" This case demonstrates the potential effect of dietary changes on cholesterol levels. Typically, patients with primary severe hypercholesterolemia, defined as an LDL cholesterol level of 190 mg/dL or higher, are at increased risk of atherosclerotic cardiovascular disease and are given guideline-directed statin therapy due to their elevated risk for future coronary events. 1 A careful dietary history can be valuable in identifying patients who might benefit from dietary changes rather than a statin prescription. This patient was consuming a diet high in saturated fats, including red meats, eggs, and coconut oil. 2 A behavioral modification approach was appropriate because she had multiple areas for improvement in her diet and no history of diabetes, cardiovascular disease, or hypertension. However, this conservative approach may not be appropriate for patients with cardiovascular risk factors and/or genetic hypercholesterolemia. This nutritional approach is especial...
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