/Objectives: In hypertension (HTN), lifestyle modification is important for controlling blood pressure (BP) and lipidemic profile. The HINTreat trial showed that an anti-inflammatory diet was associated with improved endothelial function, after six months of intensive nutritional treatment. Methods: This post hoc [...] Read more.
Background/Objectives: In hypertension (HTN), lifestyle modification is important for controlling blood pressure (BP) and lipidemic profile. The HINTreat trial showed that an anti-inflammatory diet was associated with improved endothelial function, after six months of intensive nutritional treatment. Methods: This post hoc analysis of the HINTreat trial examined how adherence to various nutritional patterns like the Mediterranean Diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH) diet, and anti-inflammatory diet, had impact on the blood lipids profile and the CVD risk. Patients with stage 1 HTN, allocated either on intensive lifestyle treatment (ILT) or usual care (UC) standard treatment, participated in the analysis. From the original sample size of the HINTreat trial, all patients that were prescribed lipid lowering medication at any time of the study period were excluded from the total analysis; thus, the intervention and the control groups consisted of 33 and 28 patients, respectively. Nutritional intakes were assessed with repeated 24 h recalls from the previous day, and dietary indexes and scores were calculated as follows: MedDiet score, DASH index, and Dietary Inflammatory Index (DII). After six months of intervention, changes in the nutritional indexes and their effect on the lipidemic profile and CVD risk were analyzed. Results: In the ILT group, reductions were noted in Ambulatory Blood Pressure Monitoring (ABPM) for day systolic BP (SBP) (−12.7 mmHg) and diastolic BP (DBP) (−8.4 mmHg), total cholesterol (TC) (−35.4 mg/dL), triglycerides (TG) (−21.4 mg/dL), LDL cholesterol (LDL-C) (−27.5 mg/dL) concentrations, and CVD risk score (−1.5%), p < 0.001 for all. Multiple regression analysis showed that dietary quality indices independently influenced improvements in blood lipid profile and cardiovascular disease (CVD) risk among patients receiving ILT. Specifically, a higher Mediterranean Diet (MedDiet) score was significantly associated with reductions in TC (B = −7.238, p < 0.001), TG (B = −4.103, p = 0.035), and LDL-C (B = −6.431, p = 0.004). The DASH index was positively associated with TG levels (B = 9.913, p = 0.010), suggesting a more complex relationship that may require further investigation. In addition, DII was positively associated with increased CVD risk (B = 0.973, p < 0.001). Conclusions: The findings suggest that ILT can improve BP levels, target blood lipids concentrations, and reduce CVD risk in patients with stage 1 HTN. Full article
(This article belongs to the Special Issue Nutrition, Lifestyle and Treatment in Patients with Hypercholesterolemia)
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Review

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23 pages, 1809 KB  
Review
Pediatric Familial Hypercholesterolemia: Targeting Intestinal Absorption and Other Therapeutic Strategies
by Konstantinos Arvanitakis, Elena Chatzikalil, Christina Antza, Christos Topalidis, Georgios Kalopitas, Elena Solomou, Vasilios Kotsis, Georgios Germanidis, Theocharis Koufakis and Michael Doumas
Nutrients 2025, 17(14), 2357; https://doi.org/10.3390/nu17142357 - 18 Jul 2025
Viewed by 1993
Abstract
Familial hypercholesterolemia (FH) is a genetic disorder marked by significantly elevated levels of low-density lipoprotein cholesterol (LDL-C) since childhood, substantially increasing the risk of premature atherosclerosis and cardiovascular disease. While dysfunction of hepatic LDL-C receptors is the main underlying cause, the gastrointestinal tract [...] Read more.
Familial hypercholesterolemia (FH) is a genetic disorder marked by significantly elevated levels of low-density lipoprotein cholesterol (LDL-C) since childhood, substantially increasing the risk of premature atherosclerosis and cardiovascular disease. While dysfunction of hepatic LDL-C receptors is the main underlying cause, the gastrointestinal tract plays a key role in cholesterol homeostasis and represents an important therapeutic target. Inhibition of intestinal cholesterol absorption has emerged as an effective strategy in the management of pediatric FH, particularly in patients for whom statins may not be the ideal first-line treatment. Ezetimibe, an inhibitor of the Niemann-Pick C1-like 1 (NPC1L1) protein, has been shown to reduce LDL-C levels in children with FH, with a greater efficacy observed when used in combination with statins. Bile acid sequestrants also enhance cholesterol excretion but are often limited by gastrointestinal side effects, while dietary interventions, such as phytosterol supplementation and fiber-enriched diets, provide additional benefits in lowering LDL-C and are generally well tolerated. Emerging therapies, including microbiota-targeted strategies and novel cholesterol absorption inhibitors, show promise for expanding future treatment options. This review explores the mechanisms of intestinal cholesterol absorption and their relevance to pediatric FH. We examine key pathways, including dietary cholesterol uptake through NPC1L1, bile acid reabsorption, and cholesterol efflux mediated by ATP-binding cassette transporters, while also discussing clinical and experimental evidence on pharmacological and dietary interventions that modulate these pathways. A deeper understanding of cholesterol metabolism, the emerging role of the gut microbiota, and innovative therapeutic agents can support the development of more effective and personalized approaches to the treatment of children with FH. Full article
(This article belongs to the Special Issue Nutrition, Lifestyle and Treatment in Patients with Hypercholesterolemia)
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