Background: Though it is well established that therapeutic life style change (TLC) program including low saturated fat diet and exercise is effective in some degree for control of hyperlipidemia, longer term follow-up data is scarce to see whether the effect of TLC persists after the subjects finished the life style modification program. Methods: Subjects with hypercholesterolemia without clinical cardiovascular diseases (N=157) participated in a TLC program. According to the NCEP ATP-III guideline, they were divided into high, intermediate and low risk groups and target LDL-cholesterol level was set accordingly. After initial visit for baseline evaluation and counseling for TLC from physician, dietician and exercise therapist, they had four additional visits along 6-month course to follow the LDL goal achievement and reinforce the motivation. Lipid profile was checked at every visit. After the course was finished, subjects were free-living and came back for yearly routine health check-up on their own discretion. Results: Among the subjects participated the program, 124 (M:F= 64:36%) completed long-term follow up (median duration 2.9 years, interquartile range 2.0-3.1). The mean age was 53.7 짹 7.9 years. Majority (60.5%) of the subjects belonged to the low risk group. Mean LDL-cholesterol at baseline was 184.3 짹 22.6 mg/dL and decreased for 26.0 짹 32.2 mg/dL at the end of the 6-month program (p<0.001) and the decrease was maintained at the at long-term follow-up (- 22.9 짹 29.9 mg/dL compared to baseline, p<0.001). TLC was successful in maintaining acceptable LDL level in 21.8% at 6 months and 37.1% at long-term follow-up (p<0.001) Conclusions: This study suggests that long-term non-pharmacological control of hyperlipidemia is possible in selected patients as well as in short-term program. Significant part of the motivated patients with mild hypercholesterolemia may avert lifelong lipid-lowering drug treatment by more aggressive intervention for lifestyle modification.