How to lower LDL cholesterol

The table ranks each lever by the size of the average LDL-C drop in its best meta-analysis or trial. Percentages depend on where you start: people with higher LDL usually see bigger drops [3].

Effects add up. A diet change on top of a statin still lowers LDL further, and drug effects multiply, because each one removes a share of what is left.

What counts for the arteries is the absolute drop and how long it lasts. Each 39 mg/dL (1 mmol/L)1 mmol/L (39 mg/dL) lower cuts major vascular events by about 22% [9], whichever receptor-based route gets you there [8].

Change the fat first. In metabolic ward studies, swapping saturated fat for complex carbohydrate at 10% of calories lowered LDL-C by about 14 mg/dL (0.36 mmol/L)0.36 mmol/L (about 14 mg/dL), and replacing a further 5% of calories of carbohydrate with polyunsaturated fat lowered it by another 0.11 mmol/L [1]. Replacing saturated fat with unsaturated oils also improves the total to HDL ratio, which swapping for refined carbohydrate does not [10]. Over at least two years, cutting saturated fat reduced combined cardiovascular events by 21% [11].

Add soluble fiber. Each gram of soluble fiber a day lowers LDL-C by about 2.2 mg/dL (0.057 mmol/L)0.057 mmol/L (2.2 mg/dL); 3 g from oats, about three servings of oatmeal, lowers it by about 0.13 mmol/L [12].

Stack cholesterol-lowering foods. The Portfolio diet combines plant sterols, soy protein, viscous fiber and almonds. With all food provided for a month, it lowered LDL-C by 28.6%, against 30.9% for lovastatin 20 mg [5]. With advice only over six months, it lowered LDL-C by about 13%, against 3% on a standard low saturated fat diet, and adherence predicted the result [13].

Lose excess weight. In 70 studies, weight loss by dieting lowered LDL-C, total cholesterol and triglycerides [14].

See foods that lower LDL for the food-by-food evidence, and the Mediterranean diet, whole-food plant-based and longevity focus protocols for ways to put this into a week of meals.

• Plant sterols and stanols. Across 124 studies, 0.6 to 3.3 g a day lowered LDL-C by 6% to 12%, with little extra effect above about 3 g [2]. They come in fortified spreads, yogurts and capsules.
• Soluble fiber. Psyllium, oat bran and pectin lowered LDL by similar amounts per gram, about 2.2 mg/dL (0.057 mmol/L)0.057 mmol/L (2.2 mg/dL) [12]. Oat beta-glucan at a median 3.5 g a day lowered LDL-C by about 7 mg/dL (0.19 mmol/L)0.19 mmol/L (about 7 mg/dL) [15].
• Soy protein. About 25 g a day lowered LDL-C by 3% to 4% [4].

Many other supplements are sold for cholesterol. We have not listed them because we could not find meta-analyses of the same quality. Supplements are not tested to the standard of medicines, and their contents vary by brand. Tell your clinician what you take, because some interact with prescription drugs.

• Statins block cholesterol production in the liver, so the liver makes more LDL receptors. High-intensity statins lower LDL-C by at least 50% [6]. They raise the odds of new type 2 diabetes by about 12% [16].
• Ezetimibe blocks cholesterol absorption in the gut. Alone it lowers LDL-C by about 18.6% [17]; added to a statin after acute coronary syndrome it took LDL-C from 69.5 to 53.7 mg/dL and reduced events [18].
• Bempedoic acid acts in the liver, upstream of the statin target. In statin-intolerant patients it lowered LDL-C by 21.1 percentage points more than placebo and cut major events by 13% [19].
• PCSK9 antibodies (evolocumab, alirocumab) are injections that protect LDL receptors. Evolocumab lowered LDL-C by 59% on top of statins [7] and also cut first events in people without a prior heart attack or stroke [20].
• Inclisiran silences PCSK9 production with an injection twice a year and lowered LDL-C by about 50% [21].

The 2026 US guideline allows a more flexible choice among these non-statin options once a statin is not enough [22]. Which medicine fits you depends on your risk, other conditions and cost. That is a decision to make with your clinician.

In the first Portfolio trial, the full 28.6% drop appeared after four weeks of controlled eating [5]. Dietary fat and coffee studies lasting about four to six weeks also showed clear changes within that time [1] [23].

The 2018 US guideline recommends a repeat lipid panel 4 to 12 weeks after starting a statin or changing its dose, then every 3 to 12 months as needed, and judging response by the percentage change from baseline [6].

The trials above measured change after four weeks or more, so they do not support claims of large drops within 7 days. To judge a change, compare panels taken a month or more apart, ideally under similar conditions.