There are different ways to reduce your cholesterol levels, including treatments that are available and changes you can make to your diet.
If you have high cholesterol, or you’re worried about your risk, contact your GP surgery for individual advice. They will be able to suggest things that are suitable for you. What is right for one person will not necessarily be right for someone else.
Why is managing your cholesterol important?
It’s important to know if you have high cholesterol. If cholesterol is not managed, it could lead to long-term health problems and increase your risk of stroke or heart attack.
If you’ve had a stroke or transient ischaemic attack (TIA), you will be assessed and may be offered cholesterol treatment, regardless of what your cholesterol level is. This is because any reduction in your cholesterol may help prevent another stroke. You should also be given advice and support with lifestyle measures, such as eating more healthily and quitting smoking.
I’m cooking from scratch and eating clean. It might be a combination of this and the statin medication but so far, my cholesterol has gone down by about five points.
Pamela, stroke survivor
Treatments
Treatments can work well at lowering cholesterol levels. Your doctor may suggest you take treatment long-term to help manage your cholesterol. Here are the different types of treatments:
Statins
Statins are the main type of medication given to reduce the risk of stroke and heart attack. If you’ve had a stroke caused by a clot (ischaemic stroke) or a TIA, your doctor may prescribe statins to help prevent another stroke or TIA. This treatment will usually start before you leave hospital after a stroke. If you were taking statins before your stroke, you should continue to take them unless advised not to by a clinician.
Statins come as daily tablets. They work by reducing the levels of ‘bad’ cholesterol produced by the liver. This helps prevent fatty deposits (atherosclerosis) forming on the walls of your arteries and blocking them.
How much do statins lower the risk of stroke?
Taking statins may help to reduce your risk of an ischaemic stroke by over 10%. It may also reduce your risk of another stroke by more than 10% in people who have already had an ischaemic stroke.
Other lipid-lowering drugs
If you cannot take statins or statins have not worked for you, there are other types of drugs available. Talk to your doctor about whether these medications are suitable for you.
The main alternative to statins is a selective cholesterol absorption inhibitor such as ezetimibe, which comes as a daily tablet.
Some people who have had a stroke but cannot take statins or ezetimibe (or whose cholesterol was not lowered sufficiently by these medications) may be prescribed PCSK9 inhibitors, such as evolocumab or alirocumab. They are given by injection every two to four weeks.
There are also some newer medications such as inclisiran and bempedoic acid. They may be offered in combination with other cholesterol-lowering treatments. Bempedoic acid comes as a daily tablet. Inclisiran is given as an injection. After the initial dose, it’s given again after three months, and then every six months.
Other treatments
Plant sterols and stanols are naturally found in foods such as fruit and vegetables, nuts, seeds and vegetable oils. They can help reduce cholesterol in your blood when taken as supplements alongside a healthy diet. You can buy products such as yoghurts, margarines and mini drinks which contain stanols and sterols. You need to consume about 2-3g of plant sterols each day to lower your cholesterol.
You can use plant sterols and stanols alongside cholesterol-lowering medication. But they should not replace your medication. Although sterols and stanols can reduce cholesterol, they do not reduce your stroke risk in the same way as statins.
Changing your diet
What you eat is linked to your cholesterol levels. For example, eating an unhealthy and unbalanced diet can lead to weight gain. Being overweight or obese increases your risk of developing health conditions such as high cholesterol.
Healthy eating tips for reducing your cholesterol
Making the following changes to your diet can help to lower your cholesterol:
- Cut down on foods high in saturated fat such as full-fat dairy products, fatty meat, and cakes, pastries and biscuits. Also try to reduce foods high in coconut oil, palm oil or ghee.
- Eat foods high in soluble fibre such as oats, beans, peas, pulses, nuts, fruit and vegetables.
- Eat five or more portions of a variety of fruit and vegetables each day.
- Eat oily fish such as salmon, mackerel, sardines, trout or herring. Aim for two portions each week.
- Use olive or rapeseed oil for salad dressings, or an oil that is high in polyunsaturated fats like sunflower oil.
- Try to include soya-based products in your diet such as tofu, edamame beans, soya milk or soya yoghurt.
Cholesterol from eggs, liver, kidneys and some seafoods has little effect on your blood cholesterol levels, unless you eat very large amounts.