Preventing High Cholesterol: Lifestyle & Dietary Strategies

11 Evidence-Based Prevention Pillars

1. Mediterranean/DASH Diet: Vegetables, fruits, whole grains, legumes, nuts, olive oil, fish; limit red meat, sweets.
2. Limit Saturated Fat (<7% calories) & Eliminate Trans Fat: Replace with MUFA/PUFA.
3. Increase Soluble Fiber: 10–25 g/day (oats, barley, beans, psyllium, apples) → binds bile acids.
4. Plant Sterols/Stanols: 2 g/day (fortified foods) → block cholesterol absorption.
5. Regular Exercise: 150 min moderate or 75 min vigorous/week → ↑HDL, ↓LDL, ↓TG.
6. Weight Management: BMI 18.5–24.9; waist <40" (M), <35" (F).
7. Moderate Alcohol: ≤1 drink/day (women), ≤2 (men); excess ↑TG, BP.
8. Quit Smoking: ↑HDL, ↓oxidation, ↓endothelial damage.
9. Limit Added Sugars & Refined Carbs: ↓TG, ↓small dense LDL.
10. Manage Comorbidities: Diabetes, hypothyroidism, kidney disease, sleep apnea.
11. Regular Screening: Lipid panel every 4–6 years (adults); sooner if risk factors.

When Medication Is Needed

Statins (atorvastatin, rosuvastatin) are first-line for primary/secondary prevention per ACC/AHA risk calculator. Ezetimibe, PCSK9 inhibitors, bempedoic acid for additional lowering.