Anyone who visits a doctor regularly, watches the news, or pays attention to nutrition knows that keeping cholesterol numbers low is an important way to safeguard their health. But most of us have only a vague idea of what cholesterol is, or what exact role it plays in cardiovascular health. On a more practical level, despite knowing its importance, many of us lack a clear understanding of how to go about lowering our cholesterol levels. What exactly is cholesterol? What is its role in health and longevity? And how can we make and execute an action plan to get our cholesterol levels under control?

Cholesterol basics

A common misunderstanding about cholesterol is the idea that it is a foreign substance that we put into our bodies by eating bad food. In truth, cholesterol is a naturally occurring lipid (fatty substance) produced by the liver which plays several crucial roles in our health. However, it is decidedly not the case that more cholesterol is better. That’s where diet enters the picture. We can upset the balance of cholesterol in our bodies by eating too many foods that contribute to elevated lipid levels, a condition known as hypercholesterolemia. When we do so, we significantly increase our risk for poor cardiovascular outcomes.

What are the dangers of high cholesterol?

Most people know that high cholesterol is a significant contributing factor in heart attack and stroke. But those are just two of several dangerous outcomes linked to hypercholesterolemia. Other diseases and conditions in which cholesterol is at least partially implicated include:

  • Peripheral artery disease (PAD), which occurs when built-up cholesterol impairs circulation to the limbs. In fact, sometimes a full-on blockage occurs to a limb, called limb ischemia, which can result in a loss of the appendage.
  • Unstable angina, chest pain from a blood clot in a coronary artery.
  • Vascular dementia, a form of dementia characterized by damage to blood vessels in the brain caused my strokes or mini-strokes.
  • Parkinson’s Disease.
  • ALS (Lou Gehrig’s Disease).
  • Alzheimer’s Disease.
  • Retinal vein occlusion, an eye condition involving impaired or lost vision.
  • Cancer.
  • Sexual dysfunction in men and women.

Risk factors for high cholesterol

As with most diseases and conditions, cholesterol levels are attributable to a mix of risk factors, some of which we can control (“modifiable” risk factors) and some of which we cannot (“non-modifiable” risk factors).

Non-modifiable risk factors include:

  • Age (cholesterol tends to rise as you get older)
  • Gender (Men usually have lower HDL, or “good cholesterol,” than women)
  • Genetics (Hypercholesterolemia tends to run in families)
  • Race (Black adults are at greater risk)
  • Type 2 diabetes
  • Kidney disease

Modifiable risk factors include:

  • Diet (especially the consumption of processed foods, added sugars, and the saturated fats found in animal products)
  • Exercise
  • Smoking
  • Certain medications which can increase risk of hypercholesterolemia

How to lower cholesterol naturally

As the above list of modifiable risk factors suggests, you can greatly reduce your risk for high cholesterol by not smoking, maintaining an active lifestyle, and eating right.

A good general rule of thumb when it comes keeping cholesterol low through diet is, “More food from plants, less from animals.” A second helpful mantra is, “Natural and whole beats processed and refined.” That’s because saturated fats, added sugars, and refined carbohydrates such as those found in white bread and pasta stimulate the production of cholesterol in the liver. The Mediterranean Diet has been proven again and again to be associated with superior health outcomes that include cholesterol control. It emphasizes fruits, vegetables, whole grains, fish, poultry, and olive oil, while avoiding processed foods and those high in sugar. Of particular importance is that you avoid saturated fats found in animal products, replacing them with the healthy unsaturated fats found in olive oil, nuts, fish and avocadoes.

When it comes to exercise, any form of physical activity is better than none. That means you don’t need to undertake a formal exercise routine or become a gym rat, as long as you make sure you’re moving rather than sitting. Aim for 2.5 to five hours of moderate-intensity physical activity each week. Aerobic exercise, the kind that moves large muscle groups rhythmically for an extended time, is particularly beneficial. This includes swimming, walking, running, cycling, and dancing. Strength training also helps, but should be thought of as a supplement to aerobic exercise.

Using medication to lower cholesterol

Despite your best efforts to maintain a healthy lifestyle, you may need to use cholesterol medications. Note, though, that generally speaking, cholesterol-lowering drugs are less effective than diet and exercise, and that they work better as a supplement, rather than alternative, to lifestyle changes.

Statins are sometimes referred to as wonder drugs for their ability to keep cholesterol at bay. They work by blocking the liver enzyme responsible for producing cholesterol. You’ve likely heard of at least two of these drugs, atorvastatin (Lipitor) and rosuvastatin (Crestor), although there are several more. Besides reducing production of LDL (“bad”) cholesterol, statins are also thought to raise HDL (“good”) cholesterol, reduce inflammation, lower triglycerides, and make coronary plaques less likely to rupture. Some people experience side effects when on statins which may include headache, gastrointestinal issues, muscle pain, liver problems, elevated blood sugar, and trouble with cognition. However, most people experience no side effects at all, and those who do can usually work with their doctors to adjust their dosage or dosing schedule to continue taking the drugs without issue.

Statins are taken orally, but in some cases, doctors will prescribe a class of injectable cholesterol-lowering drugs called PCSK9 inhibitors. They’re even more effective than statins in lowering LDL, without the side effect of muscle soreness but with occasional flu-like symptoms and irritation at the injection site. They’re currently only prescribed for high-risk patients whose cholesterol hasn’t come down through high-dose statin use. Currently, two PCSK9s are on the market, alirocumab (Praluent) and evolocumab (Repatha). Other PCSK9 inhibitors are in clinical trials, including a version in pill form.

Related Articles