Most people don't notice anything when they have high cholesterol , but their arteries certainly feel it. While tests continue to show figures that worry doctors worldwide, science is refining which dietary and lifestyle changes can make a difference and when medication is appropriate.
In Spain and the rest of Europe, where cardiovascular disease remains a leading cause of death, experts agree that a significant part of the problem can be addressed from the kitchen, the supermarket, and the primary care clinic, by combining a good diet , exercise, and effective treatments for those who need them.
Why is LDL cholesterol such a concern?
LDL cholesterol , known as "bad" cholesterol, is the type that most concerns cardiologists because it is associated with the formation of plaques that narrow and harden the arteries. Harvard Health Publishing and other institutions emphasize that this process occurs silently, without clear symptoms, until complications such as a heart attack or stroke arise.
One of the challenges is that even young people, athletes, or those of normal weight can accumulate cholesterol in their arteries without realizing it. For this reason, organizations like the Mayo Clinic and various scientific societies recommend regular blood lipid checks , starting in late childhood and adolescence, and adjusting the frequency according to individual risk.
In countries with well-collected data, such as Argentina and several European countries, a large proportion of the adult population has total cholesterol levels exceeding what are considered optimal. This has led many guidelines to suggest reviewing lipid profiles every few years in low-risk individuals, and even annually after a certain age or when there is a family history of high cholesterol.
Although some cholesterol comes from what we eat, specialists remind us that between 20% and 30% of cases can be controlled with diet and physical activity , but that there is an important genetic component, especially in conditions such as familial hypercholesterolemia , where drugs are often needed from early stages.
Soluble fiber: a modest but constant ally
One of the dietary cornerstones for improving lipid profile is soluble fiber . This type of fiber, found in oats, legumes, sweet potatoes, broccoli, Brussels sprouts, carrots, apples, berries, and avocados , forms a gel-like substance in the intestine that binds to cholesterol and prevents its easy absorption.
Studies cited by institutions such as the Mayo Clinic agree that a higher consumption of these foods helps reduce LDL cholesterol and is associated with a lower risk of coronary heart disease, as well as promoting better glucose regulation. It's not a dramatic short-term effect, but rather a steady trickle that, maintained over time, can be very significant.
The problem is that, in practice, most people fall far short: around 38 grams of fiber per day is recommended for men and 25 grams for women , and many people don't even reach half that amount. This limits a simple and inexpensive way to improve cholesterol without resorting to more medication right away.
In addition, fiber has a greater feeling of fullness , which helps control body weight, another key factor for heart health. Its supply of antioxidants and anti-inflammatory compounds also helps reduce oxidative damage to blood vessels.
Plant-based proteins, almonds and other nuts
The increased consumption of plant-based protein is another major trend supported by evidence. Products such as soy (tofu, tempeh, edamame), legumes, and nuts have been shown to help reduce LDL cholesterol, according to various studies referenced by universities such as Harvard.
In the specific case of soy , an approximate reduction of 3% to 4% in LDL has been observed when consumed regularly, an effect that is enhanced when red or processed meat is replaced by these plant sources that are lighter in saturated fats and rich in fiber.
Nuts and seeds hold a special place in cardiometabolic recommendations. Among them, walnuts and almonds stand out for their combination of unsaturated fats, fiber, phytosterols, and antioxidants. The Mayo Clinic indicates that consuming 50 to 100 grams of nuts five times a week is associated with a decrease in LDL cholesterol and improved overall cardiovascular health.
A recent analysis commented on by the Spanish doctor Alberto San Agustín reviewed data from more than 2.400 people and confirmed that almonds not only lower LDL somewhat , but also influence a lesser-known but very important marker: apolipoprotein B (ApoB) , which reflects the number of particles that transport cholesterol through the blood.
In the specialist's words, if cholesterol is the passageway, ApoB are the "vehicles" that transport it through the arteries. Reducing this number implies a lower probability of plaque formation , even if total cholesterol doesn't change significantly. In studies, almonds showed modest reductions in LDL (around five points), but these reductions were sustained over time, which could translate to up to a 7% lower risk of heart attack when consumption is maintained for years.
The effective amount is between 30 and 50 grams daily , approximately a handful. It is recommended to use raw or roasted almonds, not fried or sugared, and preferably with the skin on, where many of their antioxidants are concentrated.
Healthy fats: olive oil and fatty fish
In the Mediterranean region, extra virgin olive oil remains the star fat for managing cholesterol. Its richness in monounsaturated fats and antioxidants has led many cardiologists to recommend it as the best option for cooking and dressing, ahead of butter, lard, or other oils high in saturated fats.
Available evidence indicates that replacing saturated fats with vegetable oils such as olive or canola helps lower LDL cholesterol and improves arterial health. Conversely, oils high in saturated fat, such as coconut or palm oil, are associated with a higher cardiovascular risk , and their regular use should be limited.
Among animal protein sources, fatty fish such as salmon, sardines, and mackerel hold a prominent place in cardiovascular prevention recommendations. They are rich in omega-3 fatty acids, which have been shown to increase HDL ("good") cholesterol , reduce triglycerides, and exert anti-inflammatory effects on the arterial walls.
It's important to note that these fish don't typically lower LDL cholesterol directly, but they do improve other risk factors such as triglycerides and certain arrhythmias. That's why they're considered a key component of heart-healthy diets like the Mediterranean diet, when combined with whole grains, fruits, vegetables, and legumes.
In the seafood sector, the issue of cholesterol in prawns, shrimp, and langoustines often sparks debate. Although they have been attributed with a high cholesterol content, data indicates that a dozen prawns contain less cholesterol than an egg , around 175 mg, an amount that can fit into a balanced diet for most people without specific lipid problems or allergies.
The role of garlic and other functional foods
Beyond the major food groups, some ingredients commonly found in Spanish cuisine have also demonstrated significant effects on lipid profiles. One of these is garlic , a key ingredient in many traditional sofritos and stews.
The Spanish Heart Foundation has published a meta-analysis by Chinese researchers that examined 26 studies on the effect of garlic on blood lipids. Overall, garlic was superior to a placebo in reducing total cholesterol and triglycerides , especially when consumed over a prolonged period.
The results indicate that preparations such as garlic powder and aged garlic extract appear to be more effective at lowering total cholesterol, while garlic oil seems to play a somewhat more significant role in reducing triglycerides. However, these studies did not show clear changes in HDL or LDL cholesterol separately.
Even so, the authors conclude that a garlic-based therapy could be beneficial , provided it is integrated into a healthy dietary pattern and not used as a substitute for other treatments prescribed by a doctor.
According to the Healthline website, many of garlic's beneficial effects are due to sulfur compounds released when it is chopped or crushed, including the well-known allicin. A recent review suggests that these substances may promote relaxation of blood vessels and limit the production of angiotensin II, a hormone that raises blood pressure, thus improving blood flow.
In addition, garlic is rich in minerals such as selenium, potassium, phosphorus, magnesium, zinc, and iodine , as well as B vitamins and small amounts of vitamins C and E. Incorporating it daily into typical Mediterranean diet dishes is a simple and affordable way to support cardiovascular health without resorting to complex products.
Green tea and cholesterol control
Another beverage that has gained popularity in recent years is green tea , traditional in Asia and increasingly common in Europe. Its leaves, rich in catechins and other polyphenols, contain antioxidants that help combat oxidative stress , a factor involved in the development of atherosclerosis.
Several studies indicate that regular consumption of green tea is associated with a decrease in LDL cholesterol and a smaller decline in HDL cholesterol with age. Although the quantitative effects are moderate, this daily habit could support, along with other lifestyle changes, a reduction in cardiovascular risk.
Nutritionists typically recommend three to five cups a day , preferably unsweetened, as a substitute for sugary drinks or sodas. However, they advise that people with certain medical conditions—such as anemia, glaucoma, osteoporosis, or diabetes—should discuss their consumption with their doctor before drinking large quantities.
In addition to its potential impact on cholesterol, green tea has been linked to a slight reduction in blood pressure , improved insulin sensitivity, and some protective effect against dementia and Alzheimer's, probably due to the combination of polyphenols and caffeine with L-theanine.
When diet is not enough: statins and other drugs
Despite the potential of diet and exercise, in many cases they are not enough to reach the cholesterol targets set by clinical guidelines. This is where statins come in , the most widely used group of medications to lower LDL cholesterol and prevent cardiovascular events.
These drugs work by blocking a key liver enzyme involved in cholesterol production, resulting in significant reductions in LDL cholesterol and, above all, a proven decrease in heart attacks, strokes, and mortality. Cardiologists like Jorge Tartaglione insist that, beyond alarmist headlines on social media, the evidence in favor of statins is very strong when they are properly indicated.
The specialist points out that only a small portion of cholesterol comes from diet , and that many people produce it internally due to genetic factors. This is the case for thin individuals or vegetarians who, despite eating carefully, have high levels and require medication to reduce future risk.
Regarding safety, large studies show that serious side effects are rare . Around 1% of patients may experience muscle pain or other symptoms, requiring dosage adjustments or a change in medication, but the vast majority tolerate them well. Experts emphasize that any decision to discontinue or modify these medications should be made in consultation with a doctor, not based on isolated information found online.
A recent study from the University of Hong Kong , published in the Annals of Internal Medicine, also provides relevant data on people with type 2 diabetes . Using an extensive UK database, the researchers observed that statins reduce both deaths and serious cardiac events, even in patients considered "low risk," especially when they start with elevated cholesterol levels.
New options: bempedoic acid and combination therapies
Not everyone tolerates statins or wants to take them. For this group, research is opening avenues with alternatives such as bempedoic acid , a drug that also acts on the liver but through a different pathway, reducing the synthesis of LDL cholesterol.
Recent data show that bempedoic acid achieves LDL reductions of up to 28% and an approximate 13% decrease in major cardiovascular events in patients who did not tolerate statins or did not want to take them. Without promising miracles, cardiologists emphasize that it is a useful option in cases of so-called “statin intolerance.”
At the same time, studies such as Santorini remind us that, in practice, combination therapies (statins plus other lipid-lowering drugs) allow a greater number of patients to reach the target cholesterol levels set by European guidelines.
Companies involved in the development of these treatments, such as Daiichi Sankyo , emphasize that cardiovascular disease continues to be the leading cause of death in Europe , so expanding the therapeutic arsenal —always supported by robust evidence— is a necessity rather than a luxury.
In any case, experts insist that medications do not replace, but rather complement, lifestyle changes. A diet rich in plant-based foods, fatty fish, nuts, and quality oils , combined with regular exercise, weight management, and quitting smoking, remains the foundation upon which any heart-healthy strategy is built.
The underlying message is that cholesterol is not an absolute enemy , but a necessary molecule that can become problematic when it accumulates in excess and in the wrong place; the key is to monitor your levels in advance, rely on a well-planned diet, and use medication without fear when evidence indicates that it can actually reduce the probability of heart attack or stroke in the coming years.
