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
- Statins, also known as HMG CoA reductase inhibitors, work to reduce the amount of cholesterol circulating in the blood. Commonly used statins include:
- Ezetimibe (cholesterol absorption inhibitors)
- Prevents cholesterol from being absorbed in the intestine
- Bile acid sequestrants
- PCSK9 inhibitors
- Adenosine triphosphate-citrate lyase (ACL) inhibitors
- Bempedoic acid (Nexletol)
- Bempedoic acid and ezetimibe (Nexlizet)
- Niacin (nicotinic acid)
- Omega-3 fatty acid ethyl esters
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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.”
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.