How to lower cholesterol

What is cholesterol?

Cholesterol is a waxy substance that is naturally present in the human body. It has many essential functions when it comes to our ability to digest fatty foods and make hormones.¹ Alternately, cholesterol can also be consumed by eating animal-based foods.

What are the risks associated with high cholesterol?

There are two types of cholesterol: low-density lipoproteins (LDL) or "bad" cholesterol, and high-density lipoproteins (HDL) or "good" cholesterol.¹ At normal levels, cholesterol does not pose any threats to overall health. High levels of LDL cholesterol or low levels of HDL cholesterol can raise your risk for heart disease and stroke.^1,2 How does this happen? A build-up of cholesterol causes plaques to form which, in turn, narrow arteries.1 This causes restriction of blood flow, which results in a lack of oxygen, and ultimately symptoms of chest pain.¹

Likely risk factors for high cholesterol

Lifestyle-related risk factors include obesity and being overweight, physical inactivity, cigarette smoking, excess alcohol intake, and diets with a high consumption of refined carbohydrates.² Secondary causes include some health conditions such as type 2 diabetes, chronic kidney disease, nephrotic syndrome, and hypothyroidism.² In addition, some medications pose risks, such as corticosteroids and protease inhibitors.²

How can I lower cholesterol naturally?

Diet is the first step in lowering your cholesterol. The most common sources of dietary cholesterol are foods high in saturated fat including cheese, fatty meats, and dairy products.¹

A heart-healthy diet should include foods that are low in saturated fat, trans fat, and added sugars, while being high in fiber. These foods include lean meats, whole grains, fruits, vegetables, beans, and oatmeal.¹

The American College of Cardiology and American Heart Association recommends participating in 3 or 4 physical activity sessions per week, with an average duration of 40 minutes per session.^2,3 The activities should be moderate- –to -vigorous in intensity.² Good cardiovascular exercises include cycling outdoors or on an exercise bike, fast walking on a treadmill or outdoors, jogging, and using an elliptical or stepper machine. ^1,2 Speak with your doctor before engaging in any exercise activity or program.

Herbal and dietary supplements are not generally recommended for treatment of patients with high cholesterol as proof of benefit is either very limited or lacking.² These include the use of: red yeast extract, turmeric and curcumin, artichoke leaf extract, polocosanol, garlic, and guggulipid.²

Make sure to contact your doctor or pharmacist if you are thinking of adding any herbs or supplements to your daily intake. As with prescription medications, the wrong combinations of these products can potentially have serious consequences.

Cholesterol lowering drugs

When diet and exercise do not achieve desired results, cholesterol-lowering medications should be started while continuing to eat healthfully and be physically active. Drug treatment will ultimately depend on your cholesterol level and other risk factors. Statins are typically the drugs of first choice.² Statins work by blocking an enzyme called HMG CoA Reductase which, the liver normally uses to make cholesterol.² Examples of statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor). Alternative drugs or add-on therapies include ezetimibe, bile acid-binding resins (such as cholestyramine), and PCSK9 inhibitors (such as alirocumab and evolocumab).²

Managing your cholesterol levels is important in maintaining a healthy lifestyle—often times it can require a combination of diet, exercise, and medications. An individual with high cholesterol levels often has no signs or symptoms, which is why routine screening and regular blood tests are very important.

Published on May 25, 2020

References:

1. Centers for Disease Control and Prevention. (2017). Preventing High Cholesterol. Retrieved from https://www.cdc.gov/cholesterol/prevention.htm

2. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T114250, Hypercholesterolemia; [updated 2018 Dec 03, cited 2020 Jan 17]. Available from https://www-dynamed-com.ezproxymcp.flo.org/topics/dmp~AN~T114250. Registration and login required.

3. AHA/AC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2018;Nov 10.