The Best Way to Lower Cholesterol

Achieving lower cholesterol is one of the best ways to protect yourself from heart attack and stroke. A fat-like substance found in the blood, cholesterol can build up and form deposits in your arteries. These cholesterol deposits can clog arteries -- or in some cases completely block -- the passage of blood and oxygen to the heart. The result, for hundreds of thousands of people every year, is chest pain, heart attack, or other cardiovascular problems.

There are two kinds of cholesterol: HDL (high-density lipoprotein) and LDL (low-density lipoprotein) cholesterol. HDL is often called the "good" kind of cholesterol because it helps remove unneeded cholesterol from the body. LDL is the "bad" cholesterol; it's made up primarily of fat and is a particular risk factor for heart disease.

So when you set out to lower cholesterol, you need to know your HDL number, your LDL number, and your total cholesterol number (which is not the total of your HDL and LDL cholesterol) too.

Total Cholesterol (mg/dL)	HDL (mg/dL)	LDL (mg/dL)
Best: Below 200	Men: 40-50	Best: Below 130
Borderline: 200-239	Women: 40-60	Borderline: 130-159
High risk: 240	High risk: Below 40	High: 160 or above

If any of your cholesterol numbers are in the high risk category, you're at an increased risk for heart disease -- which may lead to heart attack.

The good news is you have several options to help you get back in the cholesterol safety zone. These four options can all work separately -- or together -- to lower cholesterol, and keep it under control.

• Diet
• Exercise
• Weight loss
• Medications

Diet to Lower Cholesterol

The body gets cholesterol in two ways: by making it and from food. Most of the cholesterol we eat comes from animal fats found in foods such as meat, butter, margarine, milk, and fish. One of the easiest ways to lower cholesterol is to lower your intake of certain kinds of fats.

Just as there is "good" cholesterol and "bad" cholesterol, there are "good" fats and "bad" fats. To keep your cholesterol low, your total dietary fat intake shouldn't be more than 25% to 35% of your diet -- and most of those fats should be the good kind, like vegetable fats (monounsaturated fats and polyunsaturated fats), and omega-3 fatty acids, found mostly in fish.

To help lower LDL cholesterol, you'll want to avoid or reduce saturated fats (usually found in animal products like meats, eggs, and dairy), and trans fats, which are formed when hydrogen is added to vegetable oil (think French fries and doughnuts).

Exercise to Lower Cholesterol

Regular physical activity is key to keeping your cholesterol low. Studies have found that even moderate exercise is enough to boost HDL (good) cholesterol and lower LDL (bad) cholesterol. In a recent study of young and middle-aged women in Spain, researchers found that the more calories a woman burned through moderate exercise, the lower her LDL level and the higher her HDL level.

Exercise, in combination with a healthy diet, is also important because while a low-fat lower calorie diet helps lower total cholesterol and bad LDL cholesterol, one study showed it can also drop good HDL cholesterol by 7% over a year. That same study showed an increase in good HDL cholesterol (and a decrease in LDL and total cholesterol) for those who walked or jogged about 8 miles a week.

Weight Loss to Lower Cholesterol

Both a healthy diet and regular physical exercise can lead to another important tool in lower cholesterol: weight loss.

Excess weight tends to increase your LDL cholesterol level. If you are overweight and have high LDL cholesterol, losing weight may help you lower it. Weight loss also helps to lower triglycerides (another form of fat in your blood and one which you should aim to keep below 150 mg/dL) and raise HDL ("good") cholesterol levels.

Medications to Lower Cholesterol

Some people find they can't lower cholesterol enough with lifestyle changes alone. "There are genetic factors that affect cholesterol levels," says Gotto. "One person may be able to keep their cholesterol low without much effort at all, while someone else may eat right, exercise, keep their weight down, and still have high cholesterol."

That's where medications come in. There are several types of cholesterol-lowering medications, but the most commonly prescribed are statins. There's a good reason for that, says Gotto. "They are very effective in lowering LDL levels in the majority of patients." Studies have shown that statins can lower LDL cholesterol by 20% to 60%.

Other medications to lower cholesterol include:

• Bile acid sequestrants
• Nicotinic acid (niacin)
• Fibric acids
• Cholesterol absorption inhibitors
• Combination drugs such as Vytorin, Advicor

Each of these drugs act in slightly different ways. For example, some lower LDL cholesterol, while others treat high levels of triglycerides and/or raise HDL cholesterol. Your doctor will help you decide which medication -- or combination -- is best for you.

However, medication may not help you as much if you don't help yourself.

Diet, exercise, weight loss, and medication: Your cholesterol-lowering toolbox has all you need to help you lower cholesterol -- and keep it low.