How to lower cholesterol

Cholesterol is a waxy substance that’s produced by the liver, and it’s also found in foods. High levels of one form of cholesterol called low-density lipoprotein (LDL) can increase your risk for heart disease, heart attack, peripheral vascular disease and stroke. However, there are steps you can take to help lower your cholesterol and reduce these risks.

1. Avoid artificial trans fats: These types of fats have been shown to raise LDL cholesterol levels while lowering high-density lipoprotein (HDL), or good cholesterol levels, and they should generally be avoided. In the past, most of the trans fat in foods came from partially hydrogenated oils (PHOs), but because of the health risks from these fats, they are no longer allowed to be added to foods in the United States. However, trans fat is not completely gone from foods; it is present at very low levels in refined vegetable oils as an unintentional byproduct of the manufacturing process. Also, some meat and dairy products have a small amount of naturally occurring trans fats. To find the amount of trans fats in a particular packaged food, look at the nutrition facts panel.

2. Reduce your saturated fat intake: Like trans fats, saturated fats also raise LDL. The American Heart Association recommends that saturated fats make up less than 6% of your total daily calories. Sources of saturated fats include:

• Meats, including beef, lamb and pork
• Poultry skin
• Whole milk and whole-milk dairy products, such as cheese and butter
• Coconut oil
• Palm and palm kernel oil

When selecting oils for cooking, opt for monounsaturated and polyunsaturated fats. Replacing saturated fats with these healthier fats can help reduce LDL, which can lower the risk of heart disease. Cooking oils high in monounsaturated fats include:

• Avocado oil
• Olive oil
• Peanut oil
• Canola oil
• Safflower oil
• Peanut oil

Polyunsaturated fats supply omega fatty acids. They can be found in a variety of vegetable oils, including:

• Corn oil
• Cottonseed oil
• Soybean oil
• Sunflower oil

3. Modify other aspects of your diet: Making other changes to your diet may help lower your cholesterol. Choose foods that are high in soluble fiber and plant stanols and sterols, which can help reduce the amount of cholesterol absorbed from foods. These substances occur naturally in fruits, vegetables, whole grains and legumes.

Eating more meals at home and cutting back on processed foods can also be beneficial, as preparing your own food gives you full control over what you eat. When you do dine out, read online menus ahead of time and review nutritional information when provided by the restaurant so that you can make healthier choices when it comes time to order.

4. Exercise regularly: Regular exercise can help raise your HDL levels and support overall heart health. For adults, the minimum recommended amount of weekly physical activity is 150 minutes of moderate-intensity exercise, such as walking, cycling, swimming, or 75 minutes of vigorous exercise, such as jogging. However, you don’t have to start there. If you’re new to exercise, increase your physical activity gradually. For example, you can start by taking a 15- or 20-minute walk three to five days per week and then gradually increase the length and frequency of your walks. 

Increasing your number of steps can also be a good starting point. Some easy ways to get in more daily steps include parking further away from buildings, shopping in stores rather than online and pacing while you talk on the phone or watch television.

5. Quit smoking: Smoking lowers HDL levels and can cause changes in the blood vessels that contribute to heart disease. If you smoke, talk to your healthcare provider about smoking cessation aids. Using a nicotine replacement product or taking a prescription medication may help you deal with cravings, making it easier to quit.

6. Maintain a healthy weight: People who are overweight or obese are at an increased risk for high cholesterol and other risk factors for heart disease. Losing just 5% to 10% of your body weight can positively affect your health. By following a heart-healthy diet, exercising regularly and controlling your portion sizes, you may begin to lose weight naturally. Your healthcare provider can give you other weight management tips.

7. Drink alcohol only in moderation: Drinking too much alcohol can raise your total cholesterol level. As a result, the American Heart Association recommends that adults who choose to drink alcohol limit their consumption. Generally, women should consumer no more than one alcoholic beverage per day, while men should consume no more than two drinks per day. 

8. Manage stress: Chronic stress may increase levels of certain hormones that increase cholesterol production, so finding ways to cope with stressors is important for managing cholesterol. Some ways to deal with stress include:

• Limiting your exposure to social media and news
• Taking slow, deep breaths when you feel stressed
• Trying stress relief techniques and practices, such as meditation, yoga and tai chi
• Engaging in activities that you enjoy
• Exercising regularly
• Journaling
• Discussing your thoughts and feelings with loved ones, friends or a mental health professional

9. Get quality sleep: Research shows that getting seven to nine hours of restful sleep may lower your risk of high LDL and total cholesterol levels. To promote better sleep:

• Stick to a set wake-up and bedtime schedule every day
• Avoid television, computer and mobile device screens close to bedtime
• Exercise regularly, but not before bed
• Cut back on caffeine and alcohol
• Use a white noise machine or earplugs to block out noises
• Create a darker sleep environment with blackout curtains or an eye mask

10. Talk to your healthcare provider about medication: If lifestyle changes alone don’t successfully lower your cholesterol, or you're at a particularly high risk for heart disease, your healthcare provider may recommend cholesterol-lowering medication. Some cholesterol medications include:

• Statins, such as atorvastatin (Lipitor), fluvastatin (Lescol, Lescol XL), lovastatin (Altoprev, Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor)
• Bile acid sequestrants, such as cholestyramine (Prevalite, Questran), colesevelam (Welchol) and colestipol (Colestid)
• Cholesterol absorption inhibitors, such as ezetimibe (Zetia)
• Combination cholesterol absorption inhibitors and statins, such as ezetimibe-simvastatin (Vytorin)
• Citrate lyase inhibitors, such as bempedoic acid (Nexletol) and bempedoic acid-ezetimibe (Nexlizet)
• Fibrates, such as fenofibrate (Antara, Tricor, others) and gemfibrozil (Lopid)
• Niacin, such as the brand-name drugs Niacor and Niaspan
• PCSK9 inhibitors, such as alirocumab (Praluent) and evolocumab (Repatha)

Updated December 2024.