Statins vs. Lifestyle Changes: What’s the Best Way to Lower Cholesterol?

• Lifestyle changes are often the first approach for mild to moderate cholesterol elevation.
• Dietary changes include consuming soluble fiber (oats, beans, fruits), unsaturated fats (olive oil, nuts, avocados), and omega-3 fatty acids (fatty fish), and limiting saturated fats (red meat, butter, fried foods), trans fats (processed and fast foods), and refined carbohydrates and sugar.
• Effective exercises include walking, jogging, cycling, and swimming, as well as weight lifting. Even small changes like taking the stairs can help.
• This may not be enough for everyone, especially those with genetic conditions like familial hypercholesterolemia, diabetes, or age-related increases in cholesterol. Statins provide stronger protection against cardiovascular conditions.
• For some, a combination of lifestyle changes and statins may be the most effective approach.

Cholesterol is a type of fat that circulates in your bloodstream. Your body naturally produces cholesterol, and it's also found in certain foods.

Cholesterol is essential for your body. It helps maintain the structure of cell membranes, keeping them strong and flexible. It's also necessary for producing hormones like estrogen, testosterone, and cortisol. However, having too much cholesterol, particularly LDL cholesterol, can be harmful to your heart health.

Cholesterol travels through your bloodstream in different types of particles, the most well-known being:

• LDL ("bad") cholesterol: This carries cholesterol to your arteries, where it can accumulate and form plaque. Over time, plaque narrows your arteries and restricts blood flow, increasing your risk of heart disease and stroke.
• HDL ("good") cholesterol: This helps remove excess LDL cholesterol from your bloodstream, transporting it to your liver where it's broken down and eliminated from your body. Higher levels of HDL cholesterol can help protect against cholesterol buildup and reduce your risk of heart problems.

Normal Cholesterol Levels

A cholesterol test, also called a lipid panel, measures different types of cholesterol in your blood. Normal cholesterol levels include the following:

• Total cholesterol: Less than 200 mg/dL
• LDL cholesterol: Less than 100 mg/dL
• HDL cholesterol: : 40 mg/dL or higher for men, 50 mg/dL or higher for women
• Triglycerides: Less than 150 mg/dL

Read Important Cholesterol Markers You Should Know About

When cholesterol levels are too high, symptoms are not usually noticeable right away. This is why high cholesterol is often referred to as a “silent” condition. However, over time, excess LDL can lead to serious problems, such as:

• Chest pain or pressure due to narrowed arteries
• Shortness of breath, especially with physical activity
• Fatigue and weakness, which may signal reduced oxygen supply to your heart
• Leg pain or cramping when walking, a possible sign of reduced blood flow to your legs

High cholesterol often goes unnoticed until complications develop, making routine cholesterol checks an important part of maintaining heart health.

Lifestyle Changes for Cholesterol

Lifestyle choices are heavily involved with cholesterol management. In some cases, adjusting diet and physical activity can lower cholesterol levels enough to reduce the need for medication.

However, the effectiveness of these changes depends on several factors, including overall health, and the severity of cholesterol levels.

Diet

Certain foods have been shown to help improve cholesterol levels by reducing LDL cholesterol and increasing HDL cholesterol.

Foods Good for Heart Health

• Soluble fiber, found in oats, beans, lentils, apples, and berries, helps reduce LDL cholesterol by preventing it from being absorbed into your bloodstream.
• Unsaturated fats, found in olive oil, nuts, seeds, and avocados, can help lower LDL while supporting overall heart health.
• Salmon, mackerel, and sardines provide omega-3 fatty acids, which help lower triglycerides and improve cholesterol balance.

Foods That Can Raise Cholesterol

• Saturated fats: Found in red meat, butter, full-fat dairy, and fried foods, saturated fats increase LDL cholesterol, contributing to plaque buildup in your arteries.
• Trans fats: Found in processed and fast foods, packaged baked goods, trans fats raise LDL cholesterol while lowering HDL, making them particularly harmful to heart health.
• Refined carbohydrates and sugar: White bread, pasta, pastries, and sugary drinks can raise triglyceride levels, which often accompany high LDL cholesterol.

Exercise

Regular physical activity can help increase HDL cholesterol, helping remove LDL from your bloodstream. Exercise also supports overall heart health by improving circulation and reducing your risk of artery blockages.

Some of the most effective forms of exercise for cholesterol management include the following:

• Activities such as walking, jogging, cycling, and swimming help lower LDL and raise HDL.
• Lifting weights can help improve metabolism and reduce fat storage, which contributes to better cholesterol balance.
• Small lifestyle changes, such as taking the stairs instead of the elevator or walking instead of driving short distances, can also contribute to better heart health.

Are Lifestyle Changes Enough?

For some, diet and exercise alone may be enough to lower cholesterol to a healthy range. This is often the case for patients with mild cholesterol who do not have other risk factors for heart disease. Making consistent lifestyle adjustments can help maintain normal cholesterol levels and reduce your risk of complications over time.

However, lifestyle changes alone may not be enough for everyone. Factors that affect cholesterol response to diet and exercise include:

• Some patients have a genetic condition called familial hypercholesterolemia, which causes high cholesterol regardless of diet and exercise.
• Conditions such as diabetes can make cholesterol harder to manage with lifestyle changes alone.
• Cholesterol levels tend to rise with age, and hormonal changes, particularly in women after menopause, can impact cholesterol balance.

In cases where lifestyle changes are not enough to bring cholesterol to a safe level, medication may be necessary.

When Are Statins Necessary?

Statins are prescribed when cholesterol levels pose a significant risk to heart health, particularly when lifestyle changes alone do not lower cholesterol enough.

While diet and exercise can be effective, some patients need additional support to prevent complications such as heart disease and stroke. The decision to start statins is based on cholesterol levels, overall health, and other risk factors that contribute to cardiovascular disease.

Some risk factors that may require medication include the following:

• High LDL cholesterol levels: Statins are typically recommended when LDL cholesterol is 190 mg/dL or higher, as levels this high significantly increase your risk of plaque buildup in your arteries.
• Diabetes: Patients with type 2 diabetes are at higher risk of heart disease, even if LDL levels are not extremely high. The American Diabetes Association (ADA) recommends statins for most adults with diabetes who are 40 years or older.
• High cardiovascular risk: Doctors use a 10-year risk assessment to determine the likelihood of developing heart disease or having a stroke. If your risk is 7.5% or higher, statins are often recommended.
• Familial hypercholesterolemia: This genetic condition causes extremely high cholesterol levels, often above 300 mg/dL, and increases your risk of heart disease at an early age.
• Even patients with moderately high cholesterol may need statins if they have other risk factors, such as high blood pressure, obesity, smoking history, or a family history of early heart disease (before age 55 in men or 65 in women).

How Statins Work

Statins target cholesterol at its source, your liver. Statins work by blocking an enzyme called HMG-CoA reductase, which plays a key role in cholesterol production. With this enzyme partially blocked, your liver produces less cholesterol and pulls more LDL from your bloodstream to compensate. This helps lower overall cholesterol levels and reduces your risk of plaque buildup in your arteries.

Types of Statins

Not all statins work the same way. Some are more potent and lower cholesterol at smaller doses, while others may be more appropriate for patients who need milder cholesterol reduction or have concerns about medication interactions.

• Atorvastatin (Lipitor)
• Rosuvastatin
• Simvastatin (Zocor)
• Lovastatin (Mevacor)
• Pravastatin (Pravachol)
• Fluvastatin (Lescol)
• Pitavastatin (Zypitamag, Livalo)

Speak with Your Doctor

Managing cholesterol is different for everyone, and deciding whether lifestyle changes, statins, or a combination of both is the best approach depends on your overall health and risk factors. Your doctor will assess cholesterol levels, review medical history, and determine the most effective way to reduce your risk of heart disease and stroke.

For those with mild to moderate cholesterol elevation, a doctor may recommend adjusting diet and exercise first to see if these changes are enough to lower LDL and raise HDL. However, if cholesterol levels remain high or there are additional risk factors, statins may be necessary to provide stronger protection against cardiovascular conditions.

Remember that regular cholesterol screenings are important, as high cholesterol often does not cause symptoms. Discussing test results with your doctor can help determine whether medication is needed or if lifestyle adjustments alone are enough.