What to do if you have high cholesterol

High cholesterol occurs when you have too much of this fat-like substance in your blood. Over time, high cholesterol can lead to atherosclerosis (also known as "hardening of the arteries") due to a buildup of a cholesterol deposit called plaque inside the arteries. If a plaque ruptures or breaks open, 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. This can cause a stroke, heart attack, or pulmonary embolism (blood clot in the lungs).

Eating a heart-healthy diet and exercising regularly are the best ways to reduce your chance for heart disease and stroke when you have high cholesterol, according to the American Heart Association (AHA). For some people, medication may also be needed to keep cholesterol levels healthy over time.

Lifestyle approaches vs. medication

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

• Eating a heart-healthy diet that includes a variety of fruits and vegetables, whole grains, lean proteins—but limits salt, added sugars, and saturated fats, like butter
• Getting regular exercise
• Not smoking
• Maintaining a healthy weight

Many healthcare providers (HCP) will first work with their patients to try to lower cholesterol as much as possible through lifestyle changes. But if you’re at increased risk for high cholesterol, you may also be advised to take cholesterol-lowering medication.

Certain habits increase the risk for high cholesterol, including smoking, being inactive, eating a diet high in saturated (which are solid at room temperature) and trans fats that are often found in processed and junk food. Having certain health conditions can also make you more likely to have high cholesterol, such as type 2 diabetes (high blood sugar levels), obesity, or kidney disease, or having a family history of high cholesterol.

“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.”

Make a plan to lower your cholesterol

If you have high cholesterol, it can help to make a plan to manage it. Here’s a step by step approach for lowering your cholesterol:

Improve your diet

Fast and processed foods, desserts, and sweetened drinks are high in saturated fats and trans fats, which increase heart disease risk. When it comes to improving your diet, Dr. Roach says to start small.

“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 unhealthiest foods from your diet, you can begin to build an eating plan for optimal heart health. In general, heart-healthy eating plans focus on fresh fruit and vegetables, lean protein like chicken, and whole grains, as well as lowering salt and saturated and trans fats.

Exercise

Exercise as you are able can help improve your cholesterol levels, 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, which is associated with high cholesterol. The best way to control your BMI? Diet and exercise.

Consider medication

Statins have been used to treat high cholesterol for decades and are generally thought to be safe. Some people 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 people taking statins who already had heart disease, as well as evidence of worsening diabetes in some people with diabetes.

However, 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, don’t stop your medication 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. If you have questions about cholesterol-lowering medication and whether your insurance covers certain medications, ask 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.”