How to lower your cholesterol

Medicines

Statins

Statins are effective at lowering cholesterol, and the health scares about them have been categorically debunked. It's hardly surprising that there has been a lot of media interest in statins. According to the British Heart Foundation (BHF), they're one of the most commonly prescribed medicine in England, and people are always interested in stories that relate to them personally.

However, many of the scare stories about side effects have largely been shown to be down to the nocebo effect. This is the opposite of the placebo effect - where you're more likely to get better from a treatment if you believe you will, regardless of how effective it is. With the nocebo effect, you're more likely to get side effects if you're worried about them - and the more publicity there was about statins, the more people were worried.

While statins may be the best-known lipid-lowering medicines, they're not the only ones. If your cholesterol isn't adequately controlled with lifestyle and statin treatment - or you can't take statins - you may be prescribed a medicine called ezetimibe or a fibrate medicine.

Other medicines

In the last couple of years, there have been several new medicines with powerful lipid-lowering properties developed. These target a protein called PCSK9, which is linked to high levels of LDL cholesterol. Medicines in this group include Repatha (evolocumab), Praluent (alirocumab) and inclisiran (Leqvio), which has been found to reduce LDL cholesterol by around 50% with a single six-monthly injection. However, these medicines are usually only given to people at very high risk, and whose cholesterol isn't controlled with tablets.

Quitting smoking

Along with all the other benefits of stopping smoking, quitting can reduce furring up of your arteries and improve your cholesterol.

Which alternative you use is up to you - ideally in discussion with your smoking cessation healthcare professional. But two things are clear - quitting is one of the best gifts you can give your body, and you're much more likely to quit successfully with expert support than by going cold turkey.

Lifestyle changes and exercise

Exercise can help you lose weight, in combination with changes to your diet. As an added bonus, it can improve your cholesterol independent of weight loss as well. Regular exercise, ideally combining aerobic exercise - the kind that makes you mildly out of breath - with resistance exercises, can cut harmful LDL and raise HDL cholesterol.

The best form of exercise for you is the kind you enjoy - whether that's running, cycling, swimming, yoga, Pilates, spinning, high-intensity interval training (HIIT) or CrossFit. That's partly because you're more likely to stick with exercise if it isn't a chore. If you have a physical disability, you may need to adapt your routine, but there are still plenty of options.

Omega-3 fatty acids

Foods high in omega-3 fatty acids won't lower your LDL cholesterol but they have other heart-healthy benefits. Any oily fish - including sardines, mackerel, herring and salmon - are rich in omega 3s. But you can also find them in plant sources, including walnuts, soya or kidney beans and flax, chia or hemp seeds.

Patient picks for High cholesterol

Heart health and blood vessels

The pros and cons of statins

The great debate rumbles on. On the one hand, there are the passionate advocates, who believe statins should be, if not quite added to the tap water, certainly given to more than the seven million people in the UK who take them today. Squaring up on the other side of the ring are those who believe they do more harm than good. Somewhere in the middle are patients, who would be forgiven for not knowing who to believe.

by Dr Sarah Jarvis MBE, FRCGP

Heart health and blood vessels

High cholesterol

Cholesterol is a fat chemical (lipid) that is made in the cells in your body. Many different cells make cholesterol but cells in the liver make about a quarter of the total. You need some cholesterol to keep healthy.

by Dr Rosalyn Adleman, MRCGP

Introducing more fibre into your diet

When we think of fibre, we tend to focus on insoluble fibre - whole grain and wholemeal versions of refined foods like flour, bread and pasta, or beans and pulses. Insoluble fibre provides lots of benefits for your bowels, but soluble fibre has an additional superpower, reducing absorption of bad fats into your system. With a little imagination, you can up your intake of fibre through small tweaks to your diet.

Soluble fibre

Oats, barley, stone fruits - such as plums, nectarines, apricots - pears, apples, aubergines, avocados, carrots, broccoli, Brussels sprouts, and sweet potatoes are good sources of soluble fibre. So are some beans, such as black beans or kidney beans, nuts - walnuts, almonds, hazelnuts, peanuts - and seeds including sunflower seeds and flax seeds.

Pulses

Try adding beans or pulses to stews. This can bulk them out, making them more economical, but they're also a delicious way to up your heart-healthy food intake. When summer comes, many fresh fruits become cheaper and more readily available. Eat it fresh or stew it - with as little sugar as possible - for a tasty dessert.

While you may think carrot, cucumber or celery sticks are dull, pairing them with home-made hummus can really perk them up. Just whiz up a drained tin of chick peas with a spoonful of tahini - sesame seed paste, available from most supermarkets - lemon juice, garlic and pepper. Equally easy but impressive as a party dip as well as for yourself is feta and beetroot hummus. Both are heart-healthy and cheaper than shop-bought alternatives.

Seeds and nuts

Keep a pot of seeds and nuts handy as a snack, to avoid being tempted by high-sugar alternatives. If you do want a sweet treat, home-made flapjack does at least have plenty of soluble fibre from the oats. Dried fruit - such as figs and dates - shouldn't be eaten in unlimited quantities because they are high in sugar. But they feel indulgent and are a much better alternative than a chocolate bar.

Reducing your salt intake

On the whole, cooking from scratch is better for your heart health than ready-prepared foods. These are often high in hidden sugar and salt. While too much salt won't affect your cholesterol, it can raise your blood pressure - another major contributor to heart disease, as well as stroke.

It's the sodium in salt which affects blood pressure. The BHF reports that switching from standard salt to salt substitutes - where some sodium is replaced by potassium - could cut early deaths by 12%, and your chance of having a heart attack or stroke by 13%.

Rather than salt, use herbs, spices and lemon juice to season. Or if you do want to add salt, opt for a reduced sodium alternative.

Sterols and stanols

These are plant chemicals which are a similar size and shape to cholesterol. As they are absorbed from your gut, they block some cholesterol from being absorbed. It's hard to get enough even from a healthy diet, but fortified foods like Benecol and Flora ProActiv can help lower cholesterol. So too can soya-based foods, including soya milk or yoghurt, tofu and soya beans.

With thanks to 'My Weekly' magazine where this article was originally published.