What to do if you have high cholesterol

Cholesterol is a fat-like substance that appears in the blood. When a person’s cholesterol is high, over time it can build up and form plaques on the walls of blood vessels. This can lead to atherosclerosis, a type of hardening of the arteries.

If an artery 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 or heart. This can cause a stroke or heart attack.

Eating a heart-healthy diet and exercising regularly are among the best ways to reduce the chance for heart disease and stroke when you have high cholesterol. For many people, medication may also be needed to keep cholesterol levels healthy over time.

Lifestyle approaches vs. medication

Having a family history of high cholesterol increases your risk of developing the condition. So does having certain chronic health conditions, including type 2 diabetes, obesity, and kidney disease.

Certain lifestyle habits influence high cholesterol risk, as well. These include being inactive and eating a diet high in saturated fats (which are solid at room temperature) and trans fats (sometimes found in processed and junk foods).

The AHA and the American College of Cardiology recommend taking specific lifestyle steps to manage 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
• 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 a person is at increased risk for heart attack and stroke, they may also be advised to take cholesterol-lowering medication.

“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, make a plan to manage it. Here’s a step-by-step approach for lowering your cholesterol.

Improve your diet

Fast food, ultra-processed foods, desserts, red meats, and processed meats are frequently high in saturated fat, 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 certain foods, you can begin to build an eating plan for optimal heart health. In general, heart-healthy eating plans focus on fresh fruits and vegetables, lean proteins like chicken, and whole grains. They also prioritize reducing added sugar, excess salt, and saturated fats.

Exercise

Getting physical activity as you are able can help improve your cholesterol levels. It can increase levels of high-density lipoprotein (or HDL, a.k.a. "good" cholesterol), which helps to remove extra cholesterol from your blood vessels. It can also help you to better manage your weight.

The AHA recommends getting at least 150 minutes of moderate-intensity exercise per week, or about 30 minutes per day, five days a week. Brisk walking, biking, dancing, and some types of yardwork all count as moderate physical activity.

Maintain a healthy weight

Body mass index (BMI) is a ratio of height to weight. A healthy BMI is considered to be between 18.5 and 24.9. People with a BMI of 25 or more are considered overweight, while those with a BMI of 30 or over are obese. Both are linked to high cholesterol. Among the best ways to control BMI are diet, exercise, and for some people, medication.

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, as well as evidence of worsening diabetes in some people with the condition.

If you are concerned about side effects from a statin, don’t stop your taking it 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 always being researched, developed, and introduced. If you have questions about cholesterol-lowering medications and whether your insurance covers them, ask your HCP.

Give it time

Whether you’re making lifestyle changes, taking medication, or doing 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.”