Will exercise or diet help maintain lipid levels?

Question

Hello doctor,

My father is 77 years old and recently underwent a quadruple bypass surgery. His arteries were too clogged for a stent. He has never been overweight, but he smoked two to three cheap cigars a day for 15 to 20 years. While he did not engage in regular exercise, he stayed active by working in the yard, walking the dogs, and similar activities. His diet included a mix of healthy foods, but he did not avoid red meat, bacon, and other high-fat foods.

I am a 50-year-old male who has never smoked. I am 6 feet tall and weigh 185 pounds. As a teacher, I stay active during the day, though I do not follow a formal exercise routine. My recent lipid panel results are as follows: HDL 48 mg/dL, triglycerides 81 mg/dL, and LDL 158 mg/dL. I generally eat healthily but consume more red meat than I probably should.

Here are my questions:

If my dad had been on a statin all those years, is it likely that he would still have needed bypass surgery? I understand this is hypothetical, and you cannot guarantee the outcome.

If you had to advise me, given that I remain at my current weight and never start smoking, would you recommend:

Following an extremely healthy diet (e.g., fish, nuts, fruits, vegetables, minimal unhealthy fats, and little to no red meat), or
Engaging in regular, vigorous exercise (e.g., playing tennis four days a week, cycling, rowing, running, etc.)?

You must choose only one option, not both.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You are asking about three things: statins, diet, and exercise.

Statins: Scientific evidence shows that elevated lipids, especially LDL (low-density lipoprotein), are major risk factors for coronary artery disease, peripheral vascular disease, and stroke. Guidelines recommend that everyone aged 40 and older (and even earlier in familial cases) should have a lipid profile done. If LDL is above a certain threshold (which varies depending on the presence of risk factors and family history), statin therapy is recommended to help prevent coronary events. If your father had started statins early, it is likely his current condition could have been avoided.
Diet: A healthy diet is essential at all ages for the prevention of heart disease. It serves as a foundational aspect of heart health.
Exercise: Regular aerobic exercise, of at least moderate intensity, is also essential for people of all ages to reduce the risk of heart attack, stroke, and related conditions. Both a healthy diet and regular exercise are necessary, and ideally, both should be encouraged. However, if I had to choose only one, I would recommend regular exercise.

If you have further questions, I am happy to clarify.

Thank you.