Maintaining healthy cholesterol levels is key to protecting your heart, especially if you have heart disease or have already had a heart attack. To lower your chances of having another heart attack, you need to keep your "bad" low-density lipoprotein (LDL) cholesterol low and your "good" high-density lipoprotein (HDL) cholesterol high.
Cholesterol is a waxy substance that builds up in the fat in your blood. When cholesterol levels are high, this wax can block blood vessels. This can cause them to break and lead to a heart attack or stroke.
You Can Manage Your Cholesterol
The good news is that there are ways you can lower your cholesterol and improve your heart health.
"Making lifestyle changes and taking cholesterol-lowering medications can greatly lower the risk of heart attack, stroke, and death from heart disease," says Anita Wokhlu, MD, a cardiologist and associate professor at the University of Florida.
How Cholesterol Is Measured
The first step to find out your cholesterol levels is getting a blood test. This gives you a lipid panel, which measures four key types of fats:
Total cholesterol. This shows the total amount of cholesterol in your blood.
LDL. It's known as "bad" cholesterol because it builds up plaque that can block your arteries.
HDL. It's known as "good" cholesterol because it helps lower "bad" cholesterol.
Triglycerides. This is a type of fat in your blood that acts as an energy source. High levels can raise your chance of heart disease.
Once you get the panel, your doctor will explain the meaning of your results based on your age, sex, and genetics.
Cholesterol Levels That Call for Action
Because cholesterol numbers can mean different things for different people, trust the personalized treatment plan your doctor recommends.
In general, these numbers mean that your cholesterol needs attention:
Total cholesterol: higher than 200
LDL, or "bad" cholesterol: higher than 100
HDL, or "good" cholesterol: lower than 40 for men and lower than 50 for women
Treatments are personalized, but they all follow the same approach: lifestyle changes plus medication.
Medications That Lower Cholesterol
There are different types of medications that can help lower "bad" cholesterol (LDL) in your blood and your chance of heart disease.
Statins. Also known as HMG-CoA reductase inhibitors, they cut back on cholesterol formation in the liver, especially LDL. They also help lower triglycerides and raise HDL cholesterol. These include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol XL)
- Lovastatin (Altoprev)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
Ezetimibe (Zetia). This is a cholesterol absorption inhibitor that stops cholesterol from being absorbed in your gut.
PCSK9 inhibitors. They lower LDL cholesterol. There are two types:
- Monoclonal antibodies. They block the PCSK9 protein so the liver can remove more "bad" LDL cholesterol from the blood. Examples are alirocumab (Praluent) and evolocumab (Repatha).
- Small interference RNA (siRNA). It targets liver cells to lower PCSK9 production, which lowers LDL levels. An example is inclisiran (Leqvio).
Adenosine triphosphate-citrate lyase (ACLY) inhibitors. They work in the liver to block cholesterol production.
- Bempedoic acid (Nexletol). It can be used alone or with ezetimibe (Zetia) to further lower LDL cholesterol levels, especially in people who can't tolerate high doses of statins.
Bile acid sequestrants. They help your gut get rid of more cholesterol. Examples are cholestyramine (Questran), colesevelam (Welchol), and colestipol (Colestid).
Fibrates. They lower triglycerides and slightly lower LDL cholesterol. Examples are fenofibrate (Tricor) and gemfibrozil (Lopid).
Niacin (nicotinic acid). This is a B vitamin that limits the amount of blood fats the liver makes. You should only take it if it's prescribed by your doctor. Brand names include Niacor and Niaspan.
What You Eat Makes a Difference
To reach healthy cholesterol levels, a combination of medication and a healthy diet is key.
Lower the amount of saturated and trans fats that you eat and avoid processed foods.
"Many patients enjoy the variety and benefits of the Mediterranean diet, which includes fish, legumes, nuts, whole grains, and plenty of fruits and vegetables," Wokhlu says.
You can adapt your favorite dishes and include more foods high in soluble fiber.
For example, if you like grilled red meat with fries, a healthier alternative is grilled fillet of salmon with vegetables.
Foods high in soluble fiber include oats, chickpeas, lentils, eggplant, broccoli, apples, oranges, strawberries, and different kinds of nuts like peanuts, walnuts, and almonds.
Exercises That Are Good for Your Heart
Experts recommend three types of exercise that can improve cholesterol levels and heart health. But check with your doctor or cardiologist before starting any exercise program.
High-intensity aerobic exercise. It gets your heart rate up and improves blood flow. Examples are running, swimming, cycling, and playing tennis.
Resistance training. It helps lower body fat and build muscle. Combined with aerobic exercise, it can help raise "good" HDL cholesterol and lower "bad" LDL cholesterol. Examples are hand weights, resistance bands, and bodyweight exercises.
Stretching, balance, and flexibility. Stretching doesn't lower cholesterol or directly improve heart health, but it makes you more flexible and strengthens muscles, which makes aerobic exercise easier. Examples are tai chi and yoga.
Quit Smoking
Smoking is harmful to your overall health. Quitting smoking boosts "good" HDL cholesterol and helps it remove "bad" LDL cholesterol better. This helps lower your chances of heart disease and, as a bonus, protects your arteries, heart, and brain.
Show Sources
Photo Credit: marekuliasz/Getty Images
SOURCES:
Anita Wokhlu, MD, cardiologist, associate professor, University of Florida, Gainesville.
Mayo Clinic: "The role of cholesterol in heart health."
Cleveland Clinic: "Cholesterol Levels."
American Heart Association: "Cholesterol Medications."
Harvard Health: "11 foods that lower cholesterol."
Johns Hopkins Medicine: "3 Kinds of Exercise That Boost Heart Health."
American Lung Association: "8 Ways Your Health Improves When You Quit Smoking."
