How to lower your cholesterol: Diet, supplements or statins? - Nebraska Medicine

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More than one in 10 Americans have high cholesterol.

Why is this important to know? High cholesterol is one of the leading risk factors for heart disease, the number one killer of all Americans. As your total cholesterol rises, so does your risk for heart disease.

The good news is that in most cases, cholesterol levels can be lowered and maintained with a combination of diet, exercise and cholesterol-lowering medications such as statins, says Marco Gonzalez, MD, Nebraska Medicine neurologist. There is also evidence that natural health products or supplements may help lower cholesterol levels.

What is cholesterol?

Cholesterol is a fat-like, waxy substance your body uses to build cells and make hormones and vitamin D. Cholesterol travels through your body through your bloodstream. You get cholesterol from the foods you eat and your liver, which produces cholesterol.

What is the role of cholesterol?

Your total cholesterol is made up of LDL, low-density lipoproteins, and HDL, high-density lipoproteins. LDL, also known as bad cholesterol, deposits plaque in your arteries. This can lead to inflammation and blockages, raising your risk for heart attack and stroke. HDL, commonly called good cholesterol, helps move the bad cholesterol to the liver, where it can be cleaned out.

Dr. Gonzalez recommends maintaining a total blood cholesterol of 200mg/dl or less. Women should strive for HDL levels of 50mg/dl or higher, and men should aim for levels of 40mg/dl or higher. LDL levels should be 100mg/dl or less.

"Depending on your risk factors and if you have any other conditions such as diabetes or a prior history of heart disease or stroke, your doctor may recommend even tighter control of your cholesterol levels," says Dr. Gonzalez.

Diet, supplements or statins?

If you are in a low-risk group for heart disease, your doctor may recommend lowering your cholesterol through diet, natural health products and exercise. Studies show many people can reduce their cholesterol levels by 20% to 30% through a healthy diet and exercise regimen, says Dr. Gonzalez.

To lower your cholesterol through diet, follow these recommendations:

• Increase fiber in your diet by eating more high-fiber grains like barley, bran, whole wheat, flax seeds and nuts like almonds, pecan, pistachios and sunflower seeds

• Add more soluble fibers to your diet, like beans, brussels sprouts, oatmeal, apples and pears. Soluble fibers can help reduce the absorption of cholesterol into your bloodstream

• Reduce your intake of saturated fats found in red meat and full-fat dairy products, butter and coconut oil. Avoid prepackaged cookies, crackers and cakes that often contain trans fats or partially hydrogenated vegetable oil. Replace with canola, corn, safflower or olive oils

• Choose lean proteins like chicken and turkey. Increase intake of proteins with omega-3 fatty acids like salmon, mackerel and herring and nuts such as walnuts, almonds, pecans and macadamia nuts.

Natural health products

While more research is needed, says Dr. Gonzalez, some natural health products that may have an impact on lowering cholesterol include:

• Soy protein

• Green tea

• Plant sterols and stanols

• Probiotic yogurt

• Marine-derived omega-3 fatty acids

Statins

Statins are prescription medicines that can help lower your cholesterol.

"Statins are safe and can reduce cholesterol levels by up to 50%," says Dr. Gonzalez. "Reduction in LDL cholesterol levels using statin therapy is associated with a significantly reduced risk of cardiovascular events and death. Studies have shown that a 20% reduction in LDL cholesterol levels with statin therapy can reduce the risk of cardiovascular disease by 23% to 36%."

You may be a candidate for statins if:

• You are not able to lower your cholesterol through diet, supplements and exercise

• You are considered intermediate heart disease risk or higher

• You have a family history of heart disease

• You have had a prior heart attack or stroke

• You have autoimmune diseases like rheumatoid arthritis or metabolic syndrome

Statins can cause side effects such as muscle pain or liver toxicity in some individuals, notes Dr. Gonzalez. However, these can usually be managed by lowering the strength or dose of the statin or by changing to a different statin.

Pilot project to improve management of heart disease and high cholesterol patients

The Nebraska Medical Center was recently chosen as one of six facilities in the country to participate in a pilot project sponsored by the American Heart Association to improve the care of adults with cardiovascular disease and high LDL cholesterol.

"We know that heart disease and stroke patients with high LDL cholesterol levels have a much greater chance of having a second event if their LDL cholesterol levels are not reduced and managed appropriately," says Dr. Gonzalez.

Through the ASCVD Lipid Management Initiative, Nebraska Medical Center will have access to a new registry system and patient self-management app to assess the patient journey of referral and management for high-risk ASCVD patients and consider potential quality improvement efforts, explains Dr. Gonazalez.

Integrated atherosclerotic cardiovascular disease, or ASCVD, is a condition that causes arteries to narrow. This causes restriction of healthy blood flow to organs as well as the arms and legs. When blood flow is blocked to the heart or brain, it can result in heart attack or stroke.

"We are very excited and honored to participate in this study," says Dr. Gonzalez. "The end goal is to improve management of these patients through better cholesterol management, which we hope translates into a reduction in heart attacks and strokes."

Having problems managing your cholesterol levels?

To schedule an evaluation with one of our doctors, call 800.922.0000