cholesterollowering

Cholesterollowering refers to strategies used to lower blood cholesterol levels, in particular low-density lipoprotein cholesterol (LDL-C), with the aim of reducing the risk of atherosclerotic cardiovascular disease.

Lifestyle measures are the foundation of cholesterol lowering. A heart-healthy diet emphasizes fruits, vegetables, whole grains, lean proteins, and limited intake of saturated fats, trans fats, and dietary cholesterol. Increasing soluble fiber and plant sterols can help reduce LDL-C. Regular physical activity, weight management, smoking cessation, and moderation of alcohol intake further reduce cardiovascular risk. These changes are beneficial on their own and can improve the effectiveness of medications when they are required.

Pharmacologic therapy is used when lifestyle changes alone do not achieve adequate LDL-C reduction or when cardiovascular risk is high. Statins are the first-line medications and work by inhibiting cholesterol synthesis in the liver. If LDL-C remains above target, additional options include ezetimibe, PCSK9 inhibitors, bempedoic acid, and bile acid sequestrants. Niacin is rarely used today due to limited incremental benefit and more frequent adverse effects. Supplements such as red yeast rice are sometimes discussed, but they are not a proven substitute for prescribed medications and can vary in potency and safety.

Monitoring and targets vary by guideline and risk level. In general, clinicians assess LDL-C response after starting or changing therapy and adjust treatment to reach risk-based goals. Common practice includes baseline lipid panels, follow-up testing 4–12 weeks after changes, and periodic monitoring thereafter. Safety monitoring for statins includes watching for liver enzyme elevations and muscle symptoms.

Cholesterol lowering is an ongoing process, particularly for familial hypercholesterolemia or established cardiovascular disease, requiring coordinated care and regular reassessment.