Managing Your Cholesterol

Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line. It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Managing Your Cholesterol can also help you work with your doctor to individualize your treatment.

Managing Your Cholesterol Cover

Healthy Eating: A guide to the new nutrition

Eat real food. That’s the essence of today’s nutrition message. Our knowledge of nutrition has come full circle, back to eating food that is as close as possible to the way nature made it. Based on a solid foundation of current nutrition science, Harvard’s Special Health Report Healthy Eating: A guide to the new nutrition describes how to eat for optimum health.

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UPDATE: In the summer of 2015, there were two noteworthy changes regarding cholesterol-lowering medications, and a final ruling on the use of cholesterol-raising trans fats in America’s food supply. The details of these developments are now included in this report.

More and more Americans are working to prevent heart problems by detecting high cholesterol and lowering it. Those efforts appear to be paying off: between 2006 and 2010, the percentage of Americans with coronary artery disease—the cause of nearly all heart attacks—fell by 10%.

Yet despite this decline, cardiovascular disease still is the No. 1 cause of death for men and women in the United States. One in every six adult Americans has high cholesterol, making them about twice as likely to develop heart disease as those with lower cholesterol.

On the plus side, high cholesterol is something you can change. How? Healthy dietary choices and regular exercise are among the most effective weapons in the fight against high cholesterol. Medications can also help.

Managing Your Cholesterol, a Special Health Report from Harvard Medical School, offers up-to-date information to help you, or a loved one, keep cholesterol in check. The report spells out healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line. The report overs cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Managing Your Cholesterol can also help you work with your doctor to individualize your treatment.

This Special Health Report was prepared by the editors of Harvard Health Publications in consultation with Faculty Editor Mason Freeman, M.D. Dr. Freeman is Chief of the Lipid Metabolism Unit at Massachusetts General Hospital (MGH), Director of the Translational Medicine Group at MGH, and a Professor of Medicine at Harvard Medical School. 48 pages (2014).

  • Cholesterol in the body
    • HDLs, LDLs, and other lipid particles
    • From food to cholesterol
  • The cholesterol connection
    • The role of diet
    • The role of inflammation
    • From cholesterol to crisis
  • What causes heart disease
    • Risk factors for heart disease
    • Metabolic syndrome
    • Protective factors
    • Weighing the risk factors
  • Why treat cholesterol?
    • Benefits of lowering your cholesterol
    • What are the risks of treatment?
    • Is treatment worth the trouble or the cost?
  • Your cholesterol test
    • When to test
    • Taking the test
    • Understanding your test results
    • Physical examination and further tests
  • Do you need treatment?
    • Seven-step assessment
    • How low can you go?
  • Beginning treatment
    • Pinpoint the cause
    • Start your program
    • Adopt a cholesterol-lowering diet
    • Start an exercise program
  • Medications, herbs and other choices for lowering-cholesterol
    • Statins (Reductase inhibitors)
    • Ezetimibe (Zetia, Vytorin)
    • Bile acid binders
    • Fibric acid derivatives (fibrates)
    • Niacin
    • Drug combinations
    • Selective estrogen receptor modulators (SERMs)
    • Herbs, vitamins, and other substances
  • Treating other lipid problems
    • What to do about low HDL
    • How to treat high triglycerides
  • Taking an individual approach
    • Cholesterol in racial and ethnic groups
    • Cholesterol in people who have heart disease
    • Cholesterol in people who have diabetes
    • Cholesterol in people with chronic kidney disease
    • Cholesterol in women
    • Cholesterol in the elderly
  • Resources
  • Glossary

One cholesterol-lowering diet does not fit all

Every body is different, so it shouldn't come as a surprise that people respond differently to the same dietary change. In some people—call them responders—the amount of cholesterol in the bloodstream closely reflects the amount of cholesterol and unhealthy fats (saturated fats and trans fats) in their diets. In others—call them nonresponders—cholesterol levels more closely mirror how much cholesterol their livers make rather than the amount of cholesterol and unhealthy fats they consume.

A study done at the Human Nutrition Research Center on Aging at Tufts University looked at how 120 men and women responded to the National Cholesterol Education Program (NCEP) Step Two diet. It is a widely recommended low-fat, low-cholesterol diet. All the participants ate the same thing, since the researchers provided them with all their food and drink. On average, the level of harmful low-density lipoprotein (LDL) cholesterol dropped 16%. But that average masked a wide range of LDL responses, ranging from a 55% decrease to a 3% increase among men, and a 39% decrease to a 13% increase among women.

There are two important messages from research like this:

1. Determine which dietary changes work for you. Say your cholesterol is creeping upward and your physician suggests that you try a lower-fat, lower-cholesterol diet for three to six months. You make an effort to do so. But at the end of the trial period, a blood test shows that your cholesterol levels haven't budged. Your physician might misinterpret the lack of change and chide you for not sticking with the new diet. But if you have followed the diet carefully, make sure the doctor knows it. You may need a different kind of diet, such as a higher-protein, lower-carbohydrate eating pattern. Or you may need medication to control your cholesterol.

2. One size doesn't fit all. When a friend or relative tells you how much his or her cholesterol dropped after trying a particular diet, you may be tempted to try it. But if, after a few months, you discover that the diet has no effect, chalk it up to genetic and physiological differences. There just isn't a one-size-fits-all recommendation for diet or cholesterol consumption. That means you may have to try several different approaches to find one that works for you.

The take-home lesson here is to make sure your doctor knows whether or not you followed you prescribed diet — and how closely. If you followed it closely and your cholesterol numbers didn't change, you might need a different diet, or a cholesterol medication. Taking medication doesn't mean giving up on the diet, though. Even if a healthy diet doesn't lower your cholesterol, it will keep your body healthy in many other ways.

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