**Background:** Non-communicable diseases account for 29% of adult deaths in Nigeria, with 11% due to cardiovascular disease. Statins are widely prescribed for lipid-lowering, but evidence on whether statin-use promotes or hinders healthy lifestyle adoption is sparse and conflicting, particularly in sub-Saharan Africa where cardiovascular risk factors are rising. This study aimed to explore whether statin-use influences adoption of healthy dietary and exercise choices, and whether it does so by changing perceptions of high cholesterol and future cardiovascular disease risk.
**Methods:** A mixed-methods explanatory sequential design was employed. Phase 1: A structured questionnaire was administered to 148 adults (78 statin users, 70 non-statin users) with diagnosed hyperlipidaemia recruited from two sites—the Nigeria National Petroleum Corporation medical services in Abuja (urban) and the University of Calabar Teaching Hospital (semi-urban)—between August and October 2013. Mean age was 52.9 years (SD 11.1); 56.8% were female; 59.5% had hypertension; 36.5% had diabetes. The questionnaire assessed demographics, cardiovascular risk factors, dietary and exercise behaviours (using Prochaska and DiClemente's stages of change), perceptions of high cholesterol (Revised Illness Perception Questionnaire), and perceptions of future cardiovascular disease risk (Champion's Health Belief Model Scale). Logistic regression was used to identify factors associated with adoption of a low-fat diet. Phase 2: In-depth face-to-face semi-structured interviews were conducted with 8 purposively sampled participants (4 statin users, 4 non-statin users) and analysed using Braun and Clarke's thematic analysis.
**Key Results:** Overall, 68.9% of participants reported adopting a low-fat diet, and 16.2% reported adopting healthy exercise behaviours. Statin-use was not independently associated with adoption of a low-fat diet in the logistic regression model (OR = 0.82, p = 0.66). However, the odds of adopting a low-fat diet increased as perceived statin control of high cholesterol increased (OR = 2.33, p<0.05). Urban dwellers were 5 times more likely to adopt a low-fat diet than semi-urban dwellers (OR = 0.21 for semi-urban vs urban, p = 0.003). The model was statistically significant (X² = 25.822, p = 0.001) and explained 18.3–26.0% of variance. Statin users were significantly more physically inactive/moderately inactive than non-statin users (85.9% vs 74.3%, X² = 3.852, p = 0.05). Statin users reported significantly stronger statin control perceptions (mean 3.8 vs 3.6, U = 1721.500, p = 0.003), perceived fewer barriers to statin-use (mean 2.3 vs 2.6, U = 1715.000, p = 0.027), and perceived cardiovascular disease as more severe (mean 3.1 vs 2.9, U = 1745.500, p = 0.040) than non-statin users. Qualitative analysis identified five themes (consequences, cause, control, "for your own good", "the whole world will talk") and revealed three distinct relationships: (1) synergistic—statin-use and lifestyle change used together, occurring when high cholesterol was not solely attributed to diet; (2) antagonistic favoring statins—driven by perceived inability to make lifestyle changes and strong statin effectiveness beliefs; (3) antagonistic favoring lifestyle change—driven by concerns about medication side-effects and congruous cause-control beliefs (lifestyle caused it, so lifestyle should control it). Gender differences emerged: men described autonomy and hegemonic masculinity as influences, while women cited body image concerns (desire to be "trim but not too slim"), family obligations, and social stigma around weight loss as barriers.
**Clinical Implications:** The relationship between statin-use and healthy lifestyle adoption is complex and context-dependent. Clinicians should explore patients' perceptions during consultations to identify those who view statins as an easier alternative to lifestyle change—a problematic belief since lifestyle modifications enhance statin effects and benefit overall health. The high prevalence of physical inactivity (80.4% inactive/moderately inactive) and low adoption of exercise behaviours (16.2%) highlight the need for public health interventions promoting physical activity, particularly in semi-urban areas where awareness of cardiovascular risk appears lower. Interventions should address gender-specific barriers, social obligations, and environmental factors that influence lifestyle choices.