How to lower cholesterol

Cholesterol is a waxy substance that is naturally present in the human body. It has many essential functions when it comes to our ability to digest fatty foods and make hormones. Alternately, cholesterol can also be consumed by eating animal-based foods.

There are two main types of cholesterol: low-density lipoproteins (LDL) or "bad" cholesterol, and high-density lipoproteins (HDL) or "good" cholesterol. At normal levels, cholesterol does not pose any threats to overall health.

High levels of LDL cholesterol or low levels of HDL cholesterol can raise your risk for heart disease and stroke. How does this happen? A build-up of cholesterol causes plaques to form which, in turn, narrow arteries. This causes restriction of blood flow, which results in a lack of oxygen, and ultimately symptoms of chest pain.

Lifestyle-related risk factors for high cholesterol include obesity, physical inactivity, cigarette smoking, excess alcohol intake, and diets with a high consumption of saturated fats. Secondary causes include some health conditions such as type 2 diabetes, chronic kidney disease, and hypothyroidism. In addition, some medications used for other health problems can pose risks, such as steroids and protease inhibitors.

Diet is the first step in lowering your cholesterol. This is because eating certain foods, particularly those high in saturated fat, can contribute to high cholesterol. Saturated fats come from animal sources (such as cheese, fatty meats, and butter) and tropical oils (such as coconut and palm oil). Foods that are higher in saturated fat may be high in cholesterol.

A heart-healthy diet should include foods that are low in saturated fat, and added sugars, while being high in fiber. These foods include fish, whole grains, fruits, vegetables, beans, and oatmeal.

The American College of Cardiology and American Heart Association recommends participating in three or four physical activity sessions per week, with an average duration of 40 minutes per session. The activities should be moderate to vigorous in intensity. 

Good cardiovascular exercises include cycling outdoors or on an exercise bike, fast walking on a treadmill or outdoors, jogging, and using an elliptical or stepper machine. Speak with your healthcare provider before engaging in any exercise activity or program.

While some evidence hints that certain dietary and herbal supplements may be beneficial for lowering cholesterol, more research is still needed. Some examples include: red yeast extract, flaxseed, berberine, and garlic.

Make sure to contact your healthcare provider or pharmacist if you are thinking of adding any herbs or supplements to your daily intake. As with prescription medications, the wrong combinations of these products can potentially have serious consequences.

In addition to diet and exercise, cholesterol lowering medications are used to treat elevated cholesterol levels. Drug treatment will ultimately depend on your cholesterol level and other risk factors.

Statins are typically the drugs of choice. Statins work by blocking an enzyme called HMG CoA Reductase, which the liver normally uses to make cholesterol. Examples of statins include: atorvastatin (Lipitor), fluvastatin (Lescol, Lescol XL), lovastatin (Mevacor, Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor Sprinkle), and simvastatin (Zocor).

Alternative drugs or add-on therapies include ezetimibe (Zetia), bile acid-binding resins such as cholestyramine (Questran, Prevalite), colesevelam (Welchol), and colestipol (Colestid) and PCSK9 inhibitors such as alirocumab (Praluent), evolocumab (Repatha) and inclisiran (Leqvio).

Managing your cholesterol levels is important in maintaining a healthy lifestyle — it can often require a combination of diet, exercise, and medications. An individual with high cholesterol levels often has no signs or symptoms, which is why routine screening and regular blood tests are very important.

Managing your cholesterol levels is important in maintaining a healthy lifestyle—oftentimes it can require a combination of diet, exercise and medication. An individual with high cholesterol levels often has no signs or symptoms, which is why routine screening and regular blood tests are very important.

Clinically reviewed and updated March 2022.