Heart-Smart Ways to Lower High Cholesterol

The not-so-good news: You have high cholesterol.

The great news: You have the power to lower your cholesterol—and in turn reduce your risk of heart disease and stroke.

High cholesterol occurs when there is too much “bad” fat in the blood. It can be treated with medication, but not everybody with elevated cholesterol needs drugs to lower cholesterol, especially at first, says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “Depending on the level and depending on your risk factors, sometimes we can have a patient change their lifestyle.”

How to Pick the Right Cholesterol Treatment

“Medicine is recommended to treat high cholesterol based on an individual’s particular set of circumstances,” says Paul Knoepflmacher, MD, a clinical instructor in medicine at Mount Sinai Hospital in New York City. To determine whether or not you need medication, your healthcare provider will look at such risk factors as your family history, your blood pressure levels, whether you have diabetes or heart disease, or whether or not you smoke.

If your doctor does recommend that you take medication, he or she will likely prescribe statins, a class of drugs that block cholesterol formation in the liver. Statins are the most powerful and well-studied medication available to help lower “bad” LDL cholesterol levels, as well as your risk of heart disease, heart attack, and stroke. Other cholesterol medications that are less commonly prescribed include fibrates, niacin, and ezetimibe. There’s also a newer class of medicines called PCSK9 inhibitors, which work by a different way than statins; they’re used by injection. Some doctors are starting now to use them, particularly in patients that can’t tolerate statin therapy.

Other LDL-lowering medications include selective absorption control inhibitors, which prevent cholesterol from being absorbed by the intestine, and resins, which help get rid of cholesterol in the intestine. Lipid-lowering therapies, like fibrates, are another option. Unlike the others, however, these are more effective at lowering triglycerides and increasing your levels of “good” HDL cholesterol.  

Whether or not you take cholesterol-lowering medication, leading a heart-healthy life is key for healthier cholesterol numbers. Here are five lifestyle tweaks to help you improve your cholesterol levels on your own.

1. Eat less saturated and trans fats. “Saturated fat does increase LDL cholesterol,” says Frances Largeman-Roth, RDN, a nutritionist and cookbook author in New York City. High-fat dairy, fatty cuts of meat, and coconut oil are all sources of saturated fat. Trans fats are usually found in fried food and pastries, like french fries, pizza dough, and cookies—don’t eat these foods often. Switch your dairy to fat-free or low-fat varieties, and stick to lean meats, like turkey or chicken.

2. Pump up the fiber. “Adding more fiber to the diet can actually decrease cholesterol by 10 percent,” says Largeman-Roth. According to a Harvard study, a fiber-rich diet may also lower your risk of coronary heart disease by 40 percent. Beta-glucan, which a soluble fiber found in oats and barley, is specifically beneficial for lowering cholesterol, says Largeman-Roth. Lentils, whole wheat grains and breads, carrots, and apples are also great sources of fiber. 

3. Get moving. A sedentary lifestyle lowers levels of HDL cholesterol, which means there’s less “good” cholesterol to remove LDL (bad) cholesterol from arteries. To improve your HDL cholesterol levels, the American Heart Association recommends 40 minutes of moderate to vigorous aerobic exercise, three to four times a week, like brisk walking, swimming or dancing. If that’s quite a jump from your current activity level, start with just 10 minutes a day and work your way up.

4. Quit smoking. Smoking or exposure to secondhand smoke lowers “good” HDL cholesterol levels and increases the risk of coronary heart disease (more than someone who doesn’t smoke). Ask your doctor about ways to quit.

5. Lose (at least) 10 percent of your body weight. Being overweight increases “bad” LDL cholesterol and lowers “good” HDL. Losing just 10 percent of your weight—losing 20 pounds if you weigh 200, for example—can make significantly improve cholesterol, or even reverse it.

“Managing your cholesterol is a long-term investment in your health,” says Dr. Knoepflmacher. “You may not feel any different in the short term, but you’re giving yourself a better shot at a happy healthy heart, healthy blood vessels, and a longer life.”