You’re absolutely on the right track. Nutrition and other lifestyle changes are really the cornerstone of improving your heart health, and that's true regardless of whether or not you’re also taking medicine to lower your cholesterol.
In terms of your diet, the most important change you can make is to eat more vegetables and fewer potato chips, cookies and other “junk foods.” You also want to substitute the “bad” fats—saturated fats (found in red meat and full-fat dairy products) and trans-fats (which are found in cookies, cakes and other processed food)—for the “good” fats, which are monounsaturated fats in olive oil and nuts.
But just because olive oil is a “good” fat, that doesn’t mean you can have unlimited amounts of it. It’s still high in calories, and obesity is a risk factor for heart disease, so portion control is key.
Exercise is another proven way to lower your cholesterol. What’s even better is that it lowers your risk of heart disease in a lot of other ways, too. Regular physical activity—the American Heart Association recommends 30 minutes a day, at least five days a week—burns calories, reduces your appetite so you eat less, improves your overall mood and reduces inflammation, which we know is connected to heart disease.
Actually, there is one type of cholesterol, known as triglycerides, that can be more responsive to lifestyle changes than to drugs. If I have a patient with high triglycerides, I always start them off with lifestyle changes first. And I’ve had patients who’ve seen their triglycerides drop by as much as 300 points just by exercising regularly and lowering their sugar intake.
On the other hand, I also have patients who, even after they’ve made these lifestyle changes, still need to take a cholesterol lowering medication. This is usually because they have multiple risk factors for heart disease, or because they had a coronary calcium test that shows that they already have evidence of heart disease in their arteries. (The coronary calcium test is a 20-minute CT scan that takes a snapshot of your arteries to see if there is any plaque.)
Another reason why we sometimes recommend medication is because we know from studies that taking cholesterol medication increases longevity in people who have multiple risk factors or who already have evidence of heart disease in their arteries. This is true even for those who have relatively normal cholesterol.
So by all means, it’s always worth trying lifestyle changes to lower your cholesterol if you’re not ready to start taking a cholesterol-lowering medication. But also keep in mind that depending on your individual risk factors and test results, also taking medication may be ideal.