Got high cholesterol? Here are 5 ways to manage it.

Natalie Rahhal
·Reporter
·6-min read
Blood samples for cholesterol
High cholesterol is a common problem, but there are some straightforward steps you can take to lower it. (Getty Images)

High cholesterol is known as the “silent killer” because there are no outward symptoms. But as it accumulates in the body, low-density lipoprotein cholesterol (often referred to as "bad" cholesterol) can harden blood vessels, leading to blood clots, strokes and heart attack, according to the Centers for Disease Control and Prevention.

Even though cholesterol build-up is silent, it’s not impossible to detect or manage. And getting a handle on high cholesterol is one of the best things you can do to prevent cardiovascular disease and other life-threatening health problems. We spoke to experts about the steps you can take to better manage your cholesterol.

Your cholesterol is really gauged by three metrics: total cholesterol, LDL cholesterol and “good,” or high-density lipoprotein (HDL) cholesterol. Your overall or total cholesterol is the sum of your “good” and “bad” cholesterol levels. You want this number to be low. Your LDL cholesterol level is healthiest when it’s low, and your “good" HDL level is best when it’s high. Here’s a break-down of the numbers:

Levels are considered healthy if:

  • Total cholesterol is under 200

  • LDL cholesterol is under 100

  • HDL cholesterol is 60 or higher

You’re considered at-risk or borderline high if:

  • Total cholesterol is between 200 and 239

  • LDL cholesterol is between 100 and 159

  • HDL cholesterol is between 40 and 59 for men, or 50 and 59 for women

Levels are high if:

  • Total cholesterol is 240 or higher

  • LDL cholesterol is 160 or higher

  • HDL cholesterol is under 40 for men, or under 50 for women

LDL cholesterol builds up over time, forming plaques in your arteries (the blood vessels carrying blood to your heart), which can slowly narrow blood vessels over time. A plaque is “almost like a little pimple in the vessel,” Dr. Bradley Serwer, an interventional cardiologist at Vital Solution in Pennsylvania, tells Yahoo Life. The surface of the plaque can easily rupture. Inside it are fatty substances, known as lipids, which attract clotting blood cells. Those blood cells rush over, as if to address an injury. But instead, the clot they form blocks off the artery and the blood supply that normally runs through it, which can trigger a heart attack.

It’s important to work on managing high cholesterol levels immediately, rather than waiting for problematic plaques to accumulate and cause a heart attack, Serwer says.

If your cholesterol is high and you’re trying to lower it, “the best way to do it is through exercise,” says Serwer. Exercise helps boost good HDL cholesterol which will in turn “clear out bad cholesterol” and it helps to make your entire cardiovascular system more efficient and resilient, he says.

Exercise will also help you lose excess weight — especially fat — which can dramatically lower your cholesterol, Serwer says. While all exercise will help, he adds that aerobic exercise is by far the most effective for lowering cholesterol. Plus, the main goal of lowering cholesterol is preventing heart attack and stroke, and physical activity is crucial to that goal.

Doctors no longer believe that cholesterol from food is a major driver of heart disease and high cholesterol. Instead of cutting out high-cholesterol foods entirely, medical experts advise focusing on limiting foods high in saturated fat, sugars and trans fats. Many of them are found in ultra-processed and pre-prepared foods, says Serwer, such as:

  • Meat, especially red meat

  • Cheese and other dairy

  • Tropical oils, including palm and coconut

  • Ultra-processed foods, especially super sugary ones like kids’ cereal

  • Pre-prepared foods

  • Eggs

It’s equally important, according to Serwer and the American Heart Association, to increase your intake of foods that help to lower cholesterol. That means eating more foods rich in “good fats” — omega-3, omega-6 and omega-9 fatty acids. These foods help boost HDL, which reduces LDL, and they contain antioxidants that help to protect overall cardiovascular health. To get more “good” fats, try eating more:

  • Salmon

  • Avocado

  • Olive oil

Aside from fish, a plant-based diet helps lower cholesterol, Serwer says. Foods high in fiber, including vegetables, beans and whole grains help to clear LDL cholesterol out of the body. According to the National Heart, Lung and Blood Institute, plant-based diets such as the Mediterranean diet also signal to your body to slow down its production of cholesterol.

As if you needed another reason not to smoke, smoking can drive up your LDL cholesterol and lower your HDL levels.

Limiting alcohol is also a good idea. When your liver processes alcohol, it produces more LDL cholesterol and other harmful lipids. Serwer says that, on the other hand, red wine may actually help raise your levels of HDL cholesterol, and in general, light to moderate drinking may increase good cholesterol. However, the World Health Organization recently warned that there is no safe amount of alcohol.

While Serwer and other doctors encourage patients to try reducing their cholesterol through lifestyle changes, for many, that’s not always possible — and that’s OK, he says. “The first, second and third reason someone has high cholesterol are all genetics,” Serwer says.

Many people have high cholesterol “due to both multiple genetic variants and environmental factors, including poor diet, physical inactivity and other factors including smoking,” Dr. Philip Nimoityn, a clinical assistant professor of medicine specializing in cardiology at Thomas Jefferson University, tells Yahoo Life.

If changes to your lifestyle don’t help to improve your cholesterol within about six months, it may be time to consider medications, according to Nimoityn and Serwer. Statins “help reduce the risk of plaque ruptures and stabilize the blood vessels” in addition to reducing cholesterol, Serwer says. These medications are a “first-line therapy, after diet and exercise have failed to get [someone] to the goal, where their risk is lowest,” he says. If that still doesn’t work, your doctor may want to add a medication called ezetimibe to your regimen to prevent cholesterol from being absorbed in the gut.

The bottom line? Don’t delay medications for too long if lifestyle changes aren’t working. “The worst thing we can do is keep kicking the can down the road,” says Serwer.

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