How to lower cholesterol: medication and lifestyle

More people than ever are becoming aware of the role that heart health plays in their lives. 

Maybe someone you know has had a heart attack, heart failure, or a stroke. Or perhaps a relative of yours has suffered from blocked coronary arteries. You might have even heard from your healthcare provider that you’re at risk for heart disease.

One significant way to lower your risk is to get your cholesterol levels in the optimal ranges. Several lifestyle interventions can help you to lower your cholesterol. If healthy lifestyle changes alone aren’t enough, your healthcare provider can prescribe medication.

Getting your total cholesterol within range will help prevent a host of health problems down the line.

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Cholesterol is a waxy molecule found in your blood. It is essential to many of the processes in the body. Some of the many necessities your body uses cholesterol to make include (Janapala, 2020):

• Hormones

• Vitamin D

• Cell membranes

• Bile salts which help with digestion

Your body can make all of the cholesterol it needs in your liver. Your body also takes in additional cholesterol from foods made from animal sources. However, this dietary cholesterol may not have much of an impact on your overall cholesterol or heart health (U.S. National Library of Medicine, 2021). 

When healthcare providers talk about cholesterol, they usually refer to three substances made up of fats and protein that circulate in your blood. These are (U.S. National Library of Medicine, 2021):

• Low-density lipoprotein (LDL) cholesterol

• High-density lipoprotein (HDL) cholesterol

• Very low-density lipoprotein (VLDL) cholesterol 

Low-density lipoprotein (LDL) cholesterol

LDL is referred to as a type of bad cholesterol because elevated levels can lead to a build-up of dangerous plaques in your arteries (U.S. National Library of Medicine, 2021).

High-density lipoprotein (HDL) cholesterol

HDL is often called good cholesterol because it carries cholesterol back to the liver from elsewhere in the body to be removed (U.S. National Library of Medicine, 2021).

Very low-density lipoprotein (VLDL) cholesterol

VLDL is also often referred to as a type of bad cholesterol because it carries triglycerides. Chronically elevated triglycerides can cause heart disease if chronically elevated (U.S. National Library of Medicine, 2021).

When these types of cholesterol levels are out of balance, they can combine with other substances to form build-up in the blood vessels called plaques. This condition is called atherosclerosis. Over time, accumulating plaque can cause damage or block your blood vessels, causing many health issues (U.S. National Library of Medicine, 2021).

Healthcare providers follow these standard cholesterol level guidelines (Lee, 2020):

Fasting triglyceride level

• Normal: less than 150 mg/dL 

• Mildly elevated: 150 to 499 mg/dL

• Moderately elevated: 500 to 886 mg/dL 

• Severely elevated: greater than 886 mg/dL

LDL level

• Optimal: less than 100 mg/ dL

• Near-optimal/above optimal:100 to 129 mg/dL

• Borderline high: 130 to 159 mg/dL

• High: 160 to 189 mg/dL

• Very high: greater than 190 mg/dL 

HDL level 

• Low: less than 40

• Optimal: greater than or equal to 60

Your healthcare provider will look at these cholesterol levels, along with other information such as your family history, your medical history, and other lab tests to make recommendations for improving your health (Lee, 2020).

Having high cholesterol levels in and of itself will not cause severe symptoms. Still, it can increase your risk of developing heart disease. The main benefit of lowering your cholesterol is that it can decrease your risk of heart disease (Hill, 2021). 

Many studies have shown that elevated LDL cholesterol levels increase a person’s risk for developing atherosclerotic plaques and blood vessel disease. High cholesterol is often a life-long condition, but it is very manageable (Hill, 2021).

For most people, the first step to lower cholesterol is to make some healthy lifestyle changes. You can make changes to your diet, activity level, alcohol consumption, smoking status, and stress levels to help lower your cholesterol levels.

Eat a heart-healthy diet

The current dietary guidelines recommend limiting saturated fats to less than 10 percent of daily calories. If you have a condition predisposing you to heart disease, you should aim for less than five to six percent (Janapala, 2020).

Here are some common foods with high levels of saturated fatty acids you’ll want to cut back on when trying to lower cholesterol (Janapala, 2020):

• Butter

• Full-fat dairy products

• Red meat

• Salmon

• Chocolate 

• Cocoa butter

• Coconut

You should avoid calories from trans fats, such as partially hydrogenated vegetable oils, as much as possible. Common sources of trans fats in the American diet include (Janapala, 2020):

• Margarine

• Commercially baked goods

• Deep-fried fast foods

• Street vendor foods with poor oil quality

You can replace these foods with ones with lower amounts of solid fats. Here are some foods with lower amounts of saturated fats that you can add to your diet for healthy eating (Janapala, 2020): 

• Seafood 

• Legumes like chickpeas, lentils, and peas

• Nuts

• Seeds

• Lean meats

• Egg whites

• Low-fat dairy products

• Fruits

• Vegetables 

• Whole-grain products

• Olive oil

Get regular exercise

Physical activity and exercise have been shown to help maintain healthy cholesterol levels. Being active can increase your HDL cholesterol while offsetting increases in LDL cholesterol and triglycerides. More intense activity may also reduce LDL and triglyceride levels. The exact type and frequency of exercise to optimize your cholesterol levels are still under study  (Mann, 2014).

Quit smoking 

If you need another reason to quit smoking, it can also help you regulate your cholesterol. In addition to contributing to heart and lung disease, smoking intensity also has been associated with increases in LDL cholesterol and decreases in HDL cholesterol (Gepner, 2011). 

One study of smoking cessation aids looked at the cholesterol levels of participants. They found that quitting smoking improved HDL levels, especially in women. LDL levels were not significantly affected, but the increased HDL levels may help lower heart disease risk (Gepner, 2011).

Drink alcohol in moderation 

Low and moderate levels of alcohol consumption have been linked to higher levels of HDL cholesterol in both men and women, which can be good for the heart. However, heavy alcohol consumption is associated with elevated cholesterol numbers (Chiva-Blanch, 2019).

Stick to a low-to-moderate amount of alcohol (less than one drink per day for women and less than two drinks per day for men) if you are trying to lower your cholesterol. As a bonus, you’ll also reduce your risk for type 2 diabetes and high blood pressure (Chiva-Blanch, 2019).

Reduce stress

A historical cohort study with 5000 participants evaluated the effects of psychological and physical stress on the participants’ lipid profiles. The study found that psychological stress was a risk factor for increasing triglycerides and LDL levels and decreasing HDL levels. Physical stress, though, in the form of exercise, counteracted some of the negative impacts of psychological stress (Assadi, 2017).

If lifestyle changes aren’t enough to lower your cholesterol to optimal ranges, there are several types of medication that your healthcare provider can prescribe. Two of the most popular medicines to lower cholesterol are statins and PCSK9 inhibitors.

Statins

Statins first came onto the market in the late 1980s. They help to stop the body from making cholesterol. They have been shown to lower LDL cholesterol levels and reduce the risk of non-fatal heart attacks, strokes caused by blockages, and the need for surgery for blocked arteries (Toth, 2019).

One issue with statins is that people often stop taking them due to side effects. In particular, muscle pain (myalgia) is common. Research is ongoing to develop new statins that don't have this effect (Toth, 2019).

PCSK9 inhibitors

PCSK9 inhibitors are the latest class of medications to help lower cholesterol. These medications encourage the body to break down LDL particles. Studies have shown that they are effective in lowering cholesterol levels and preventing heart attacks and strokes. They also don’t cause the side effects of other cholesterol-lowering medications, like statins (Karatasakis, 2017).

If you’ve been diagnosed with high cholesterol, it’s essential to work with your healthcare provider to decrease your risk of developing heart disease and other health complications. For many people, lifestyle modification alone can significantly impact cholesterol levels. Still, you may need a combination of lifestyle changes and medications.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

May 04, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.