Q&A With Heart Experts: In this series, heart specialists answer common questions about statins and heart health.
Can I just make lifestyle changes to lower my cholesterol?
A heart-healthy lifestyle is important no matter your risk of heart disease. It is the foundation of all preventive treatment and must be done alongside any treatment prescribed for heart disease or heart disease prevention. However, there are instances when lifestyle changes alone are not enough to protect yourself from having a cardiovascular event. This depends on underlying risk and genetics.
Knowing your risk can help you and your care team decide if you may benefit from cholesterol medicine along with healthy lifestyle changes. You may be at higher risk if you have any of the following:
In people at high risk, research shows that the lower the low-density lipoprotein cholesterol (LDL-C), the better it is for their health. For example, the VESALIUS-CV trial published in 2025 studied more than 12,000 adults who were at high risk of heart disease but had never had a heart attack or stroke. Although many of these people were already taking statins and had near normal LDL-C, adding evolocumab lowered LDL-C down to about 45 mg/dL and reduced first major heart problems (like heart attack or stroke) by about 25% compared with placebo. This shows that getting LDL-C low can help protect high-risk patients even if they didn’t have extremely high cholesterol to begin with.
From a genetic standpoint, there are conditions where cholesterol particles cannot be broken down due to the absence or dysfunction of certain proteins or metabolites in the body. For example, patients with familial hypercholesterolemia cannot dispose of LDL cholesterol, leading to very high levels in the bloodstream and a substantially increased risk of heart disease. In genetic cases, medications for cholesterol are essential as lifestyle modifications will not be enough to bring cholesterol levels down.
Key Points
- Depending on your risk of heart disease, lifestyle modifications may not be enough to reach your cholesterol goal.
- Cholesterol medications can help patients achieve guideline-based LDL cholesterol targets. There is evidence that these targets reduce cardiac events.
- In certain genetic conditions, cholesterol medications are necessary as lifestyle modifications alone will not work.