More than one in three US adults have high cholesterol, which can clog arteries and cause heart attacks and strokes. The good news is that there are a variety of strategies for lowering “bad” LDL cholesterol as well as elevated triglycerides (a type of blood-fat) with the goal of decreasing your risk for heart problems.
Pros: Whether you opt for the DASH diet—short for Dietary Approaches to Stop Hypertension—or a Mediterranean-style diet, you’ll be doing your heart a favor. Each is big on fruits, veggies, whole grains, lean protein, low-fat dairy, nuts, seeds, and other healthy fats. By nixing unhealthy saturated fat in your diet, you’ll reduce your LDL cholesterol.
Cons: Much like exercise, it can be hard to eat a healthy diet consistently. And while a healthy diet is always the way to go, people with very high cholesterol due to genetics may not be able to diet their way to lower LDL.
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Pros: Exercise can help lower triglycerides and raise “good” HDL. A healthy lifestyle, including regular physical activity, is considered the best way to prevent heart disease. The American Heart Association recommends at least 150 minutes of moderate-intensity exercise a week, meaning about 30 minutes a day, five times a week
Cons: There’s really no downside to exercise. Just keep in mind, says Cleveland Clinic, that it won’t do much to budge your LDL unless you combine it with a healthy diet and weight loss (if you’re overweight).
Pros: Statins include drugs such as atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor). They can lower LDL, or “bad,” cholesterol by 30 to 50%, according to the American College of Cardiology. After diet and exercise, they’re considered the next best way to prevent heart attacks and strokes. “There’s overwhelming evidence that statins are an incredibly safe class of medications,” Erin D. Michos, MD, associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, tells Health.
Cons: Serious side effects are rare. They include muscle inflammation, increased liver enzymes (a sign of liver inflammation), and risk of developing type 2 diabetes. With statins available in generic form, it’s possible to spend at little at $10 to $15 a month for a 30-day supply, or even less per pill if you buy 90 days worth of medication.
Pros: This medication can prevent the absorption of cholesterol in the intestines. It has been shown to significantly reduce heart attacks and strokes in high-risk patients when taken with a statin. It’s often the drug that doctors prescribe when patients’ LDL remains high despite statin therapy.
Cons: Ezetimibe alone has never been shown to ward off heart attacks and strokes, so it’s only prescribed as a “monotherapy” when someone cannot tolerate a statin, says Dr. Michos.
Pros: Soluble fiber—the type found in oats, beans, apples, and other plants—binds to cholesterol in the intestine and whisks it away in your stool. One large meta-analysis in the American Journal of Clinical Nutrition found that it makes a small dent in lowering cholesterol. The major benefit of boosting dietary fiber intake: You’ll improve your overall diet, boosting your intake of protective nutrients and consuming less cholesterol and fewer unhealthy saturated fats, the study authors noted.
Cons: Americans seem to have a hard time getting enough fiber. Experts recommend 25 to 35 grams a day, yet most adults get only about 12 grams.
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Pros: EPA (eicosapentaenoic acid) is a type of omega 3 fatty acid found in fish and fish oil. Icosapent ethyl (Vascepa) is a purified form of EPA approved for people with heart disease or high risk for heart disease. Dr. Michos says it lowers triglyceride levels and may have anti-inflammatory effects. One study found that 4 grams daily reduces heart attacks and strokes by 25%.
Cons: People with fish allergies may need to take a pass on this medication. They may be at increased risk of having an allergic reaction. Icosapent ethyl poses a risk of irregular or rapid heart rate, and it can increase the risk of bleeding in people taking blood thinners.
Pros: This class of injectable therapies include alirocumab (Praluet) and evolocumab (Repatha). They improve the liver’s ability to remove LDL cholesterol from the blood—by as much as 60%. Doctors prescribe these drugs to help people who’ve had a previous heart attack or stroke, who have a genetic disorder that causes extremely high cholesterol, or whose LDL remains stubbornly high. ACC/AHA cholesterol management guidelines favor PCSK9 inhibitors over two older cholesterol-lowering options: niacin (which poses severe side effects) and bile acid sequestrants (which can cause constipation and may raise triglycerides).
Cons: Some patients may experience an infection-site reaction, says Dr. Michos. These drugs also come with a sticker price of roughly $6,000 a year, so doctors typically must submit paperwork to obtain approval for coverage from patients’ insurance companies.
Pros: These drugs include fenofibrate (Tricor and other brand names) and gemfibrozil (Lopid). They can lower triglycerides by 25% to 50% and raise HDL by 5% to 20%, says the U.S. National Library of Medicine.”We use fibrates when triglycerides are really high, above 500,” says Dr. Michos.
Cons: Side effects can include headache, constipation and diarrhea. People with liver, gallbladder, or kidney disease should not take these drugs.
Pros: This once-a-day pill—the first in a new class of non-statin drugs (called ATP Citrate Lyase inhibitors)—is an additional therapy for people with heart disease or dangerously high LDL cholesterol. It works by inhibiting cholesterol production in the liver. In studies, bempedoic acid lowered LDL by 18% when used with a moderate- or high-intensity statin.
Cons: It can increase blood levels of uric acid, which can lead to gout. It’s also new—approved in February 2020—so its use is limited until a longer-term clinical trial is completed. “We need to see whether bempedoic acid can actually reduce cardiovascular outcomes,” explains Dr. Michos.
Pros: Along with eating healthfully and being physically active, the US Centers for Disease Control and Prevention reminds Americans to maintain a healthy weight. Being overweight or obese can slow your body’s removal of LDL cholesterol, upping your chances of heart problems. Quitting smoking and limiting alcohol intake—no more than one drink a day for women and two for men—can also help your heart.
Cons: It’s hard to do the right thing every day. But knowing your risk factors for heart disease, and taking steps to manage your risks, puts you in greater control of your future well-being.