Building Your Cholesterol-Reduction Plan

Almost half of Americans don’t control their high cholesterol, which can have a serious impact on heart health. Follow these steps to help lower yours.

close up of the hands of two healthcare providers writing a nutrition plan with fruits and vegetables on the side

You probably know that high cholesterol is something to avoid as much as possible. The condition can lead to atherosclerosis, which involves a buildup of plaque in your arteries. If a plaque ruptures, a blood clot forms. This clot can block blood flow or break off and travel elsewhere in the body, such as to your brain, heart, or lungs, where it can cause a stroke, heart attack, or pulmonary embolism.

Often, the first thing that comes to people’s minds when they think of lowering cholesterol is starting a prescription they’ll have to take for the rest of their lives. It’s little surprise, then, that many Americans who should be taking cholesterol-lowering drugs are not leaping at the chance to do so. Only 55 percent of adults in the United States who could benefit from a cholesterol medicine were taking one, according to a 2017 study published in JAMA Cardiology.

The fact is, getting a handle on your cholesterol is not an either/or question of following a prescription or not. The American Heart Association (AHA) says that eating a heart-healthy diet and exercising regularly—habits that can be both healthy and enjoyable—are the best ways to reduce your chance for heart disease and stroke when you have high cholesterol. Adding medication when necessary can lend valuable support to an overall approach to managing your cholesterol for better longevity and health.

Lifestyle approaches vs. medication for high cholesterol

Guidelines from the AHA and the American College of Cardiology recommend specific lifestyle measures to control cholesterol. These include:

  • Eating a heart-healthy diet
  • Getting regular exercise
  • Not smoking
  • Maintaining a healthy weight

If you’re at elevated risk for high cholesterol, you may also be advised to take cholesterol-lowering medication. What constitutes high risk for high cholesterol?

In addition to behaviors like smoking, eating a diet high in saturated and trans fats, and not getting enough exercise, that means having certain health conditions—such as type 2 diabetes, obesity, or kidney disease, or having a family history of high cholesterol—that predispose you to elevated levels.

Many healthcare providers (HCP) will first work with their patients to try to lower cholesterol as much as possible through lifestyle changes.

“If I had to have a patient choose between lifestyle changes and medications, I’d tell them to change their lifestyle almost every time,” says Keith Roach, MD, associate professor in clinical medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital. “But lifestyle changes with medication are synergistic. That means you’ll get more out of doing both than just doing one or the other.”

Building your cholesterol-lowering plan

Getting your cholesterol under control isn’t easy. Cholesterol-lowering medication may seem like a quick fix, but you may have to deal with some side effects (more on those below). Lifestyle changes can be fun (who doesn’t enjoy eating well and spending time outdoors?) but it takes work and determination to stick with them. Here’s how to put your cholesterol-lowering plan into action, step by step:

Improve your diet: If you tend to eat a lot of fast and processed foods, desserts, and sweetened drinks, Dr. Roach says to start small when it comes to eating better. These foods are high in saturated fats and trans fats, which increase heart disease risk.

“I tell people to find the worst thing in their diet and change that,” he says. “If someone really likes hamburgers and eats two or three a week, I try to get them to change it to once a week. Making small changes incrementally, that works.”

Once you’ve started to weed out some of the worst offenders from your diet, you can begin to build a holistic eating plan for optimal heart health. The DASH Diet or Mediterranean Diet are great eating plans to try.

Exercise: If diet is one part of the lifestyle change equation, exercise is the other.

Exercise can help improve your cholesterol profile, including increasing levels of high-density lipoprotein, or HDL (aka "good" cholesterol). This is partly a result of weight loss, according to a 2017 study published in the journal BMC Lipids in Health and Disease. The AHA recommends getting at least 150 minutes of moderate-intensity exercise per week, or about 30 minutes per day, five days a week.

Maintain a healthy weight: Body mass index (BMI) is a ratio of height to weight, and a healthy BMI is between 18.5 and 24.9. People with a BMI above 25 are considered overweight and being overweight is associated with high cholesterol.

The best way to control your BMI? Diet and exercise. Follow the two tips above and you’ll be on your way to a healthy weight and a healthy heart.

Consider medication: Statins have been used to treat high cholesterol for decades and are generally thought to be safe. Some patients report muscle weakness and stiffness while taking them, and certain effects on the liver, kidney, and eyes have been observed. Research has also identified a slightly increased risk of diabetes among patients taking statins who already had cardiovascular disease, as well as evidence of diabetes progression in some people with diabetes.

All in all, these side effects do not outweigh the overall benefit of preventing heart attack and stroke that statins provide, according to a 2021 study published in BMJ. If you are concerned about side effects from a statin you may be taking, don’t stop your prescription without talking to your HCP first. They may recommend trying a lower dose or switching to a different medication.

The options for cholesterol-lowering drugs extend beyond statins, and new medications are being researched, developed, and introduced. These include PCSK9 inhibitors, cholesterol absorption inhibitors, and bempedoic acid, among others. Each type of drug as its own profile of pros and cons, which you can discuss with your HCP.

Give it time: Whether you’re using lifestyle changes, medication, or both to control your cholesterol, it takes time and effort to see results.

“I can’t tell you how many people come to see me after 30 days of taking medication and think they’re cured,” says Roach. “It takes time to accrue, about a year before it’s as effective as it’s supposed to be.”

Article sources open article sources

Centers for Disease Control and Prevention. High Cholesterol Facts. Page last reviewed: September 27, 2021.
Johns Hopkins Medicine. Atherosclerosis. Accessed February 10, 2022.
Starks MA, Schmicker RH, Peterson ED, et al. Association of Neighborhood Demographics With Out-of-Hospital Cardiac Arrest Treatment and Outcomes: Where You Live May Matter. JAMA Cardiol. 2017;2(10):1110–1118.
American Heart Association. Common Misconceptions about Cholesterol. Last Reviewed: Nov 9, 2020.
American Heart Association. New guidelines: Cholesterol should be on everyone's radar, beginning early in life. Published: November 10, 2018.
Soliman GA. Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease. Nutrients. 2018;10(6):780. Published 2018 Jun 16.
Wang, Y., Xu, D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis 16, 132 (2017).
American Heart Association. American Heart Association Recommendations for Physical Activity in Adults and Kids. Last Reviewed: Apr 18, 2018.
Johns Hopkins Medicine. 3 Myths About Cholesterol-Lowering Statin Drugs. Accessed February 10, 2022.
Ting Cai, Lucy Abel, Oliver Langford, Genevieve Monaghan, Jeffrey K Aronson, Richard J Stevens, Sarah Lay-Flurrie, Constantinos Koshiaris, Richard J McManus, F D Richard Hobbs, James P Sheppard. Associations between statins and adverse events in primary prevention of cardiovascular disease: systematic review with pairwise, network, and dose-response meta-analyses. BMJ, 2021; n1537.
Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-742.
Mansi IA, Chansard M, Lingvay I, Zhang S, Halm EA, Alvarez CA. Association of Statin Therapy Initiation With Diabetes Progression: A Retrospective Matched-Cohort Study. JAMA Intern Med. 2021;181(12):1562–1574.
Mayo Clinic. Statin side effects: Weigh the benefits and risks. Jan. 14, 2020.

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