The short answer
To lower LDL ("bad") cholesterol:
- Eat less saturated fat (fatty red and processed meat, butter, ghee, cream, cheese, coconut and palm oil), replacing it with unsaturated fats such as olive, canola or sunflower oil, nuts and fish.
- Eat more soluble fibre: oats, barley, beans, lentils, fruit and vegetables.
- Move more: about 150 minutes a week of moderate activity.
- Stop smoking, and keep alcohol low.
- Lose weight if you are carrying extra, especially around the waist.
For people at higher risk of heart disease, medicine such as a statin is often needed as well. Lifestyle changes still add to its effect.
What your cholesterol numbers mean
| Measure | What it is | General direction |
|---|---|---|
| LDL cholesterol | The main cause of artery-clogging plaque | Lower is better |
| HDL cholesterol | Helps remove cholesterol from the blood | Higher is generally better |
| Triglycerides | Another blood fat, raised by sugar, alcohol and excess weight | Lower is better |
| Total cholesterol | All of the above combined | Less useful on its own |
| Non-HDL cholesterol | Total minus HDL | Lower is better |
Results are given in mg/dL (US) or mmol/L (most other countries). To convert cholesterol from mg/dL to mmol/L, divide by about 38.7. For example, an LDL of 100 mg/dL is about 2.6 mmol/L.
For many adults without heart disease, an LDL below about 100 mg/dL (2.6 mmol/L) is considered desirable. Your own target depends on your overall risk.
What the 2026 guideline changed
In early 2026, the American College of Cardiology, the American Heart Association and partner organisations published a new guideline on managing cholesterol, replacing the 2018 version. Key changes reported in the guideline and summaries of it:
- LDL targets are back. Rather than only recommending medicine intensity, it sets LDL goals by risk level, with lower targets for people at higher risk. For example, people with existing heart disease at very high risk are given a goal of below 55 mg/dL.
- New risk calculator. It uses the PREVENT equations, which estimate 10-year and 30-year risk of heart disease.
- Earlier treatment for some people at lower levels of risk than before.
- Lipoprotein(a) should be measured at least once in adulthood. High levels are largely inherited and raise heart risk.
Other countries have their own guidelines, such as the European ESC/EAS guidelines, which also use LDL targets. Your doctor will use the ones that apply where you live.
Foods that help
- Oats and barley, which contain beta-glucan, a soluble fibre that lowers LDL.
- Beans, lentils and chickpeas.
- Nuts, a small handful a day.
- Soy foods such as tofu, edamame and soy milk.
- Oily fish (salmon, sardines, mackerel), mainly for lowering triglycerides and heart health.
- Plenty of vegetables and fruit.
- Foods with added plant sterols or stanols, which can lower LDL by a modest amount when eaten daily.
Foods to limit
- Saturated fat: fatty and processed meats, butter, ghee, lard, cream, full-fat cheese, coconut and palm oil, many pastries and fried snacks. US guidance has long recommended keeping saturated fat to under 10 percent of daily calories.
- Trans fats from partially hydrogenated oils, still found in some fried and baked foods in some countries.
- Refined carbohydrates, sugary drinks and alcohol, which raise triglycerides.
Lifestyle steps
- Exercise: regular moderate activity, such as brisk walking, improves HDL and triglycerides and supports weight loss.
- Weight: losing 5 to 10 percent of body weight, if you are overweight, improves cholesterol and blood pressure. See BMI explained.
- Smoking: quitting raises HDL and sharply cuts heart risk.
- Blood pressure and blood sugar: cholesterol is one part of heart risk. Our guide to lowering blood pressure covers another.
When medicine is recommended
Doctors look at your overall risk, not just one cholesterol number. Medicine is more likely to be recommended if you:
- Have had a heart attack, stroke or other artery disease.
- Have very high LDL, such as 190 mg/dL (about 4.9 mmol/L) or above.
- Have diabetes, chronic kidney disease or a high calculated risk.
- Have familial hypercholesterolaemia.
Statins are the most common first choice. Others include ezetimibe, PCSK9 inhibitors and bempedoic acid. Stopping a prescribed medicine without advice can raise your risk.
Get tested
Many health services recommend adults have their cholesterol checked regularly from early adulthood, more often if they have risk factors. A simple blood test gives the full profile. Ask about lipoprotein(a) if you have a family history of early heart disease.
Know the warning signs of a heart attack too.
Key takeaways
- LDL is the number that matters most; lower is better.
- Swap saturated fats for unsaturated ones and eat more soluble fibre.
- The 2026 US guideline reintroduced LDL targets based on risk.
- Medicine is often needed for people at higher risk, alongside lifestyle changes.
This article is general information, not medical advice. Speak to your doctor about your own cholesterol results and treatment.