Lifestyle Medicine and the Science of Cholesterol Reduction: A Systematic Review of Non-medication Approaches Among Adults.

Dyslipidemia is a major modifiable risk factor for cardiovascular disease and remains highly prevalent despite advances in lipid-lowering therapy. Lifestyle medicine has emerged as a comprehensive, non-pharmacological strategy for improving lipid profiles and reducing cardiovascular risk. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and evaluated the effectiveness of lifestyle-based interventions for cholesterol reduction in adults. PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched for observational studies published between 2015 and May 2026. Studies involving adults (≥18 years) that evaluated lifestyle interventions and reported lipid-related outcomes were included. Study quality was assessed using the Newcastle-Ottawa Scale. Twenty-six studies met the inclusion criteria. Mediterranean and plant-based diets, together with regular physical activity, were consistently associated with reductions in low-density lipoprotein cholesterol and triglycerides, improvements in high-density lipoprotein cholesterol, and lower cardiovascular risk. Weight management, smoking cessation, adequate sleep, and stress reduction were also associated with favorable lipid outcomes. However, long-term adherence was frequently limited by socioeconomic and behavioral barriers. Lifestyle medicine provides an important foundation for dyslipidemia management and should be integrated with pharmacological therapy when clinically indicated. Future research should focus on improving long-term adherence and equitable access to lifestyle-based interventions.