From the Guidelines
For patients with high cholesterol, the most effective dietary approach is to consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains, includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts, and limits intake of sweets, sugar-sweetened beverages, and red meats, as recommended by the American College of Cardiology and American Heart Association 1, 2. This dietary pattern can be achieved by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet.
- Key components of this diet include:
- Reducing saturated fat intake to 5-6% of daily calories
- Eliminating trans fats
- Increasing soluble fiber intake to 10-25 grams daily
- Incorporating more unsaturated fats from olive oil, avocados, nuts, and fatty fish
- Limiting dietary cholesterol to under 200mg daily
- Maintaining a healthy weight through portion control and regular physical activity
- The DASH dietary pattern, in particular, has been shown to be effective in reducing blood pressure and LDL cholesterol, and can be combined with lower sodium intake for even greater benefits 1, 2.
- Regular physical activity, such as aerobic exercise for 3-4 sessions per week, can also help reduce LDL-C and non-HDL-C, and lower blood pressure 1, 2.
- It is essential to adapt this dietary pattern to individual calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions, such as diabetes.
- By following these dietary recommendations, patients with high cholesterol can reduce their risk of cardiovascular disease and improve their overall health outcomes, as supported by the highest quality evidence from the American College of Cardiology and American Heart Association 1, 2.
From the Research
Dietary Recommendations for Patients with High Cholesterol
- To lower cholesterol and triglyceride levels and reduce cardiovascular risk, patients should minimize saturated fats and refined carbohydrates, eliminate trans-fat, and increase fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 3.
- Adhering to a Mediterranean diet is strongly recommended due to its ability to lower cardiovascular disease and total mortality 3.
- High-dose omega-3 fatty acids can lower triglyceride levels, reduce cardiovascular disease, and prevent coronary plaque progression 3.
Pharmacological Therapies for High Cholesterol
- Statins are the first-line therapy for treating dyslipidemia due to their low-density lipoprotein cholesterol (LDL-C) lowering efficacy, superior event-reduction data, and cost-effectiveness 4, 5, 6, 7.
- For patients who are intolerant of statins, other agents such as ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and bempedoic acid can be used to lower LDL-C levels and reduce the risk of major adverse cardiovascular events (MACE) 4, 5, 6.
- Ezetimibe lowers LDL-C by reducing intestinal absorption of cholesterol, while PCSK9i lower LDL-C by increasing the number and durability of hepatic LDL receptors 4, 5, 6.
- Bempedoic acid reduces hepatic cholesterol synthesis and can be used in combination with other agents to synergistically lower LDL-C and reduce the risk of MACE 4.