Q&A With Heart Experts: Can I Just Make Lifestyle Changes to Lower My Cholesterol?

January 26, 2026 CardioSmart Contributor

In this series, heart specialists answer common questions about statins and heart health.

Question: Can i just make lifestyle changes to lower my cholesterol?

Answer: A good heart healthy lifestyle is important no matter what your risk of heart disease is. It is the foundation of all preventive treatment and must be done in parallel to any treatment prescribed for heart disease or heart disease prevention. However, there are instances when lifestyle changes alone are just not enough to protect yourself from having a cardiovascular event. This depends on underlying risk and genetics.

From a risk standpoint, understanding whether or not you have elevated biomarkers like lipoprotein (a), coronary artery calcium, elevated high sensitivity, c-reactive protein, a history or inflammatory disease, high estimated risk based on validated risk calculators, or a previous diagnosis of cardiovascular disease like heart attack, stroke, or peripheral arterial disease can support being on a cholesterol medication in addition to lifestyle modifications.

There is very well-established evidence that in individuals at high risk the lower the LDL cholesterol goes the better it is for them. For example, in a recent study published in 2025, VESALIUS-CV trial, studied more than 12,000 adults who were at high risk for heart disease, but had never had a heart attack or stroke before. Even though many of these people were already taking statins had near-normal LDL-C, adding a powerful cholesterol lowering shot, 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 to placebo. This shows that getting LDL-C very low can help protect high risk patients whose cholesterol wasn’t extremely high to begin with.

From a genetic standpoint, there are conditions where cholesterol particles cannot be broken down due to the absence of dysfunction of certain proteins or metabolites in the body. A good example is familial hypercholesterolemia where patients cannot dispose of LDL cholesterol, leading to very high levels in the blood stream and a substantially increased risk of heart disease. In genetic cases, medications for cholesterol are essential as lifestyle modifications will not work to bring the cholesterol down.

Key Points

Depending on your risk for heart disease, lifestyle modifications may not be enough to reach your cholesterol goal.
Cholesterol medications can help patients achieve guideline-based LDL targets. There is evidence that these targets reduce cardiac events.
In certain genetic cholesterol disorders, cholesterol medications are necessary as lifestyle modifications alone will not work.

Read More: Q&A With Heart Experts: Statins

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