The U.S. has a cholesterol problem. Roughly 37% of Americans have high cholesterol, a statistic that’s likely underreported, considering that, according to a 2023 study, many people with high cholesterol don’t know they have it.
The problem specifically is low-density lipoprotein, or LDL cholesterol, which clogs arteries when there’s too much of it. This is different from high-density lipoprotein (HDL), which transports cholesterol to the liver, where it’s broken down and excreted.
Dr. Sunny S. Intwala, MD, a preventive cardiologist with Nuvance Health in New York, says that high cholesterol often flies under the radar. Even if you’re young and in good shape, if your diet and lifestyle habits don’t support healthy cholesterol levels, it will catch up with you. “You can be lean, fit, and young, and still silently be accumulating plaque in your arteries,” Dr. Intwala says. “Your arteries don’t care how good your VO2max is. Supporting healthy cholesterol levels is about protecting your future health.”
High cholesterol is literally life-threatening. It increases the risk of heart attack and cardiovascular disease, which is the number one cause of death in the U.S. Here’s the good news: It’s completely controllable, and the sooner you have cholesterol-supporting habits in place, the better. A major part of that has to do with what you’re eating.
How to lower cholesterol through diet and lifestyle
According to Dr. Corey K. Bradley, MD, FACC, a preventive cardiologist at Columbia University Irving Medical Center, roughly 20 to 30% of high cholesterol is controllable through diet and lifestyle habits. The rest, she says, comes down to whether you are genetically predisposed to have high cholesterol.
Dr. Bradley says that roughly one in 250 people has a genetic disorder called familial hypercholesterolemia (FH), an inherited disorder leading to extremely high LDL cholesterol and must be treated with medication, along with diet and lifestyle interventions. “You can be the picture of health on the outside, but still have really dangerous levels of LDL cholesterol,” she says, emphasizing that this is why it’s important for everyone to have their cholesterol levels checked at least every couple of years.
As for the 20% and 30% that is in your control, all three cardiologists we spoke to advise a combination of not smoking, exercising regularly, and following a heart-healthy diet. Dr. Bradley is a big advocate of following the Mediterranean diet, which has been repeatedly scientifically shown to keep LDL cholesterol low. This way of eating prioritizes seafood, lean proteins, vegetables, fruit, and whole grains, while minimizing ultra-processed foods and fatty meats.