How to decrease Low-Density Lipoprotein (LDL) with lifestyle measures?

From the Guidelines

To decrease Low-Density Lipoprotein (LDL) with lifestyle measures, adults who would benefit from LDL-C lowering should consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains, and limits intake of sweets, sugar-sweetened beverages, and red meats, as recommended by the American College of Cardiology and American Heart Association 1.

Key Lifestyle Modifications

• Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• Limit saturated fats, trans fats, and dietary cholesterol
• Replace unhealthy fats with monounsaturated and polyunsaturated fats found in olive oil, nuts, and fatty fish
• Increase soluble fiber intake from foods like oats, beans, and apples
• Aim for at least 30 minutes of moderate-intensity exercise most days of the week

Dietary Recommendations

• Consume a dietary pattern that achieves 5%–6% of calories from saturated fat, as recommended by the NHLBI 1
• Reduce percent of calories from saturated fat and trans fat, as recommended by the ACC/AHA 1
• Follow plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet

Physical Activity Recommendations

• Engage in aerobic physical activity to reduce LDL-C and non–HDL-C: 3–4 sessions per week, lasting on average 40 minutes per session, and involving moderate- to vigorous-intensity physical activity, as recommended by the ACC/AHA 1

Additional Considerations

• Maintain a healthy weight, as losing even 5-10% of body weight can significantly improve cholesterol levels
• Limit alcohol consumption and quit smoking, as smoking damages blood vessels and lowers HDL cholesterol
• Consider adding plant sterols and stanols found in certain margarines and supplements, which can reduce LDL by up to 10%

From the Research

Decreasing Low-Density Lipoprotein (LDL) with Lifestyle Measures

To decrease LDL cholesterol through lifestyle measures, several strategies can be employed:

• Replacing saturated fat with polyunsaturated fat, such as n-6 polyunsaturated fat, can lead to a reduction in LDL cholesterol 2
• Substituting low glycaemic index carbohydrates for high glycaemic index carbohydrates can lower triglyceride levels and reduce cardiovascular risk 2
• Consuming large doses of fish oil can lower triglyceride levels, with a mean lowering of 0.45 mmol/L for a 3.5 g/day amount 2
• Increasing intake of soluble fibre, such as Konjac glucomannan, can lower LDL cholesterol by 0.2-0.35 mmol/L 2
• Plant sterols or stanols can lower LDL cholesterol by about 10% for a 2 g/day dose 2, 3
• Exercise and weight loss can lower cardiovascular risk predominantly by lowering fasting triglyceride 2

Dietary Interventions

Dietary interventions can be effective in lowering serum LDL cholesterol, with comprehensive dietary intervention indicated in all patients with an absolute 5 year risk for coronary disease of 10% or greater 4

• Replacing saturated and trans fatty acids with poly- and monounsaturated fats can lower LDL cholesterol 4, 5
• Increasing intake of plant sterols and non-glyceride components from natural plant foods and vegetable oils can provide an additional dietary means for prevention/correction of dyslipidaemia 3
• Combining plant sterols, soy protein, viscous fibers, and almonds in a single diet (portfolio diet) can achieve cholesterol reductions similar to those reported in statin trials 6

Lifestyle Modifications

Lifestyle modifications, including dietary composition, alcohol intake, weight reduction, and physical activity, can affect plasma lipid levels 5

• A multifactorial approach including multiple changes with additive effects is the best option for decreasing LDL cholesterol and improving cardiovascular health 5