How to lower cholesterol

A lipid panel measures the levels of LDL, HDL, total cholesterol, which includes all types of cholesterol, and triglycerides (NHLBI TLC booklet, NIH Pub. No. 24-HL-5235, February 2024). LDL is sometimes called bad cholesterol, because it carries cholesterol to tissues, including the arteries, and most of the cholesterol in the blood is the LDL form, so the higher the level of LDL cholesterol in the blood, the greater your risk for heart disease (NHLBI TLC booklet). HDL is sometimes called good cholesterol, because it takes cholesterol from tissues to the liver, which removes it from the body (NHLBI TLC booklet). Total cholesterol is the total amount of cholesterol in your blood, and it includes both LDL and HDL cholesterol (NHLBI TLC booklet).

The usual advice to raise your good cholesterol comes with a caveat in the same paragraph of that booklet. HDL isn't necessarily good for everyone, a low level of HDL cholesterol may predict a higher risk of heart disease for White adults but not for Black adults, and studies show that HDL cholesterol does not work well in some people, so they don't get as much protection from heart disease (NHLBI TLC booklet).

Non-HDL is your total cholesterol minus your HDL, and it includes LDL and other types of cholesterol such as VLDL, very-low-density lipoprotein (MedlinePlus, August 20, 2026). Triglycerides are a type of fat, and they are the most common type of fat in your body (MedlinePlus Triglycerides, August 10, 2025). They are produced in the liver and become elevated when certain foods are consumed, such as fried foods, red meat, and full-fat dairy products (NHLBI TLC booklet), and the combination of high levels of triglycerides with either low HDL cholesterol or high LDL cholesterol levels can increase your risk for heart attack and stroke (CDC, May 15, 2024).

Nothing about any of this announces itself. More than 85 million people over age 20 in the United States have high total cholesterol levels but don't have symptoms, which is why it's important to have your cholesterol levels checked regularly (NHLBI TLC booklet). The NHS says the same thing to a UK reader: high cholesterol does not usually cause symptoms, and you can only find out if you have it from a blood test (NHS, reviewed 13 March 2026). What happens meanwhile is mechanical. Having high blood cholesterol can lead to a buildup called plaque on the walls of your arteries, and as plaque builds up over time, the insides of your arteries narrow, which blocks blood flow to and from your heart and other organs (CDC, May 15, 2024).

Talk with your healthcare provider about what your cholesterol numbers should be, because the numbers that are best for you may depend on your age, race, blood pressure, weight, family history, and more (MedlinePlus, August 20, 2026). That sentence goes before the table rather than after it. What follows is MedlinePlus's own set of general guidelines showing the desirable levels, meaning levels that are healthy for most people, all in mg/dL (MedlinePlus, August 20, 2026):

• Anyone age 19 or younger: total cholesterol less than 170, non-HDL less than 120, LDL less than 110, HDL more than 45
• Men age 20 or older: total cholesterol less than 200, non-HDL less than 130, LDL less than 100, HDL greater than or equal to 60 is best and levels less than 40 are considered low
• Women age 20 or older: total cholesterol less than 200, non-HDL less than 130, LDL less than 100, HDL greater than or equal to 60 is best and levels less than 50 are considered low

LDL has a fuller range of its own: less than 100 mg/dL is optimal, 100 to 129 mg/dL is near optimal or above optimal, 130 to 159 mg/dL is borderline high, 160 to 189 mg/dL is high, and 190 mg/dL and above is very high (MedlinePlus LDL, March 22, 2024).

Triglycerides are not a type of cholesterol, and they are measured in the same test. A normal triglyceride level is below 150 mg/dL, and you might need treatment if you have triglyceride levels that are borderline high at 150 to 199 mg/dL or high at 200 mg/dL or more (MedlinePlus, August 20, 2026). The fuller range runs normal below 150, borderline high 150 to 199, high 200 to 499, and very high 500 and above (MedlinePlus Triglycerides, August 10, 2025). NHLBI uses three tiers and names the consequence at the top one, calling less than 150 mg/dL for adults and less than 90 mg/dL for children ages 9 to 11 the desirable target level, 150 to 499 mg/dL moderately raised, where your provider will recommend healthy lifestyle changes and may also prescribe medicine, and 500 mg/dL or higher severely raised, because high levels of triglycerides can clog tiny blood vessels in the pancreas and lead to pancreatitis (NHLBI TLC booklet).

The CDC states its numbers differently, and its list is not the same table. The CDC gives optimal values of about 150 mg/dL total cholesterol, about 100 mg/dL LDL, at least 40 mg/dL HDL in men and 50 mg/dL in women, and triglycerides less than 150 mg/dL, and it separately says that if you are an adult or child, a total cholesterol above 200 mg/dL may be considered high (CDC, May 15, 2024). Set that beside MedlinePlus and you have three framings of one axis, so here they are side by side rather than blended: the CDC's optimum is about 150 mg/dL (CDC, May 15, 2024), MedlinePlus's healthy adult level is less than 200 mg/dL (MedlinePlus, August 20, 2026), and the CDC's own threshold for calling a total cholesterol high is above 200 mg/dL (CDC, May 15, 2024). HDL splits the same way. The CDC asks for at least 40 mg/dL in men and 50 mg/dL in women (CDC, May 15, 2024), MedlinePlus calls 60 mg/dL or more best (MedlinePlus, August 20, 2026), and NHLBI's booklet is stricter still, asking you to aim for an HDL level of 60 mg/dL or more (NHLBI TLC booklet).

UK readers work in mmol/L off different targets, and the two systems should be kept apart instead of converted into each other. The NHS gives total cholesterol below 5 mmol/L, HDL above 1.0 mmol/L for men or above 1.2 mmol/L for women, and non-HDL below 4 mmol/L, and it adds that targets depend on things like your age, whether you have any health conditions and your risk of cardiovascular disease, and that if you have been ill, are taking some medicines, or have recently had a baby, your levels may be lower or higher (NHS Cholesterol levels, reviewed 13 March 2026).

The guideline in force is the 2026 Guideline on the Management of Dyslipidemia, issued on March 13, 2026 by the ACC, the AHA and nine other societies and published jointly in JACC and Circulation (AHA newsroom release, March 13, 2026). It replaces the Pooled Cohort Equations with a newer, more contemporary cardiovascular disease risk calculator, Predicting Risk of Cardiovascular Disease EVENTs, or PREVENT, now recommended for primary prevention of ASCVD, with PREVENT-ASCVD equations designed for adults ages 30 to 79 years without known ASCVD or subclinical atherosclerosis and with LDL-C 70 to 189 mg/dL, estimating 10-year and 30-year risk (AHA newsroom release, March 13, 2026). The reason for the swap is stated plainly in the release: older risk scores like the Pooled Cohort Equations overestimated the 10-year risk of a heart attack and stroke by 40% to 50% (AHA newsroom release, March 13, 2026).

The bands moved when the tool did. The updated risk categories from the PREVENT-ASCVD equations classify 10-year ASCVD risk as low, meaning under 3%, borderline, meaning 3% to under 5%, intermediate, meaning 5% to under 10%, and high, meaning 10% or higher, and these risk categories guide treatment decisions, including whether to initiate statin therapy and the recommended intensity of lipid-lowering therapy (AHA newsroom release, March 13, 2026). LDL-C and non-HDL-C goals are back in the new guideline. To prevent a first heart attack or stroke, the LDL-C goal should be less than 100 mg/dL for those at borderline or intermediate risk and less than 70 mg/dL in those at high risk, and for individuals with ASCVD who are at very high risk of ASCVD events, the LDL-C goal should be less than 55 mg/dL for secondary prevention of cardiac events (AHA newsroom release, March 13, 2026).

Older consumer material, including NHLBI's February 2024 booklet, still carries risk tiers built on the earlier Pooled Cohort Equations, and those tiers are not the current ones (NHLBI TLC booklet, February 2024; AHA newsroom release, March 13, 2026). The current bands are the PREVENT-ASCVD ones above, where 10% or higher is itself the high-risk band (AHA newsroom release, March 13, 2026).

Risk is wider than the panel. The enhancers the guideline names are family history of heart disease, chronic inflammatory conditions such as lupus or rheumatoid arthritis, cardiometabolic conditions such as overweight or obesity, diabetes or chronic kidney disease, higher-risk ancestry such as South Asian or Filipino ancestry or other ancestral groups with an enhanced risk for developing atherosclerosis, and reproductive risk markers, including early menopause, preeclampsia and gestational diabetes (AHA newsroom release, March 13, 2026). The writing committee chair gives the honest version in one line: having healthy LDL-cholesterol levels or high-density lipoprotein-cholesterol, traditionally thought of as good cholesterol, isn't necessarily a get out of jail free card (AHA newsroom release, March 13, 2026). It is estimated 1 in 4 U.S. adults has high levels of LDL-C, and 80% or more of cardiovascular disease is preventable, with elevated LDL cholesterol a major part of that risk (AHA newsroom release, March 13, 2026).

One number on the panel will not move for you no matter how the rest of this page goes. Lp(a) should be measured at least once in adulthood, its levels are largely genetically determined and remain relatively stable over a lifetime, and lifestyle changes minimally affect Lp(a) levels, so repeat testing is generally not needed (AHA newsroom release, March 13, 2026).

Any calculator deserves the caveat NHLBI prints next to its own. The ASCVD Risk Estimator Plus isn't the only type of risk calculator, and that's a good thing, because no single risk calculator is right for everyone, since studies show that some calculators overestimate risk for certain groups, while others may underestimate risk (NHLBI TLC booklet). Keep in mind that your cholesterol numbers and your risk score are only part of the story, and you should talk to your provider to learn what the numbers mean for you (NHLBI TLC booklet).

Three sources give the testing interval three ways, and they agree on the adult number while describing it differently. The CDC gives the shortest version, saying most healthy adults should be screened every 4 to 6 years, children at least once between ages 9 and 11, and adolescents between ages 17 and 21, with more frequent testing for people who have heart disease, diabetes, or a family history of high cholesterol (CDC Cholesterol Testing, May 15, 2024). It repeats the adult number on its treatment page, saying you may need to have your cholesterol levels tested at least once every 4 to 6 years if you do not have heart disease, with the caveat that some people need to get their cholesterol checked more often or less often (CDC, May 15, 2024).

NHLBI and MedlinePlus band it by age instead, in identical wording. Age 19 and younger: screening, which begins at ages 9 to 11, should be repeated every 5 years, and if you have a family history of high cholesterol, heart attack, or stroke, your child's healthcare provider may suggest testing as early as age 2. Ages 20 to 65: younger adults should be screened every 5 years, and men ages 45 to 65 and women ages 55 to 65 should be screened every 1 to 2 years. Older than age 65: older adults should be screened every year (NHLBI TLC booklet, and MedlinePlus, August 20, 2026). The 2026 guideline adds a line about children specifically, saying cholesterol screening is recommended for all children between the ages of 9 to 11 years not previously screened, to help assess risk and guide care, in collaboration with clinicians, parents and caregivers (AHA newsroom release, March 13, 2026).

Being on a statin makes it a different question, and NHLBI hands it back to the prescriber. People taking medicines to lower their cholesterol levels can benefit from regular testing to ensure that the dose and type of statin are working, and if you are taking a statin, talk with your provider about how often is best for you (NHLBI TLC booklet).

Fasting comes with three windows from three documents, so here they are unaveraged. NHLBI says your provider may ask you to fast, meaning no food or calorie-containing drinks, for 8 to 12 hours before the test (NHLBI TLC booklet). The CDC says you may need to fast for 8 to 12 hours before your cholesterol test (CDC Cholesterol Testing, May 15, 2024). MedlinePlus says you'll need to fast, meaning not eat or drink anything but water, for 9 to 12 hours (MedlinePlus, August 20, 2026). Every one of them also says to confirm the prep with the clinic, which is the part worth doing.

For scale, nearly 25 million adults in the United States have total cholesterol levels above 240 mg/dL, about two thirds of US adults say they have had their cholesterol checked within the last 5 years, and slightly more than half of US adults, 54.5% or 47 million people, who could benefit from cholesterol medicine are currently taking it (CDC High Cholesterol Facts, October 24, 2024).

One document puts a percentage on each lifestyle change, and it is NHLBI's booklet, so every figure in this section is that document's. Box 3, headed Potential LDL Lowering Using the TLC Program, reads as follows (NHLBI TLC booklet, NIH Pub. No. 24-HL-5235, February 2024):

• Saturated fat, decreased to less than 7% of calories: 8% to 10% off LDL
• Dietary cholesterol, decreased to less than 200 mg a day: 3% to 5%
• Weight, losing 10 pounds if overweight: 5% to 8%
• Soluble fiber, adding 5 to 10 grams a day: 3% to 5%
• Plant sterols and stanols, adding 2 grams a day: 5% to 15%
• All of it together: 20% to 30%

The footnote travels with the table. Those percentages are based on an average 2,000-calorie diet for women and an average 2,500-calorie diet for men, and a 7% reduction means that, on average, a woman would eat 16 grams less of saturated fat per day, or 140 fewer calories, than before, and a man would eat 19 grams less of saturated fat per day, or 175 fewer calories, than before (NHLBI TLC booklet).

NHLBI works the whole thing as one example, which is the plainest version of this page. Let's say your LDL cholesterol is 200 mg/dL, and if you made all the changes suggested in the chart above, it's possible your LDL cholesterol could go as low as 160 mg/dL, a 20% reduction in LDL, or even 140 mg/dL, a 30% reduction (NHLBI TLC booklet).

Saturated fat raises your cholesterol more than anything else in your diet, Americans consume an average of 11% of their total calories from saturated fat, and reducing the amount of saturated fat in your diet is an excellent way to lower LDL (NHLBI TLC booklet). The greatest amounts are found in foods from animals, such as fatty cuts of meat, poultry with the skin, whole milk dairy products, and lard, as well as in some plant oils, including coconut and palm oils (NHLBI TLC booklet).

The target can be read as a percentage or as grams, and the two are worth keeping apart. The TLC diet asks for less than 7% of your daily calories from saturated fat, less than 200 mg a day of cholesterol, and 25% to 35% of daily calories from total fat, including saturated fat calories (NHLBI TLC booklet), and MedlinePlus states it identically, saying no more than 25 to 35% of your daily calories should come from dietary fats and less than 7% should come from saturated fat (MedlinePlus, May 5, 2025). The grams are easier to use at a table. Box 5, the guide for saturated fat intake, gives 8 grams at 1,200 calories a day, 10 grams at 1,500, 12 grams at 1,800, 13 grams at 2,000, and 17 grams at 2,500 (NHLBI TLC booklet). That box carries its own footnote saying the amounts shown are equal to about 6% of total calories, so this page prints the grams and leaves the percentage to the sentence above rather than presenting them as the same number.

Dietary cholesterol is a smaller lever and the booklet says so. The cholesterol in the food you eat raises the cholesterol level in your blood, though not as much as saturated fat, and the two are often found in the same foods (NHLBI TLC booklet).

The CDC says the same thing without numbers, asking you to limit foods high in saturated fat and to choose foods low in saturated fat, trans fat, sodium, and added sugars (CDC Preventing High Cholesterol, May 15, 2024). The NHS gives a food list instead, asking you to eat more oily fish like mackerel and salmon, olive oil, rapeseed oil and spreads made from these oils, brown rice, wholegrain bread and wholewheat pasta, nuts and seeds, and fruits and vegetables, and to eat less meat pies, sausages and fatty meat, butter, lard and ghee, cream and cheese, cakes and biscuits, and food that contains coconut oil or palm oil (NHS, reviewed 13 March 2026).

There are two main types of fiber, soluble and insoluble, and both have health benefits, but only soluble fiber reduces the risk of heart disease, and it does that by helping to lower LDL cholesterol (NHLBI TLC booklet). It's found in plant-based foods, such as oats, peas, beans, apples, citrus fruits, carrots, barley, and psyllium (NHLBI TLC booklet).

Two numbers do two different jobs here. The daily target is 10 to 25 grams per day of soluble fiber (NHLBI TLC booklet), which MedlinePlus repeats as 10 to 25 grams per day (MedlinePlus, May 5, 2025). The measured increment is smaller: research shows that people who increased their soluble fiber intake by 5 to 10 grams each day, the TLC minimum recommendation, saw their LDL cholesterol drop by about 5%, and increasing it even more, by 10 to 25 grams a day, would be even better (NHLBI TLC booklet).

Grams of soluble fiber per serving are what make that reachable, and Box 8 lists them (NHLBI TLC booklet): barley, half a cup cooked, 1 gram; oatmeal, 1 gram; oat bran, 1 gram; ground psyllium seeds, one tablespoon, 5 grams; apple, 1 gram; banana, 1 gram; blackberries, half a cup, 1 gram; citrus, an orange or a grapefruit, 2 grams; nectarine, 1 gram; peach, 1 gram; pear, 2 grams; plum, 1 gram; prunes, a quarter cup, 1.5 grams; broccoli, half a cup cooked, 1 gram; Brussels sprouts, 3 grams; carrots, 1 gram.

Read that list next to the 5 to 10 gram increment and you can see why this page carries no claim that oats lower LDL by any particular percentage. Oatmeal is 1 gram of soluble fiber per half cup cooked (NHLBI TLC booklet), which is a fraction of the smallest amount anyone measured, and no source cited here attaches an LDL reduction to a single food. The defensible sentence is the gram one.

The booklet's practical tips are the same size as the daily work. Choose hot or cold breakfast cereals, such as oatmeal and oat bran, that have 3 to 4 grams of fiber per serving; eat the whole fruit instead of just drinking its juice, because a single orange has about 6 times more fiber than a 4-ounce glass of orange juice; add lentils, chickpeas, or beans to salads, since four servings, two cups, of cooked beans contain about 25 grams of total fiber (NHLBI TLC booklet). Go up slowly. Increase the amount of fiber in your diet gradually, because a sudden increase in fiber can cause abdominal cramps, gas, or bloating (NHLBI TLC booklet).

A daily intake of about 2 grams of stanols or sterols can reduce LDL cholesterol by about 5% to 15%, often within weeks (NHLBI TLC booklet). Stanols and sterols, sometimes called phytosterols, come from oils made from soybeans and certain types of pine trees, and they are added to some foods and drinks you can buy in stores, such as orange juice with added sterols and spreads used in place of butter that contain added stanols (NHLBI TLC booklet). They help block the absorption of cholesterol from the digestive tract, which helps to lower LDL cholesterol and doesn't affect HDL cholesterol or triglycerides (NHLBI TLC booklet).

Getting to 2 grams takes more than a slice of toast. One tablespoon of stanol buttery spread provides about 1 gram of stanols, about half the suggested amount for a day (NHLBI TLC booklet). Those foods are not calorie-free either, so if you use these products, you may need to offset the calories by cutting back elsewhere (NHLBI TLC booklet).

Supplements sit on weaker ground than foods do. The evidence for the effectiveness of supplements is weaker than it is for foods containing stanols or sterols, though in general, studies show that stanol or sterol supplements, when taken with meals, can reduce cholesterol levels (NHLBI TLC booklet).

Three weight figures come out of one institution, and they are printed here side by side because averaging them would invent a fourth. Box 3 of the booklet prices the change at losing 10 pounds if overweight, worth 5% to 8% off LDL (NHLBI TLC booklet). The booklet's own body text asks for a proportion instead, saying that if you are overweight, losing even 10% of your current weight would lower your risk for heart disease and other health problems (NHLBI TLC booklet). NHLBI's web page gives a smaller proportion again, saying adults with overweight and obesity can lower bad LDL cholesterol and raise good HDL cholesterol by losing only 3% to 5% of their weight (NHLBI, Blood Cholesterol: Treatment, April 19, 2024).

Pace and sequence are stated too. Losing weight gradually is the best approach, a safe and reasonable weight loss is 1 to 2 pounds a week, and to lose 1 pound a week you need to burn 500 more calories a day than you eat (NHLBI TLC booklet). The order of operations is useful for anyone trying to do everything at once: at the start of the TLC Program, your main focus will be on lowering your LDL cholesterol level by reducing saturated fat and calories and increasing fiber, and after about 2 to 3 months of TLC, if you still need to lose weight, you may need to focus more on losing weight as you approach your LDL and total cholesterol goals (NHLBI TLC booklet).

BMI comes with a warning label from the same booklet. BMI is not perfect, it doesn't directly measure body fat, which is the main health concern, and BMI categories are based on data collected from previous generations of non-Hispanic White people, mostly men, so the categories do not consider a person's gender, race/ethnicity, or age (NHLBI TLC booklet).

Regular physical activity can boost HDL, reduce triglycerides, and help you lose weight or maintain a healthy weight, which also helps lower your LDL (NHLBI TLC booklet). The inverse holds as well, since physical inactivity, such as spending a lot of time sitting while watching TV or using a computer, is linked to lower levels of HDL cholesterol (NHLBI TLC booklet).

The dose is stated four ways. NHLBI asks that, unless your provider tells you otherwise, you try to do a moderate-intensity activity, such as brisk walking, for at least 30 minutes on most if not all days, and you can do the 30 minutes all at once or break it up into shorter periods of at least 10 minutes each, aiming to reach at least 150 minutes, two and a half hours total, per week, with strength training at least two days a week (NHLBI TLC booklet). The CDC asks for 2 hours and 30 minutes of moderate-intensity exercise, such as brisk walking or bicycling, every week, and 1 hour of physical activity every day for children and adolescents (CDC Preventing High Cholesterol, May 15, 2024). The NHS asks for at least 150 minutes, 2.5 hours, of moderate intensity exercise or 75 minutes of vigorous intensity activity a week, naming walking, swimming and cycling (NHS, reviewed 13 March 2026). MedlinePlus declines to give a number at all, saying studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol, then asking you to ask your health care provider what level of physical activity is right for you (MedlinePlus How to Lower Cholesterol, May 5, 2025).

Starting a program has a short safety list attached to it. If you're planning to be very active but have heart disease, asthma, diabetes, or high blood pressure, or if you are a man over age 40 or a woman over age 50, check with your healthcare provider before starting your physical activity program (NHLBI TLC booklet). And although physical activity can strengthen your heart, some types of activity may worsen existing heart problems, so watch for sudden dizziness, cold sweats, paleness, fainting, or pain or pressure in your upper body right after you do a physical activity, and if you notice any of these signs, stop and call 9-1-1 at once (NHLBI TLC booklet).

Drinking too much alcohol, meaning more than two drinks a day for men or one drink a day for women, can raise your total cholesterol level, and binge drinking, when a woman has four or more drinks or a man has five or more drinks within about 2 hours, is also a key risk factor for unhealthy cholesterol, since drinking less is better for health than drinking more (NHLBI TLC booklet). Alcohol use is linked to high blood pressure, high triglycerides, and lower levels of HDL cholesterol (NHLBI TLC booklet), and MedlinePlus names it as a cause of high triglycerides specifically, alongside regularly consuming excess calories, especially sugar, smoking, and being overweight (MedlinePlus Triglycerides, August 10, 2025).

The calories are their own line item: 12 ounces of beer is 150 calories, 5 ounces of wine is 100 calories, and 1.5 ounces of 80-proof spirits is 100 calories (NHLBI TLC booklet).

The daily limits repeat across US sources. The CDC states no more than two drinks per day for men and no more than one for women (CDC Preventing High Cholesterol, May 15, 2024), and MedlinePlus states them identically (MedlinePlus, May 5, 2025). The NHS uses a weekly unit cap instead, asking you to avoid drinking more than 14 units of alcohol a week on a regular basis, to spread your drinking over 3 or more days if you regularly drink as much as 14 units a week, and to have several drink-free days each week (NHS, reviewed 13 March 2026).

Smoking raises LDL cholesterol and lowers HDL cholesterol, particularly in women (NHLBI TLC booklet). MedlinePlus explains why stopping helps in the other direction: quitting smoking can raise your HDL cholesterol, and since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol (MedlinePlus, May 5, 2025).

Both the CDC and the NHS list it among the steps that prevent high cholesterol, with the NHS adding that stopping also reduces the risk of heart attacks, strokes and cancer (CDC Preventing High Cholesterol, May 15, 2024; NHS, reviewed 13 March 2026).

Getting 7 to 9 hours of sleep a day lowers your risk for high bad cholesterol, LDL, and total cholesterol (NHLBI, Blood Cholesterol: Treatment, April 19, 2024). The booklet agrees on the amount, saying most adults need 7 to 9 hours of sleep a night (NHLBI TLC booklet).

It also made the 2026 guideline's short list of what to do first, which names maintaining a healthy weight, engaging in regular physical activity, avoiding tobacco products, prioritizing healthy sleep habits, and taking cholesterol-lowering medication when recommended by a health care professional (AHA newsroom release, March 13, 2026).

Try to have about two fish meals every week, and fish high in omega-3 fats include fresh or canned salmon, tuna, sardines, and mackerel (NHLBI TLC booklet). MedlinePlus gives the same frequency, saying most people should try to eat these fish two times a week (MedlinePlus, May 5, 2025).

The pill version has not earned the same sentence. It's not yet clear whether omega-3 supplements are beneficial too, and if you are considering taking omega-3 supplements, talk to your healthcare provider (NHLBI TLC booklet).

Risk is the frame every source uses, rather than a single number on a page. The 2026 guideline's writing committee chair puts it this way: while we want to try to optimize healthy lifestyle habits as the first step to lower cholesterol, we realize that if lipid numbers aren't within the desirable range after a period of lifestyle optimization, we should consider adding lipid-lowering medication earlier than we would have considered 10 years ago, and lower LDL cholesterol for longer, just like lower blood pressure for longer, results in much greater protection against future heart attack and stroke risk (AHA newsroom release, March 13, 2026). The risk bands above are what guide that decision, including whether to initiate statin therapy and the recommended intensity of lipid-lowering therapy (AHA newsroom release, March 13, 2026).

Statins are the foundation, and there is a named order after them. If LDL-C levels are not adequately lowered by healthy lifestyle habits and statin therapy, which remains the foundation of lipid-lowering and risk reduction, the guideline recommends the addition of non-statin therapies, and depending upon the level of risk and patient characteristics, evidence-based options include ezetimibe and/or bempedoic acid, a newer oral agent, or a PCSK9 monoclonal antibody, an injectable therapy (AHA newsroom release, March 13, 2026). On magnitude, statins are the main type of medicine used for lowering LDL cholesterol, they can cut LDL levels by more than half, 20% to 55%, and they also lower triglycerides and raise HDL by moderate amounts (NHLBI TLC booklet). No dose belongs on a page like this one, and there is none here.

The guideline also names groups to start therapy in, listing people age 40 or older who have chronic kidney disease at stage 3 or higher, HIV, or Type 1 or Type 2 diabetes, and it asks for continuing lipid-lowering therapy in people being treated for cancer, unless contraindicated (AHA newsroom release, March 13, 2026). It asks for deferring most lipid-lowering therapies during conception, pregnancy and lactation (AHA newsroom release, March 13, 2026), which matches the booklet's instruction to talk to your provider if you are planning to become pregnant and its statement that you should not take statins if you are breastfeeding (NHLBI TLC booklet). For a UK reader, the NHS says statins may be offered if you're at higher risk of getting cardiovascular disease and healthy lifestyle changes have not helped or are unlikely to help on their own, or if you already have cardiovascular disease, and that you'll usually take statins long term, which helps keep the risk of a heart attack or stroke as low as possible as you get older (NHS Statins, reviewed 5 May 2026).

Starting a pill does not retire the rest of the page. Even if you start taking medicines, stick with your TLC lifestyle changes, because they are essential to lowering your risk of heart disease and serious complications (NHLBI TLC booklet), and MedlinePlus says the same, that if you take medicines to lower your cholesterol, you still should continue with the lifestyle changes (MedlinePlus, August 20, 2026). The CDC frames the whole thing as a combination, saying high cholesterol often is treated and managed by a combination of adjusting certain lifestyle factors and taking cholesterol-lowering medicines prescribed by a doctor (CDC, May 15, 2024).

Stopping is a conversation, every time. Never stop taking your medicine without first talking to your doctor, nurse, or pharmacist (CDC, May 15, 2024), and NHLBI spells out why, saying you should never stop taking a statin on your own because that could increase your risk for a serious complication (NHLBI TLC booklet). Side effects are worth raising rather than quietly acting on. Tell your provider about side effects, since some people report muscle problems while taking statins, and if you start having muscle pain, your provider may order a blood test to look for muscle damage, although that is rare, and the pain may go away if you switch to a different statin (NHLBI TLC booklet). Food can interact too, and grapefruit, fresh or as juice, affects how your liver breaks down some statins (NHLBI TLC booklet).

One more thing the booklet prints, which does not usually make it onto a page like this. By the end of 2018, unhealthy cholesterol levels had become more common among U.S. women than among men, and because women are more likely to experience side effects of statins, they may delay starting them or stop taking them, which is worrisome because healthcare providers are less likely to prescribe statins for women in the first place, for reasons that are not clear (NHLBI TLC booklet).

Six weeks is the clearest sourced answer, and it comes from NHLBI's own path through the program. Box 4, a typical TLC path to success, runs Visit 1, where you start lifestyle changes, cut saturated fat and cholesterol, and increase activity, then allow 6 weeks, then Visit 2, where you check cholesterol levels, add plant stanols and sterols, and increase soluble fiber, then allow 6 weeks, then Visit 3, where you adjust treatment as needed, check cholesterol levels, keep working on weight management and physical activity, and start medicines for LDL lowering if needed, and then every 4 to 6 months after that, checking progress and sticking with the program (NHLBI TLC booklet). In plain words, after a real change to how you eat, the first check lands about six weeks out, and after that it is every four to six months.

Starting a statin has its own number, and it comes off the drug label. Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating CRESTOR, and adjust dosage if necessary (CRESTOR rosuvastatin prescribing information, revised 4/2026, section 2.1). That is four weeks from the label, and the six weeks above is from NHLBI, so use whichever matches what you actually changed and say which one you are working from.

Plant sterols are the only other change with a stated speed, at about 5% to 15% off LDL from 2 grams a day, often within weeks (NHLBI TLC booklet).

I never diagnose, never set your target, and never touch a dose. What I do is the daily half. Food comes to me by text, and I keep the saturated fat and the soluble fiber in view while we talk about it, using the grams above rather than a verdict on the meal. Your walking minutes come off your phone, so I know whether the walk happened before I ask. The six-week check and the follow-up sit on the calendar and I bring them up before they arrive. Your panel numbers stay with their dates and I read them back when you want them, which is the thing NHLBI actually asks for: keep records, record your test results at each visit, prepare for your appointments by making a list of questions, symptoms, and concerns, and write down any treatment instructions (NHLBI TLC booklet).

A missed day is a data point here. The program is a new way of living rather than a quick fix, so don't worry if you fail now and then, because everyone slips up sometimes, especially when they're learning something new (NHLBI TLC booklet). What the booklet asks for next is the same thing I ask for: work out why you got off track, check whether you tried to do too much at once, reset your goals so they are more reachable, and look back at what you ate, the physical activity you did, and the weight you tracked (NHLBI TLC booklet). Goals get specific for the same reason. Saying you'll do more is vague, saying you'll walk 3 miles a day when you've not been physically active may be unrealistic, and committing to an extra 2,000 steps a day is the kind of goal that survives a Tuesday (NHLBI TLC booklet).

No clinician reviewed this page. It restates NHLBI's TLC booklet, AHA's release on the 2026 ACC/AHA dyslipidemia guideline, MedlinePlus, the CDC, the NHS, and the CRESTOR label linked below, and those are the documents to trust over anything here.