Effective dietary approaches to lowering LDL cholesterol include replacing saturated and trans fatty acids with dietary carbohydrates or unsaturated fatty acids and reducing dietary cholesterol. Although the response to dietary interventions is variable, a diet low in saturated fat and cholesterol typically lowers LDL cholesterol by 10% to 15%.497 500 Other benefi- cial dietary interventions can include addition of plant sta- nols/sterols (2 g/d), which trials suggest lower LDL choles- terol by 5% to 15%, and addition of viscous fiber (.10 g/d), which reduces LDL cholesterol by 3% to 5%.512 515 A 10-lb weight loss reduces LDL cholesterol by 5% to 8%.496 Regular physical activity is also a key component of therapeutic lifestyle modification. Although exercise does not reliably lower LDL cholesterol, it facilitates weight loss and has other beneficial effects on the lipid profile.516 518 Controlled clinical trials of lipid-lowering drug therapy have demonstrated that lowering of LDL cholesterol is associated with a reduced risk of adverse cardiovascular events. Earlier trials used bile acid sequestrants (cholesty- ramine), fibric acid derivatives (gemfibrozil and clofibrate), or niacin. More contemporary studies have convincingly established the efficacy of statins in the primary and second- ary prevention of coronary events.394 396,398,400,501,519 522 In a prospective meta-analysis published by the Cholesterol Treat- ment Trialist Collaborators in 2010 that examined data from 26 randomized trials of statin therapy (comparing higher- to lower-dose statin therapy or statin therapy to a control regimen), the mean difference in LDL cholesterol was 31 mg/dL, ranging from 12 to 68 mg/dL. 