Treating High LDL Cholesterol: A Step-by-Step Guide to Better Heart Health

There are various reasons that might affect the health of our hearts. Elevated LDL cholesterol, popularly known as “bad cholesterol”, is considered the primary concern when it comes to risks related to the heart. Unlike other factors such as family history or ageing, which aren’t under our control, LDL cholesterol (LDLC) can be actively managed and kept within the recommended levels.

When the levels are high, LDLC creates plaques in the arteries, causing blockages that restrict the blood flow. This can lead to heart attacks and strokes. This is why it's important to curb LDLC and maintain it to the required levels. Since elevated LDL generally causes no obvious symptoms, getting regular lipid profile checks becomes essential. Being proactive with testing is the first step when dealing with high LDL cholesterol. Cardiological Society of India (CSI) guidelines, published in 2024, recommend that cholesterol checks should begin at an early age of 18. Diagnosing high LDLC early makes the treatment easier, and LDLC can be managed better.

Once the test results are available, the next step is to consult a cardiologist for personalized advice. The healthcare provider will estimate the targets for LDLC, specifically for the patient’s risk profile. It’s important to understand that LDLC targets aren’t universal and differ from patient to patient. The doctor decides it based on your age, family history, lifestyle, and other comorbidities. Specialized guidance can tailor the cholesterol management plan to your specific health needs and risks. It considers a person's personal preferences, requirements, cultural context, and lifestyle factors.

Dr. PLN Kapardhi, Cath Lab Director, Senior Consultant, Cardiologist, Care Hospital Banjara Hills, Hyderabad says, “When it comes to treating high LDL cholesterol, the first and most vital step is education. Patients must understand that cholesterol is not simply a number, but a key driver of heart disease. For many with mild elevations, lifestyle changes alone can bring LDL within healthy limits. However, for the majority of patients, particularly those with diabetes, obesity, or prior heart health events, lifestyle must be complemented by medical therapy. The targets will be set by the doctor as LDL goals vary. Repeated testing and timely dose adjustments are necessary; therefore, patients have to be proactive. Treating high LDL is not about quick fixes but about sustained protection, which requires both discipline and medical guidance.”

Treatment paradigms have shifted in recent years, and this has been reflected in LDL cholesterol management. Previously, cholesterol-reducing medicines were prescribed for patients with LDLC levels above 130 mg/dL for those with diabetes or above 160 mg/dL for non-diabetics. Many a times, people aren’t informed of this change, thinking medication is only prescribed to patients with high risks. New draft guidelines for the UK's National Health Service (NHS) suggested broader use of cholesterol-lowering drugs, recommending that they be prescribed even to individuals with less than a 10 percent risk of heart attack or stroke within the next decade.This change is incorporated at a global level, which reflects that the approach has shifted to early action.

Taking care of the heart can be started by making changes in the diet and lifestyle. Following a diet rich in fruits, vegetables, and whole grains is known to support overall heart health. A balanced meal, introducing diverse nutrients, is always a good approach. Even when consuming fatty foods, being mindful about proportions and food hygiene will help cardiovascular well-being. A healthcare provider can determine which diet suits you the best while factoring in various aspects such as overall health, food choices, cultural context, etc.

Maintaining a healthy weight is essential for overall cardiovascular health. Excess body weight, even if it's just a few extra kilos, can significantly impact cholesterol levels by increasing LDL cholesterol. Engaging in moderate-intensity exercise consistently can bring good health transitions and help lower LDLC levels. Even occasional workouts have been shown to provide decent results. Physical movements, strength training, and cardio training have been shown to improve HDL cholesterol levels. HDL cholesterol is considered good cholesterol, which helps remove LDL cholesterol from the organs.

Still, it is important to recognize that exercise alone is not a guaranteed safeguard against high cholesterol. It's incorrect to assume that peak physical fitness equals perfect health. Even elite athletes have been found to exhibit high LDL levels. Cardiac death (SCD) is the most common medical cause of sudden death in athletes.Rigorous exercise routines and healthy diets alone aren't always enough to protect against heart problems. Medicines play an equally important role in managing LDLC levels along with leading a healthy lifestyle.

For patients who do not achieve adequate results with conventional medicines, newer advanced therapies are emerging as safe and effective alternatives. Targeted treatments such as PCSK9 inhibitors, siRNA-based therapies, and inclisiran are showing significant promise in helping individuals reach their LDLC targets when standard approaches are insufficient.

Consulting with a healthcare provider can help determine the best combination of lifestyle changes and medication to maintain optimal heart health.