High LDL (the “bad” cholesterol) raises your risk for heart attacks and strokes. You don’t need to memorize every study to act. Start with a clear plan: measure, change habits, use medicines when needed, and track progress.
Get a fasting or non-fasting lipid panel to know your LDL number. Ask your clinician to calculate your 10-year cardiovascular risk. If you already have heart disease, diabetes, or very high LDL (usually ≥190 mg/dL), the goal is lower and treatment starts sooner. For most high-risk people, aim for LDL <70 mg/dL; for moderate risk, targets are usually <100 mg/dL. Recheck 4–12 weeks after starting a new treatment, then every 3–12 months once stable.
Food changes work. Swap butter and fatty cuts of meat for olive oil, oily fish, and lean protein. Eat more soluble fiber—oats, beans, apples and psyllium—because it binds cholesterol in the gut and lowers LDL. Plant stanols and sterols (found in fortified margarine and spreads) can cut LDL by 5–15% when used daily. Aim for 30 minutes of brisk walking most days; exercise raises HDL and helps lower LDL a bit. Losing 5–10% of body weight often moves cholesterol numbers in the right direction.
Quit smoking and limit alcohol. Smoking damages arteries and reduces the benefits of good cholesterol control. Alcohol can raise triglycerides and add calories, so keep it moderate.
Statins are first-line meds. They cut LDL by 30–60% depending on intensity and lower heart risk. Common options include atorvastatin and rosuvastatin. Side effects to watch for: muscle aches, dark urine, unexplained fatigue, or persistent nausea. Most people tolerate statins well; if you have muscle symptoms, your doctor can change dose or try a different statin.
If statins don’t get you to target, add ezetimibe (blocks cholesterol absorption) or newer options like PCSK9 inhibitors and inclisiran. PCSK9 drugs can cut LDL by another 50–60% but cost more and are given by injection. Bempedoic acid is another oral option for certain patients. Your doctor will weigh benefit, side effects, and cost.
Mind drug interactions. Grapefruit can raise levels of some statins. Tell your clinician about all medicines and herbal supplements you take.
Want clear next steps? Get a lipid panel, ask about your 10-year risk, try diet and activity changes for 3 months, and discuss statins if your risk is moderate or higher. Track results and adjust. Small, consistent steps add up—lower LDL lowers your chance of a heart attack or stroke.
Curious if you really need to stick with statins to bring down your cholesterol? This detailed guide explores the latest and most effective statin alternatives doctors are prescribing in 2025, from new meds like PCSK9 inhibitors to nutraceuticals like berberine. Find out how these options work, who they’re right for, and get tips to discuss with your doctor. Everything you need to know, served up in plain English.