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Further, there are a limited number of studies focused on certain types of diet or dietary composition including functional foods or exercise modality. Many factors likely contribute to the variability in observations, including presence of substantial heterogeneity in study settings and designs, publication biases, issues related to self-reported measures of dietary intakes as well as adherence measurements to study diet. Given the complexity of the individual lifestyle choices, it is not surprising that a substantial heterogeneity regarding outcomes has been observed across studies, underscoring the challenge of accurately assessing effects of lifestyle changes, including diet- or physical activity-based interventions, on the lipid profile and cardiovascular risk. Precision medicine options such as personal preferences regarding food choices and long-term dietary strategies are needed to improve the overall lipid profile. Based on a large body of evidence, current dietary guidelines uniformly recommend reducing intakes of saturated and trans fatty acids with replacement by increasing intake of mono- and polyunsaturated fatty acids.

Lifestyle changes recommended for those with high cholesterol levels include adopting a diet low in saturated and trans fatty acids, incorporating functional foods rich in bioactive substances such as fiber, antioxidants, plant sterols and stanols, exercising regularly, and maintaining a healthy weight. Lifestyle changes remain the cornerstone of management of lipid and lipoprotein disorders and obesity, and are warranted in primary as well as secondary prevention settings.

This reduction in CVD mortality is largely driven by decreases in coronary heart disease mortality rate.

Although CVD remains as the leading cause of mortality in adults, there is a decreasing trend in overall CVD mortality rate over the last two to three decades. The role of lipids and lipoproteins as risk factors for cardiovascular disease (CVD) is well established.

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