High cholesterol is common and treatable. The key is focusing on LDL — the kind that builds up in arteries — and using a mix of lifestyle changes, smart medications, and routine checks. Below are simple, practical steps you can start today.
Start with food. Replace butter, fatty cuts of meat, and full-fat dairy with olive oil, lean proteins, and low-fat dairy. Add soluble fiber: oats, beans, apples, and psyllium reduce LDL absorption. Plant sterols (in fortified margarine or yogurt) can drop LDL by a few percent when used daily.
Move more. Aim for 150 minutes of moderate aerobic activity a week — brisk walking, cycling, or swimming. Losing 5–10% of body weight often lowers LDL and improves overall risk.
Quit smoking and limit alcohol. Smoking raises heart risk even if cholesterol numbers look okay. If you drink, keep it moderate: up to one drink a day for women, two for men.
Doctors usually start with statins. They lower LDL reliably and cut heart attacks and strokes. Statins vary by strength: low, moderate, and high intensity; your doctor picks one based on your risk. Common side effects are muscle aches and rare liver enzyme changes — report symptoms so your provider can adjust treatment.
If statins don’t drop LDL enough or you can’t tolerate them, other options exist. Ezetimibe blocks cholesterol absorption in the gut and adds a decent LDL drop when used with a statin. PCSK9 inhibitors (injectable) give large LDL reductions for people at very high risk. Newer pills like bempedoic acid also help and may suit those with statin intolerance. Bile acid sequestrants work too but can cause constipation and interact with other drugs.
Be cautious with supplements. Fish oil (prescription-strength EPA) can reduce triglycerides and some heart risks, but over-the-counter omega-3s vary. Red yeast rice contains a natural statin — effective but unpredictable and not a safe statin substitute without medical supervision.
Monitoring matters. Get a fasting or non-fasting lipid panel as your doctor recommends. After starting or changing meds, labs are typically checked within 6–12 weeks, then every 6–12 months. Your provider may check liver enzymes and, if you have muscle pain, creatine kinase.
Drug interactions are real. Grapefruit juice interacts with some statins and can raise side effects. Tell your pharmacist every medication and supplement you take so they can spot risks.
If you have diabetes, known heart disease, or a strong family history of early heart attacks, target LDL numbers are lower — talk with your doctor about your specific goal. Managing cholesterol is a team effort: you, your clinician, and your pharmacist. Small daily choices add up fast, and the right medication can make those gains stick.
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Mar, 18 2025