Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/8/2021
Doctor's Notes on How to Lower Cholesterol
Cholesterol is a waxy, fat-like substance that is naturally present in the blood and it is needed to produce certain hormones, vitamin D, and bile acids that help digest fat. The most common causes of high cholesterol include a high-fat diet, inactivity, and obesity. Some people have a genetic predisposition for high cholesterol. Other risk factors for developing high cholesterol include smoking and age (men older than 45 and women older than 55). The main ways to control cholesterol are lifestyle changes or medications.
High cholesterol does not cause symptoms by itself but high cholesterol levels in the blood (hypercholesterolemia) can cause fatty deposits in blood vessels, which cause narrowing (atherosclerosis) and chest pain (angina) and are a risk factor for heart attack, stroke, and peripheral artery disease.
What Is the Treatment for High Cholesterol?
The treatment for high cholesterol includes lifestyle changes and possibly medications. Talk to your doctor to see what combination of treatments is right for you.
Treatments and lifestyle modifications include:
- Eat a heart-healthy diet
- Reduce your intake of saturated fat and trans fat
- Limit your intake of red meat and dairy products made with whole milk
- Choose skim milk, low-fat or fat-free dairy products instead
- Limit fried food and cooking with healthy oils, such as vegetable oil.
- Limit salt (sodium) and sugar-sweetened foods and beverages
- A heart-healthy diet is one that emphasizes fruits, vegetables, whole grains, poultry, fish, nuts, and non-tropical vegetable oils such as DASH (Dietary Approaches to Stop Hypertension) eating plan
- Become more physically active
- Physical activity is important
- 150 minutes of moderate-intensity aerobic exercise a week is enough to lower cholesterol
- Quit smoking
- Lose weight
- A weight loss of 5% to 10% can improve cholesterol
- Medications
- Statins, also known as HMG CoA reductase inhibitors, work to reduce the amount of cholesterol circulating in the blood. Commonly used statins include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol)
- Lovastatin (Mevacor, Altoprev)
- Pravastatin (Pravachol)
- Rosuvastatin Calcium (Crestor)
- Simvastatin (Zocor)
- Ezetimibe (cholesterol absorption inhibitors)
- Prevents cholesterol from being absorbed in the intestine
- Bile acid sequestrants
- Causes the intestine to get rid of cholesterol
- PCSK9 inhibitors
- Alirocumab
- Evolocumab
- Adenosine triphosphate-citrate lyase (ACL) inhibitors
- Bempedoic acid (Nexletol)
- Bempedoic acid and ezetimibe (Nexlizet)
- Fibrates
- Fibrates are especially good for lowering triglyceride (blood fat) levels and have a mild LDL-lowering action.
- Gemfibrozil (Lopid)
- Fenofibrate (Antara, Lofibra, Tricor, and Triglide)
- Clofibrate (Atromid-S)
- Niacin (nicotinic acid)
- Omega-3 fatty acid ethyl esters
- Lovaza
- Vascepa
- Epanova
- Omtryg
- Statins, also known as HMG CoA reductase inhibitors, work to reduce the amount of cholesterol circulating in the blood. Commonly used statins include:
High Cholesterol (Hyperlipidemia) : Test Your Medical IQ Quiz
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Aerobic Exercise
Aerobic exercise is moderate physical activity that's sustained for a few minutes with the goal of improving health. Walking, biking, swimming, dancing, and jogging are examples of aerobic exercise. Aerobic exercise has many benefits, including improving bone density, endurance, HDL, weight control, insulin resistance, balance, and odds of surviving a heart attack and reducing blood pressure, cancer risk, body fat, and triglycerides. -
Cholesterol Levels: What the Numbers Mean
Blood cholesterol levels are measured by a simple blood test. Elevated LDL cholesterol (the "bad" cholesterol), and low levels of HDL cholesterol (the "good" cholesterol) levels, and high triglyceride levels puts a person at an increased risk for heart attack or stroke. The primary goal for a person with high triglycerides or cholesterol levels is to lower them with lifestyle changes like exercise, weight loss and diet changes to include more fiber, fruits and vegetables. -
Cholesterol Test
Cholesterol tests measure the cholesterol and triglyceride levels in the blood. The test is also referred to as a lipoprotein profile or lipoprotein analysis. The test measures total cholesterol, HDL, LDL, and triglyceride levels in the blood. Few risks are associated with cholesterol tests. -
Diet and Nutrition
Nutrition and diet is needed for health. Read dietary guidelines, dietary reference intakes, food guide pyramid, calories, carbohydrates, protein, fats, vitamins, minerals, and phytochemicals. A healthy variety of food provides nutrients for health and weight management and weight loss. -
Exercise
Exercise has been shown to reduce one's risk of heart disease, diabetes, colon and breast cancer, lower blood pressure and cholesterol, and reduce depression and anxiety. The Surgeon General recommends accumulating 30 minutes of exercise on a daily basis. -
HDL (Good) vs. LDL (Bad) Cholesterol Meaning, Ratios, and Ranges
Your total cholesterol number is a measurement of lipo-proteins (fat and proteins used a carrier for cholesterol through the bloodstream) and triglycerides (fats). The types are HDL ("the good"), LDL ("the bad"), and VLDL ("very bad"). The body needs HDL and LDL, but too much LDL and not enough HDL can lead to health problems like heart attack, stroke, peripheral vascular disease, heart disease, and other health problems. Add high triglycerides to this condition and disease risk increases even further. -
High Cholesterol
High cholesterol increases your risk for heart attack and stroke. There are no symptoms and it is often diagnosed during routine blood tests. Learn about prevention and treatment. -
High Cholesterol and Children
High cholesterol is a risk factor for coronary heart disease in adults, but some children may be at risk for premature coronary heart disease if they have high cholesterol levels. Lowering high cholesterol levels in children can be accomplished with diet, exercise, and other lifestyle changes. -
High Cholesterol Management
Lifestyle cholesterol management is important to lower your risk for heart disease, which includes: heart attack, stroke, and peripheral artery disease. Cholesterol management with lifestyle changes such as diet and exercise can effectively lower blood cholesterol levels in some individuals. -
High Cholesterol: Medications to Lower
Cholesterol is a waxy, fatlike substance that your body needs to function normally. If a person has too much cholesterol in their bloodstream, it can lead to heart disease. Cholesterol lowering medications include statins (Lipitor, Lescol, Mevacor, Altocor, Pravachol, Zocor, and Crestor), bile acid sequestrants (Questran, Colestid, WelChol), nicotinic acid agents (niacin, Niacor, Slo-Niacin), and fibrates (Lopid, Tricor). Side effects, drug interactions, and warnings and precautions should be reviewed prior to taking these medications. -
How Long Does It Take for Red Yeast Rice to Lower Cholesterol?
Red yeast rice dietary supplements work if they contain lots of a chemical called monacolin K. The red yeast rice dietary supplements available in the U.S. contain very little monacolin K because of FDA rules, however, and may as a result have little or no effect on blood cholesterol levels. -
Obesity
More than two-thirds of Americans are overweight, including at least one in five children. Nearly one-third are obese. Obesity is on the rise in our society because food is abundant and physical activity is optional. The safest way to lose weight is to eat less and exercise more. Treatment may also include medications, surgery, and behavior modification. -
Statins (Cholesterol Lowering Drugs)
Statins are a class of drug prescribed for reducing blood cholesterol levels in individuals with high cholesterol. Examples of statins available include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pravastatin (Pravachol), pitavastatin (Livalo), simvastatin (Zocor), and rosuvastatin (Crestor). Common side effects include brown, discolored urine, vomiting, muscle weakness, leg pain, muscle soreness, and stomach cramps. Drug and food interactions, warnings and precautions, and serious side effects should be reviewed prior to taking any medication. -
Weight Loss
Obesity is simply the accumulation of excess body fat. It is much more than that, however. Obesity is a chronic (long-term) disease that is very difficult to treat. It takes 3,500 extra calories to gain 1 pound. To lose weight, you must eat 3,500 calories less than you need, say, 500 fewer calories per day for one week, to lose 1 pound. -
What Does It Mean When Your LDL Cholesterol Is High?
When you have high LDL cholesterol levels, it means you are at greater risk for cardiovascular disease like heart attack and stroke. The plaque formed by this fatty substance on the inner walls of arteries can block or restrict blood flow. -
What Foods Should You Avoid If You Have High Cholesterol?
Foods to avoid if you have high cholesterol include tropical oils (coconut oil and palm oil), fatty meats, processed meats, red meat, full fat dairy products, egg yolks, fried foods, fast foods, frozen foods, salty foods (foods high in sodium), sugar-sweetened foods, and sugar-sweetened beverages. -
What Is the Normal Range for Cholesterol Levels?
Total cholesterol below 200 mg/dl, with LDL at lower than 130 mg/dl or below are the blood cholesterol levels an average healthy person should aim for to be considered “normal.”
REFERENCE:
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.