Lower LDL Cholesterol and Heart Disease Risk

Cholesterol is a waxy substance made by the liver. When blood cholesterol is too high, it builds plaque in artery walls and leads to heart disease, but a low-fat vegan diet can lower cholesterol and even reverse heart disease. This fact sheet from the Physicians Committee for Responsible Medicine explains how.

Nearly 2,400 Americans die of cardiovascular disease every day, about one death every 37 seconds. Heart disease is the leading cause of death in the United States, and Black Americans are hit hardest. Diet, lack of health care, food insecurity and other lifestyle factors play a major role in heart disease risk.

Atherosclerosis

Atherosclerosis is a common form of heart disease in which plaques of cholesterol and other material build up in artery walls and restrict blood flow, often causing chest pain (angina) during exertion. When a plaque ruptures, a blood clot can block blood flow and cause a heart attack. It is not simply a result of aging: examinations of American soldiers killed in the Korean and Vietnam wars found serious atherosclerosis at age 18 or 20. Only about 5% of people have a genetic tendency toward heart disease.

The Framingham Heart Study, begun by William Castelli, MD, in 1948 in Framingham, Massachusetts, found that people with total cholesterol below 150 mg/dL had a much lower risk of coronary artery disease. In the study's first 50 years, only 5 participants with cholesterol below 150 mg/dL developed coronary artery disease.

Cholesterol

The liver makes cholesterol to build hormones and cell membranes, and it produces all the cholesterol we need. Saturated fat and cholesterol in animal products raise cholesterol levels, and many Americans have total cholesterol above 200 mg/dL. LDL, or "bad" cholesterol, sharply raises heart attack risk at high levels, while HDL, or "good" cholesterol, picks up cholesterol and removes it. Heart health is best with enough HDL and normal total and LDL cholesterol.

How to Lower Total and LDL Cholesterol

Cut Dietary Cholesterol

Cholesterol is found only in animal foods, including red meat, poultry, fish, eggs and dairy products. Chicken has as much cholesterol as beef, about 25 milligrams per ounce, so 4 ounces of either has roughly 80 to 120 milligrams, and most shellfish, such as shrimp, have even more. Every 1% drop in cholesterol lowers heart disease risk by about 2%, so lowering cholesterol from 300 to 200 mg/dL cuts the chance of a heart attack by two-thirds.

Cut Fat, Especially Saturated Fat

About 30% of the calories in the leanest beef come from fat, and about 23% in skinless chicken. Most cheeses get 60% to 80% of their calories from fat, ice cream 45% to 65%, and butter, margarine and oils 95% to 100%. Nearly all grains, legumes, vegetables and fruits get less than 10% of their calories from fat. Saturated fat raises LDL cholesterol. It makes up 50% of beef tallow, 39% of lard and 30% of chicken fat, and the tropical oils are also high: 87% for coconut oil and 49% for palm oil. Vegetable oils contain far less, from 9% for safflower oil to 17% for peanut oil, but all fats and oils are worth minimizing, because too much unsaturated fat can also cause health problems.

Go Vegan

A diet of only plant foods, including whole grains, legumes, vegetables and fruits, is the best way to lower heart disease risk. Plant foods contain no cholesterol, are generally low in saturated fat, and are the only foods with fiber. Large studies have found that vegetarians are much less likely to die of heart disease. A 2018 review found strong and consistent evidence that vegetarian, and especially vegan, diets can prevent and reverse atherosclerosis and lower blood pressure, blood lipids and body weight. In a 2014 study of 198 patients with cardiovascular disease who ate no fish, meat, dairy or added oils, 89% stuck with the diet; of those, 81% saw their symptoms improve, they lost an average of 18 pounds, and 22% had their disease reversed.

Fiber

Soluble fiber from oats, barley, beans and some fruits and vegetables slows cholesterol absorption and reduces the amount the liver makes. American adults average only 10 to 15 grams of fiber a day, short of the recommended 20 to 35 grams.

Maintain a Healthy Weight

Excess weight, especially around the abdomen, raises heart disease risk. A 2020 study in the International Journal of Epidemiology projected that by 2030, 33% of children, 50% of adolescents, 81% of men and 74.9% of women will be overweight or obese.

Keep Blood Pressure Normal

High blood pressure is another major risk factor. Dietary guidelines advise less than 2,300 milligrams of sodium a day, or 1,500 milligrams for people over 51 or with high blood pressure, while Americans average about 3,400 milligrams. Vegetarians and vegans tend to have lower blood pressure, likely thanks to less fat and sodium and more potassium, magnesium, antioxidants and fiber.

Avoid Smoking, Stay Active and Manage Stress

Smokers have a much higher risk of heart disease whatever their diet. Regular activity such as brisk walking, gardening, cycling, swimming or dancing helps, and so do rest and stress-reduction techniques such as meditation and deep breathing.

Reversing Heart Disease

On July 21, 1990, The Lancet published Dean Ornish, MD's landmark finding that heart disease can be reversed without drugs. Patients who followed a low-fat vegetarian diet, moderate exercise, no smoking and stress management improved quickly, and after one year 82% showed measurable reversal of artery blockages. The control group on conventional care mostly saw their chest pain and plaque get worse.