High Cholesterol Management

What Are the Risk Factors for Heart Disease and High Cholesterol?

  • It is possible to minimize the risk of heart disease, one of the leading causes of death in the United States. High blood cholesterol can lead to coronary artery disease, heart attack, transient ischemic attack (TIA), stroke, and peripheral artery disease; keeping cholesterol levels in the normal range can decrease the risk of these diseases.
  • Lifestyle changes can let you take control of your heart health, and managing your cholesterol level is one such important lifestyle change. Other risk factors that can also be controlled include maintaining normal blood pressure, exercising, keeping your weight within normal limits, quitting smoking, and controlling diabetes and stress.
  • While one cannot control risk factors like age and family history of heart disease or stroke, it is possible to minimize the other risk factors to live a longer and healthier life.
  • Knowing your cholesterol number is a good first step in reducing risk. These include total cholesterol, HDL (high density lipoprotein or good cholesterol), LDL (low density lipoprotein or bad cholesterol) and triglyceride levels. Together they are part of a blood screening test called a lipoprotein analysis and can give direction to you and your health-care professional about the potential need to control cholesterol levels.
  • If a person's cholesterol levels are normal, but they have other risk factors for heart attack or stroke, they still may want to lower their cholesterol levels further.
  • Diet and exercise are strategies to use to lower your cholesterol before cholesterol-lowering medications are prescribed.

Where Can You Get Your Cholesterol Tested?

Measuring your cholesterol involves taking a sample of blood. Often your health-care professional will recommend and arrange these tests during an office visit, although it is best to have the blood drawn after fasting for 14-16 hours.

Cholesterol screening opportunities are often available in the community such as:

  • Screenings held in shopping centers
  • Community health fairs
  • Neighborhood medical clinics
  • Home testing devices
  • Work site testing

What Do the Cholesterol Numbers Mean (Chart)?

Making Sense of Your Cholesterol Count*
Type of FatBadBetterDesirable
Total Blood Cholesterol240 mg/dL** and above needs evaluation of HDL and LDL levels200-239 is borderline high200 and less; 150 is ideal
HDL40 mg/dL or less45 for men; 55 for women60 or more
LDL190 mg/dL or more considered very high; 160-189 considered high130-159 is borderline high100-129 is nearly the best; under 100 is ideal
Triglycerides500 mg/dL or more is very high; 200-499 is considered high150-199 is borderline highUnder 150 is normal

*From the revised guidelines ATP III, National Institutes of Health **mg/dL means milligrams per deciliter of blood

How Do I Lower My Cholesterol Through Exercise?

Regular aerobic exercise helps lower cholesterol levels as well as control high blood pressure, diabetes, and body weight. While most health organizations recommend 30 minutes a day of some type of exercise, the bottom line is that more is probably better, but some is still better than none.

Many people get their exercise at work performing manual labor but may not have much aerobic exercise. Exercise comes in many forms and keeping the body moving is an important part of maintaining physical conditioning as well as good bone density, muscle flexibility, and joint function. Many people get their exercise at work performing manual labor but may not have much aerobic exercise.

How Much Exercise Do I Need?

Walking 2 miles in 30 minutes 3 times a week constitutes a moderate level of aerobic exercise. That may be enough to raise your HDL cholesterol by 1 to 3 points (higher is better) and lower your LDL cholesterol (lower is better).

If you can't get in a 30-minute block of exercise all at once, do a few minutes of exercise here and there throughout the day (climb the stairs at work, walk around the block on your lunch break, park and walk). Researchers have demonstrated that exercise even without weight loss can have a positive impact on improving cholesterol levels. It is the amount of activity, and not necessarily any changes in fitness or intensity of exercise that is important for cholesterol improvement and decreasing the risk factors for heart disease and stroke.

Is There a Diet to Lower Cholesterol?

Diet and other lifestyle changes affect your blood cholesterol levels. Changing daily habits may prevent the need to take medication to control cholesterol levels, if no other risk factors for atherosclerotic cardiovascular disease (ASCVD) are present. Cholesterol-lowering medications are available, but they should be used in addition to and not as a substitute for exercise, dietary changes, avoiding smoking, and controlling blood pressure and blood sugar levels. Lifestyle changes should be employed first and continued for a lifetime to manage cholesterol levels.

Diets high in saturated fat are linked to high total blood cholesterol levels and pose an increased risk for heart disease and other vascular diseases. Simply put, reduce all fats in your diet, paying particular attention to saturated fats.

The American Heart Association suggests that fats should represent no more than 30% of total calories you consume in a day, but 25% or 20% is even better. Most of the fats in the diet should be unsaturated.

  • Decide how many total calories you need a day to maintain your desired weight. As a rule of thumb, you multiply your desired weight in pounds by 11, if your life is sedentary; 13 if moderately active; and 15 if active. The total gives you your recommended daily calorie count.
  • Determine how many grams of fat you should eat in a day (see chart). Don't get distracted by trying to measure the grams of saturated and unsaturated fat (this information is on food labels). Simply focus on total grams of fat.
Grams of Fat Allowed Per Day
Daily Calorie IntakeGrams of Fat Using Guide of 20% of Calories from Fat Per day

Certain foods really do have health benefits for controlling cholesterol and overall heart health beyond providing basic nutrition. The Department of Health and Human Services identifies these food choices.

  • Broccoli: benefits heart health, blood pressure, cholesterol, cancer
  • Fish or fish oil benefits heart health, blood pressure, cholesterol
  • Green leafy vegetables benefit heart health, blood pressure, cholesterol, cancer
  • Oranges or orange juice benefit heart health, blood pressure, cholesterol, cancer
  • Carrots benefit heart health, blood pressure, cholesterol, cancer
  • Garlic benefits heart health
  • Fiber benefits heart health
  • Oats/oat bran/oatmeal benefits heart health

What Foods Lower High Cholesterol Levels?

Lower cholesterol levels should start at the grocery store. Read food labels and buy foods low in saturated fat and low in cholesterol (cholesterol itself is found in some foods, and this type of cholesterol is different from blood cholesterol). If possible, try to include fresh fruits and vegetables in every grocery shopping trip.

To help you know what to look for when grocery shopping, use this shopping list from the National Heart, Lung, and Blood Institute:

  • Breads such as whole wheat, rye, pumpernickel, or white
  • Soft tortillas, corn or whole wheat
  • Hot and cold cereals except granola or muesli
  • Rice (white, brown, wild, basmati, or jasmine)
  • Grains (bulgur, couscous, quinoa, barley, hominy, millet)
  • Fruits: Any fresh, canned, dried, or frozen without added sugar
  • Vegetables: Any fresh, frozen, or (low salt) canned without cream or cheese sauce
  • Fresh or frozen juices, without added sugar
  • Fat-free or 1% milk
  • Cheese (with 3 grams of fat or less per serving)
  • Low fat or nonfat yogurt
  • Lean cuts of meat (eye of round beef, top round, sirloin, pork tenderloin)
  • Lean or extra lean ground beef
  • Chicken or turkey, white or light meat (remove skin)
  • Fish (most white meat fish is very low in fat, saturated fat, and cholesterol)
  • Tuna, light meat canned in water
  • Peanut butter, reduced fat
  • Eggs, egg whites, egg substitutes
  • Low-fat cookies or angel food cake
  • Low fat frozen yogurt, sorbet, sherbet
  • Popcorn without butter or oil, pretzels, baked tortilla chips
  • Nuts such as walnuts, pecans, and macadamia nuts
  • Margarine (soft, diet, tub, or liquid)
  • Vegetable oil (canola, olive, corn, peanut, sunflower)
  • Non-stick cooking spray
  • Sparkling water, tea, lemonade

Health Solutions From Our Sponsors

The Mediterranean Diet for Heart Health

The Mediterranean diet lets you eat rich-tasting foods such as roasted sweet potatoes, hummus, and lima bean spread. Greek meals are often small, easily assembled plates called mezzes. For your own serve-it-cold casual meal, you could put out plates of cheese, olives, and nuts.

Medically reviewed by Robert J. Bryg, MD; Board Certification in Cardiovascular Disease/Internal Medicine REFERENCES:

American Heart Association. "What Your Cholesterol Levels Mean." Updated: Aug 17, 2016.

health.gov. "Dietary Guidelines for Americans 2015-2020; Eigth Edition."