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Random freezes, missing sound and display glitches usually trace back to one bad driver. Find and replace yours safely.Free scan · under a minuteLowering LDL cholesterol safely usually means combining a heart-healthy eating pattern and regular activity with medication when a clinician recommends it. The right plan—and the LDL goal—depends on your overall cardiovascular risk, health history and test results, not one number alone. This is general U.S. guidance, not a personal diagnosis or treatment plan.
Start with your overall risk, not just your LDL result
An LDL result is one part of a broader assessment. Age, prior cardiovascular disease, diabetes, kidney disease, family and personal history, and other risk factors can change whether medication is appropriate and what treatment goal makes sense. The 2026 U.S. multisociety dyslipidemia guideline replaces the 2018 AHA/ACC blood-cholesterol guideline and recommends individualized decisions with a healthcare professional. The AHA’s guideline summary describes using risk assessment, additional risk factors and, in selected cases, coronary artery calcium (CAC) testing to refine decisions.
For primary prevention in adults ages 30–79, the 2026 guideline recommends the PREVENT-ASCVD equations to estimate 10- and 30-year risk. Its summary says LDL-lowering therapy can be considered when 10-year risk is 3% to less than 5%, and should be considered at 5% to less than 10% after a clinician–patient discussion. It also recommends LDL-lowering therapy for primary prevention in adults ages 40–75 with diabetes, stage 3 or 4 chronic kidney disease, or HIV regardless of LDL-C level. These are clinical recommendations, not a self-treatment algorithm.
The guideline restores LDL-C and non-HDL-C treatment goals alongside percentage reduction, with goals varying by risk. For very-high-risk secondary prevention—people with established cardiovascular disease at very high risk—the summary recommends LDL-C below 55 mg/dL and non-HDL-C below 85 mg/dL. That target is not a general-population goal.
The guideline summary recommends measuring Lp(a) at least once. It identifies Lp(a) levels of at least 125 nmol/L (50 mg/dL) as a risk-enhancing level associated with about 1.4-fold increased ASCVD risk; levels of at least 250 nmol/L (100 mg/dL) are associated with two-fold higher estimated risk. ApoB testing may help in selected situations, including elevated triglycerides, diabetes or low achieved LDL-C. See the AHA summary for the guideline’s risk-assessment details.
Build meals around heart-healthy substitutions
The American Heart Association recommends a dietary pattern rich in fruits, vegetables, beans and other legumes, nuts, whole grains, fiber and lean protein, while reducing saturated and trans fats. Rather than relying on one “cholesterol-lowering” food, make practical substitutions across meals. The AHA’s prevention and treatment guidance advises discussing major dietary changes with a healthcare professional.
- Choose beans, oats, fruit and other fiber-rich foods more often. NHLBI’s Therapeutic Lifestyle Changes (TLC) program highlights soluble-fiber foods such as fruits, beans and oats.
- Use unsaturated plant oils in place of some foods high in saturated fat.
- Build meals around vegetables and fruit, and choose whole grains and lean proteins more often.
- The TLC plan includes low- or non-fat dairy, fish, poultry without skin and moderate amounts of lean meat as options.
NHLBI’s TLC approach combines reduced saturated fat and dietary cholesterol with soluble fiber, plant stanols and sterols, physical activity and weight management. Nuts, legumes, whole grains and some oils are among foods it identifies as sources of plant stanols and sterols. These are elements of an overall eating pattern, not a promise that one food will normalize an individual’s LDL. NHLBI explains the TLC approach and heart-healthy eating.
Very-low-carbohydrate or keto eating patterns often do not align with AHA heart-healthy guidance because they can be high in saturated fat, which may raise LDL. That does not establish that these diets raise LDL for every person; discuss a major diet change with a healthcare professional.
Choose activity you can keep doing
Regular physical activity supports cardiovascular health and can help lower LDL and raise HDL. The AHA says about 150 minutes of moderate-intensity activity each week can make a difference. Walking, dancing, swimming and gardening are examples; choose something manageable and build up if you are starting from a low activity level. AHA guidance on cholesterol prevention emphasizes activity as part of a broader healthy pattern.
NHLBI’s TLC program also connects regular activity and weight management with healthier cholesterol and triglyceride levels. Activity contributes to risk reduction, but no specific LDL reduction is guaranteed for an individual. Smoking or vaping, weight and sleep also matter to broader cardiovascular health.
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Use medication when the likely benefit warrants it
Lifestyle improvements are important, but they do not replace medicine when a clinician recommends treatment. Statins lower cholesterol production in the liver and are often the first medication recommended for LDL lowering. Depending on a person’s risk, response, medical circumstances and preferences, a clinician may consider other medicines, including ezetimibe, PCSK9 inhibitors, bempedoic acid or bile acid sequestrants. Specialized medicines are used for particular inherited conditions. The AHA’s cholesterol medication guidance describes these options.
The 2026 guideline announcement says non-statin options such as ezetimibe, bempedoic acid and PCSK9 monoclonal antibodies may be added when lifestyle and statin therapy do not lower LDL adequately, depending on risk and patient characteristics. The medication choice is not a do-it-yourself comparison: ask about expected benefit, treatment intensity, adverse effects, interactions, pregnancy considerations and alternatives. The AHA advises taking medicine as directed, reporting side effects and speaking with a healthcare professional before stopping treatment.
Supplements are not recommended by the AHA for cholesterol management and may interact with medicines. Tell your healthcare professional about supplements and other products you take rather than adding them as a substitute for prescribed treatment.
Make follow-up part of the plan
Use follow-up visits to review your lipid results against your agreed goal, whether you are able to follow the plan, any side effects and what to do next. If a medicine is difficult to tolerate or does not appear to be working as expected, discuss that with the prescriber rather than stopping it on your own. Treatment decisions should account for both the results and your circumstances.
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