Genetics versus lifestyle: The best ways to lower cholesterol

While most people know they need to keep their cholesterol in check to reduce the risk of heart attack, stroke and cardiovascular disease, it can be difficult to know what works and what’s just a myth made popular in the age of the internet.

High cholesterol is typically caused by two factors: genetics and lifestyle. Some people are genetically predisposed to high cholesterol and no amount of diet or exercise will drastically reduce their low-density lipoprotein (LDL), or ‘bad’ cholesterol, levels. For others, high cholesterol can be blamed squarely on modifiable lifestyle factors such as poor diet and lack of exercise.

Once a patient is over the age of 60, a GP should request a blood test to investigate whether low-density lipoprotein (LDL) cholesterol levels, more commonly known as ‘bad’ cholesterol, are high. They will then assess how diet and lifestyle factors are influencing a patient’s cholesterol and advise them from there.

“Lifestyle and diet change should be the first point of call in anyone looking to reduce their risk of heart disease,” Australian Integrative Cardiologist Jason Kaplan tells Starts at 60.

“My guidance to people is to first increase the amount of fibre in your diet. So plenty of vegetables, plenty of foods like oats, flaxseed, psyllium husks are also very helpful as well. You need a reasonable amount of soluble and non-soluble fibre in your diet.

“The other big dietary recommendation for patients who are looking to lower their cholesterol is to move to a more plant-based diet. Reduce the amount of red meat in their diet and include some plant-based options, which will also help lower the cholesterol.”

Cholesterol found in foods can cause blockages in the arteries and produce even more bad cholesterol in the body. Trans fat – which is typically found in deep-fried foods, processed foods, biscuits, cakes, pastries and buns – is one of the biggest culprits for increasing LDL levels. The fats are added to foods to increase their shelf life or give them added flavour, but can cause the deposition of bad cholesterol in the arteries and can lead to inflammation in the artery wall.

Read more: Signs, symptoms and when to talk to a health professional about cholesterol

Nuts, walnuts, almonds and pecans are also helpful in lowering cholesterol, while the Heart Foundation also recommends switching to fruit-, nut- and seed-based oils such as canola oil or olive oil instead of butter or animal-based fats. Foods rich in omega-3 can also reduce LDL levels so replacing some serves of red meat with fish such as salmon or mackerel is advised.

Similarly, staying active is also highly effective when it comes to lowering cholesterol. Research published by the American College of Cardiology found heart disease patients who practiced yoga and aerobic exercises such as brisk walking, dancing, tennis or cycling saw twice the reduction in their cholesterol levels compared to those who practiced just one type of exercise.

The Heart Foundation says any exercise is better than none but that at least 150 minutes of moderate intensity or vigorous intensity physical activity is recommended per week. Muscle-strengthening activities such as lifting weights, climbing stairs or push-ups are also advised at least twice a week. There are also ways to remain active even when there are health issues that may prevent physical activity.

“A lot of older people have arthritis, hip problems and knee problems so doing things like running or more heavily impacted exercises are more difficult,” Kaplan says.
In these cases, rowing, aqua aerobics and simple exercises such as brisk walking can make all the difference. A health professional can advise which exercise is best for individual circumstances and whether other treatment options are needed.

While modifying lifestyle factors is often the first port of call, medication may still be required to keep cholesterol at healthy levels for some people. While some studies have raised concerns over statins or other cholesterol-lowering medications in recent years, Kaplan says the benefits outweigh the risks in patients most at risk of major heart health events.

“There’s been some concern about their overall safety [of statins] so I tend to prescribe them when I feel that they are necessary and there will be a benefit,” Kaplan explains.

Read more: The unexpected food to avoid when taking statins

Those who have had a heart attack, stroke or significant coronary artery disease are considered at-risk patients and in these cases, statins can lower cholesterol and prevent further events.

“There seems to be an effect of statins not just lowering cholesterol, but at reducing global cardiovascular risk for development of stroke and heart attack,” Kaplan says. “That’s thought partly to be somewhat independent to their cholesterol lowering effects.”

Do you have high cholesterol? How do you manage the condition?