A high level of LDL “bad” cholesterol can be dangerous because it puts a person at greater risk of hardened arteries (atherosclerosis) and coronary artery disease. If a blood test shows an elevated level of LDL cholesterol (130 milligrams per deciliter or higher), it is important to lower it to a healthier level.

Healthy diet choices and exercise are the first line of defense against high LDL cholesterol. Fatty and processed foods can elevate LDL cholesterol, whereas certain other foods can reduce it.

Foods that are naturally high in cholesterol include:

• Liver
• Eggs
• Red meat (especially organic red meat)
• High fat milk products

Foods that are naturally low in cholesterol include:

• Skimmed milk products
• Certain types of fish
• Plant foods (e.g., vegetables)

It is also thought that eating foods that contain soy protein may lower total and LDL cholesterol levels, according to the U.S. Food and Drug Administration (FDA).

Knowing which foods to avoid and which to include in the diet will not only improve cholesterol levels but will improve overall health as well. Physical activity is also an excellent strategy for reducing LDL cholesterol.

If diet and exercise strategies are unsuccessful in reducing levels of LDL cholesterol, a cholesterol-reducing drug may be prescribed.

Cholesterol is a fat-like substance present in all human beings. It comes from two sources – it is produced naturally in the body and it is found in certain foods. Maintaining a healthy level of cholesterol is important and the type and the amount of fat that a person eats has a direct impact on LDL cholesterol levels. Consuming foods with saturated fat or trans fat will cause the body to produce more LDL cholesterol.

Therefore, a key strategy for reducing LDL cholesterol is to limit the amount of unhealthy fats in the diet. Meat, dairy and other animal products are high in saturated fats, as are palm and coconut oils. Trans fat is mainly found in vegetable shortenings and foods that contain partially hydrogenated oils. This includes most types of snack and fast food.

The American Heart Association (AHA) has published guidelines to help people plan their diet to limit their fat and cholesterol intake. In general, people are urged to limit their consumption of saturated and unhealthy fats. 

In healthy people, the AHA recommends reducing saturated fat intake to less than 10 percent of total calories. This means that a 2,000-calorie diet should include no more than 22 grams of saturated fat.

In people who are overweight or already have coronary artery disease, the intake of saturated fat should be limited to less than 7 percent of total calories. This means that a 2,000-calorie diet should include no more than 16 grams of saturated fat.

The amount of  trans fat also should be limited in the diet. Trans fat acts like saturated fat in the body, raising bad cholesterol and increasing the risk of heart disease. Products that list “partially hydrogenated oil” or “hydrogenated oil” in their ingredients contain trans fat.

As trans fat travels through the bloodstream, various fatty particles may stick to the walls of the arteries, speeding the development of atherosclerosis and coronary artery disease. Until 2006, only saturated fat and dietary cholesterol were listed on food labels in the United States. However, starting in January 2006, the U.S. Food and Drug Administration required trans fat to be listed as well. The revised food labels will now provide information about all three elements to help people choose healthy options.

Not all fats are bad for the heart. Some, in fact, are good for the heart. For example, monounsaturated fats may lower levels of LDL cholesterol and triglycerides, as well as increase HDL cholesterol. The net effect can be a lower risk of heart disease. Foods that contain monounsaturated fats include:

Studies have found that a diet emphasizing heart-healthy fats, along with fiber and vegetable proteins, may be able to lower cholesterol levels with the same effectiveness as statins, a type of cholesterol-reducing drug.

The sooner an individual starts managing fat intake in the diet, the better. Cholesterol deposits begin forming at a young age and build gradually over time. Monitoring cholesterol through life can help reduce the risk of heart disease, as well as other medical conditions.

“Low cholesterol” products
Reducing the amount of cholesterol in the diet is generally a good idea. Dietary guidelines established by the American Heart Association (AHA) recommend that an individual consume less dietary cholesterol (cholesterol obtained through food rather than manufactured in the liver) than the average person (particularly the average man) is currently consuming.

In general, people are advised to eat less than 300 milligrams of cholesterol a day. Those people who already have heart disease or risk factors for heart disease (e.g, obesity, smoking or diabetes), are advised to eat less than 200 milligrams of cholesterol a day.

Individuals who want to lower their cholesterol often choose to eat food products that are marked as being  “low-cholesterol”. However, not all products packaged with “low cholesterol” or even “no cholesterol” labels are as healthy as they sound. Some of these products may still be high in saturated fat or trans fat, which can raise cholesterol levels higher than eating high-cholesterol foods. They may also contain high levels of sugar or salt, which are also detrimental to health.

Therefore, pay careful attention to levels and types of fats when seeking low-cholesterol foods. An increasing number of packaged foods (and even beverages) have added plant sterols, which have been shown to lower LDL cholesterol. All individuals should carefully read the Nutrition Facts that are listed on food labels when comparing products.

Garlic
Although garlic has been touted for years as a way to reduce LDL cholesterol, although medical opinion has long been divided over the issue. In 2007, a study funded by the National Institutes of Health (NIH) found that there was little evidence to suggest that garlic plays any part in reducing LDL cholesterol. However, garlic is thought to provide other heart-health benefits, such as thinning the blood and slowing the development of atherosclerosis (hardening of the arteries).

If a patient and physician decide that garlic supplements might be helpful, choose supplements that are well coated (enteric coated). This coating will help prevent the garlic from being broken down within the stomach before it is passed into the small intestine for absorption. Also, all vitamin and herbal supplements should be taken only after consulting with a physician.

Red meat
Researchers continue to study the effects of red meat on cholesterol and heart disease. For years, red meat has been avoided because of its high fat and cholesterol content. In studies, research has shown that meats such as beef, pork and veal produce a greater increase in blood cholesterol levels than fish.

However, a recent study suggests that lean cuts of red meat (e.g., beef) are comparable to white meat (e.g., chicken) in their effect on cholesterol levels. While research continues, most experts agree that the best choice is still fish or skinless poultry (e.g., chicken or turkey).

Part of the U.S. National Institutes of Health, the National Cholesterol Education Program (NCEP) is designed to optimize prevention and enhance the management of heart disease. This involves a systematic approach based on an individual’s long-term or short-term risk of heart disease.

As with previous recommendations, reduction of low-density lipoprotein (LDL) cholesterol continues to be the primary strategy. However, the NCEP now defines desired LDL levels based on the risk for developing coronary artery disease or having a cardiac event, such as a heart attack.

For healthy people, the NCEP recommends an optimal LDL cholesterol level of 100 milligrams per deciliter (mg/dL). This guideline, however, is not sufficient for patients already at higher risk of having a heart attack. For higher-risk patients, goals for LDL levels are set according to each patient’s risk category. These “therapeutic goals” in milligrams per deciliter (mg/dL) are:

A “therapeutic goal” is the target that physicians hope to reach through therapies to lower their patients’ LDL. Such therapy usually includes lifestyle changes (e.g., diet and exercise) and the use of cholesterol-reducing medications. The two stages of therapeutic goals (primary and secondary) give physicians the option of a lower goal for some patients.

Risk categories are determined by the National Heart, Lung, and Blood Institute (NHLBI) and based on a person's likelihood of having a heart attack in the next 10 years. These risk factors include:

The NCEP also promotes a series of dietary and fitness guidelines known as Therapeutic Lifestyle Changes. These include:

• Reduce dietary intake of saturated fat (less than 7 percent of total calories) and cholesterol (less than 200 milligrams a day).
  
• Achieve and maintain a healthy weight.
  
• Increase physical activity to at least 30 minutes on most days.

In addition to Therapeutic Lifestyle Changes, a physician may recommend cholesterol-reducing drugs to lower LDLs to desirable levels.

Exercise and LDL levels
Greater amounts of body fat usually mean higher levels of cholesterol. Research has shown that even a modest increase of one pound a year over time can have a significant impact on cholesterol levels. One of the best ways to reduce body fat is to exercise.

Aside from the cardiovascular benefits, exercise increases muscle mass and triggers a series of reactions in the body that help to burn more fat and to lower cholesterol levels. Furthermore, exercise reduces levels of triglycerides, another type of fat in the blood. The American Heart Association and the National Institutes of Health recommend that people exercise for at least 30 minutes a day on most days of the week. 

Medications and LDL levels
If changes in diet and lifestyle are unsuccessful in lowering cholesterol, medications may be prescribed. Often, the medication will be a cholesterol-lowering statin. These medications have shown excellent results in improving cholesterol ratios, but are not suitable for everyone.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about lowering cholesterol:

1. What is the difference between HDL and LDL cholesterol?
   
   
2. What are my cholesterol levels?
   
   
3. What should they be?
   
   
4. What diet changes should I make to lower my cholesterol?
   
   
5. What is the difference between fats and which ones should I avoid?
   
   
6. Are there any herbal supplements or vitamins that might help me?
   
   
7. What are the best types of exercise for me?
   
   
8. Should I be on a cholesterol-lowering drug?
   
   
9. What will be done to monitor my cholesterol levels?
   
   
10. What steps should I take to maintain healthy cholesterol levels?
    
    
11. What is my risk for heart disease?
    
    
12. What role does genetics play in my ability to lower my cholesterol?
    
    
13. How often should I have a cholesterol test?
    
    
14. What other tests will be conducted based on my risk for heart disease?