How to Lower Cholesterol

Reviewed on 11/8/2021

What Is Cholesterol?

What is cholesterol?
Controlling high cholesterol is a lifelong commitment. Important first steps include eating a healthy diet low in saturated fats, get routine exercise, lose weight, avoid or quit smoking.

Cholesterol is a waxy, fat-like substance that is naturally present in cell walls or membranes everywhere in the body. Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat.

High cholesterol levels in the blood can cause fatty deposits in blood vessels which cause narrowing and may lead to heart attack, stroke, or peripheral artery disease.

What Causes High Cholesterol?

The most common causes of high cholesterol are all related and include

  • a high-fat diet,
  • inactivity, and
  • obesity.
  • Less commonly, genetic causes can decrease the ability of the body to metabolize cholesterol or cause the liver to produce too much cholesterol.

How Often Should I Have My Cholesterol Checked?

The American Heart Association recommends that blood cholesterol levels should be checked every 5 years after the age of 20. If cholesterol levels are high (usually over 200 mg dL), people are often started on medicine to reduce the cholesterol and are usually advised to begin a low-cholesterol diet. Then the cholesterol levels are usually checked about every three months to see if the levels normalize. Once the levels normalize, they are often rechecked at least once per year by many healthcare professionals.

How Is Cholesterol Checked?

Cholesterol screening is part of a blood test called a lipoprotein analysis that measures not only total cholesterol in the body but also different types of cholesterol and triglycerides (another type of fat in the body). Total cholesterol is made up two types of cholesterol;

  1. High-density lipoproteins (HDL) may protect the body against narrowing blood vessels and is considered good cholesterol, and
  2. Low-density lipoproteins (LDL) are considered bad cholesterol and may make arterial narrowing worse.

The test is done after a 9 to 12 hour fast and your healthcare professional can help interpret the results and decide whether treatment is required.

What Are LDL and HDL cholesterol ranges (charts)?

High-density lipoprotein (HDL) cholesterol is called the "good" cholesterol because it absorbs LDL "bad" cholesterol and carries it back to the liver, which helps remove it from your body.

Just knowing your total cholesterol isn't enough. Not only does the total cholesterol number need to be normal but HDL and LDL numbers need to be in the appropriate range. Normal total cholesterol associated with a high LDL may still increase the risk of heart disease and stroke. Triglyceride levels also need to be controlled.

Total cholesterol ranges chart
Cholesterol Ranges (mg/dL) Risk
Less than 200 desirable
200-239 borderline high risk
240 and over high risk
HDL (high-density lipoprotein) ranges chart
HDL Ranges (mg/dL) Risk
Less than 40 mg/dL (men), less than 50 mg/dL (women) heart disease
Greater than 60mg/dL some protection against heart disease

LDL (low-density lipoprotein) ranges chart
LDL Ranges (mg/dL) Risk
Less than 100 optimal 
100-129 near-optimal
130-159 borderline high
160- 189 high
Above 190 very high
Triglyceride ranges chart
Triglyceride ranges (mg/dL) Risk
Less than 200 desirable
Less than 150 normal
150-199 borderline to high
200-499 high
500 very high

Which Risk Factors for High Cholesterol Are Controllable and Uncontrollable?

A person can control lifestyle options to maximize their potential to control high cholesterol levels with a healthy diet, exercise, weight control, and avoiding or quitting smoking.

However, there are some situations that are beyond the control of the individual. Family history and genetic predisposition to high cholesterol, aging (men older than 45 and women older than 55), and diseases that cause the liver to produce more cholesterol or prevent it from metabolizing cholesterol are risk factors for high cholesterol. These risks can be minimized by living a healthier lifestyle but may require cholesterol-lowering medication.

What Are the Signs and Symptoms of High Cholesterol?

High cholesterol does not cause symptoms by itself. Instead, it is a risk factor for the development of atherosclerosis or narrowing of arteries in the body that can lead to heart attack, stroke, or peripheral artery disease. Blood tests are used to measure cholesterol levels as part of routine screening for risk factors for heart disease and stroke.

What Are the Medication Guidelines to Lower Cholesterol?

The main goal of a treatment program is to lower total cholesterol levels, LDL ("bad") cholesterol levels, and triglyceride levels. Treatment may cause a slight rise in HDL or good cholesterol in the blood. There are two main ways to control cholesterol;

  1. lifestyle changes, and
  2. medication.

Medications may be prescribed by a healthcare professional if attempts at lifestyle changes fail to make a difference in cholesterol levels (the usual goal is to be under 200 mg dL). A variety of medication options are available and the decision as to which medication to use depends upon the individual situation and other medical conditions that might be present. Usually, the healthcare professional and patient will discuss options and decide together upon the treatment options. There are many treatment options such as statins, niacin, and fibric acid agents - though statins are the primary treatment option.

What Are the Complications of High Cholesterol?

What Can I Do To Prevent High Cholesterol?

Controlling high cholesterol is a lifelong commitment. Important first steps include:

If these actions fail to lower cholesterol levels (below 200 mg dL), most healthcare professionals will recommend a medication to lower cholesterol.

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Cholesterol Lowering Medications

If lifestyle changes such as diet, exercise, and weight loss don't lower your cholesterol enough your doctor may prescribe a cholesterol lowering medication. There are a variety of medications to lower cholesterol, for example:

  • Statins
  • Bile acid sequestrants
  • Fibrates
  • Nicotinic agents
  • Cholesterol absorption inhibitors
  • PCSK9 inhibitors
Reviewed on 11/8/2021

American Heart Association. "What Your Cholesterol Levels Mean." Updated: Apr 21, 2014.

Singh, V.N., MD. "Low HDL Cholesterol (Hypoalphalipoproteinemia): Treatment & Medication." Updated: Nov 03, 2016.