Vegan and high cholesterol ... what now?

Updated 18 July 2024

Below are some suggestions on how to lower your cholesterol values (serum cholesterol concentration) and/or triglycerides (serum triacylglyceride concentration).

What types of blood cholesterol levels are there?

The most common test is to assess "total cholesterol", i.e., all types of cholesterol combined. In addition, the so-called good and bad cholesterol values are also assessed. "So-called" because this is a drastic oversimplification.
When we talk about "lowering cholesterol", we are talking about all kinds of cholesterol except HDL cholesterol. If HDL cholesterol is too low (below the reference values), this is considered "bad". However, it is my understanding that focusing on lowering all the bad types of cholesterol (total, LDL, non-HDL, and remnant cholesterol) is most important. Any beneficial effect of increasing HDL cholesterol is extremely uncertain.
In addition to cholesterol concentrations (levels) in the blood, there is the triglyceride concentration (i.e., "blood fats"; triglycerides are often abbreviated as TG or TAG, the latter is for triacylgylcerol, which is the technically "more correct" way of saying it). Triglyceride levels are probably less important than the bad cholesterol, but still values that are too high (see below) aren't ideal for your arteries.

Your arteries (see picture above) are all over your body (deep inside, not the veins you can see superficially, for example on your arms). Arteries carry blood that comes from your heart and, therefore, there is a lot of pressure inside of them and against the artery walls. This pressure (blood pressure) is one factor that over the course of a lifetime, starting in childhood (or even in utero) that will damage your artery walls, leading to atherosclerosis (also called arteriosclerosis). The amount of cholesterol and the number of cholesterol particles floating around in your blood (and therefore arteries) is another very important factor in "creating" atherosclerosis, i.e., accelerating the lifelong process of atherosclerosis. If you can manage to slow down this process of artery damage so much that - theoretically - you would have your first heart attack at 150 years old (no one lives that long), that would be great, because even if you end up living to 110 years old, you would never have a heart attack. It's not just the final "end problem" (such as heart attack or stroke) that can result from atherosclerosis but also the problems "on the way" such as loss of energy as we get older and impaired function or practically all of our organs. Slowing down atherosclerosis is basically slowing down aging (to put it simply).

What you can do ...

Cholesterol levels

This will likely lower your bad cholesterol:

• Eat healthy fats daily: nuts, seeds, avocados [Schoeneck and Iggman et al. 2021], olives (they can be salty, remove salt as much as you can and don't eat all that many), cold-pressed oils (keep them in the refrigerator), i.e., rapeseed (canola) oil, hemp seed oil, linseed (flaxseed) oil, Camelina sativa oil [Manninen et al. 2019] [Talebi et al. 2020, Schoeneck and Iggman et al. 2021], or cold-pressed "extra virgin" olive oil (the cholesterol-lowering effect is probably low but it is probably beneficial in other ways). Oils that can effectively lower LDL cholesterol in most people seem to be rapeseed oil, linseed oil, and hempseed oil [WHO 2024]. Store oils in a cool, dark place, i.e., not in clear bottles exposed to light and/or in a warm place. 
• A dietary pattern based on - apart from vegetables and fruit - legumes and whole grains, plus nuts daily (for example, two handfuls of nuts) is probably best [Schoeneck and Iggman et al. 2021] - these three food groups (legumes, whole grains, nuts) might be the most important dietary factors to lower cholesterol levels [Schwingshackl et al. 2018]. A daily (more or less) intake of nuts (about two handfuls, i.e., about 60 g/day) seems to lower cholesterol levels by about 5 to 10 mg/dL (0.1 to 0.3 mmol/L) (e.g., almonds [Dikariyanto et al. 2020, Schoeneck and Iggman et al. 2021]). There does not seem to be a clear difference between different types of nuts [Houston et al. 2023, Guasch-Ferré et al. 2023, Asbaghi et al. 2021, Liu et al. 2020, Mukuddem-Petersen et al. 2005]. But, be aware that Brazil nuts are different from other nuts in terms of their selenium, barium, and radium levels. So do not eat more than about two Brazil nuts per day (on average; it's OK to eat more occasionally).
• Reduce the intake of unhealthy fats: deep-fried foods, fried foods, unhealthy margarine (consider using olive oil or rapeseed oil instead of margarine; margerines are generally much healthier than they used to be but the hard margarines generally have a large percentage of coconut fat, palm fat, or sometimes shea butter - all of which are high in saturated fatty acids and will probably rather increase than decrease your cholesterol levels), hydrogenated fats and especially partially hydrogenated fats, palm fat (palm oil), and coconut fat (coconut oil) [Kelly et al. 2021] - and animal fats of course (especially butter and lard [pig fat] increase cholesterol [WHO 2024]).
• If you are overweight, lose weight, especially belly fat (abdominal fat) [Wang et al. 2024, Corrao et al. 2024, Kajikawa et al. 2024, Martin et al. 2024, Kirkpatrick et al. 2023, Wang et al. 2023, Forero Torres & Forero 2023]. This might be the most important recommendation - if you are overweight. There are many different ways to lose weight (body fat) but importantly this should be done in a healthy and sustainable way, because the long-term goal is good health.
• If you are not overweight, avoid becoming overweight.
• Focus on healthy "carbs" (carbohydrate sources): whole grains [Marshall et al. 2020] (these include brown rice, whole wheat pasta, whole grain bread [bread can be high in salt, so, use less salt if you bake yourself or avoid eating too much bread], and [pseudograins] like buckwheat, quinoa, amanranth, etc.), sweet potatoes, fresh fruit (avoiding extremely high fruit intake may be best, although there isn't much data on this) [Sun et al. 2023, He et al. 2023, Mekonene et al. 2023, Madsen et al. 2023, Huang et al. 2023], and also legumes (which have healthy proteins, healthy carbohydrates, and healthy vitamins and minerals).
• Reduce the intake of "free sugars" (refined sugar, brown sugar, syrup, fruit juice concentrate [also honey, if you eat it - honey is not a vegan food strictly speaking]) [Kelly et al. 2021, Schoeneck and Iggman et al. 2021]. Free sugars also include 100% fruit juice [Xu et al. 2023, Zhang et al. 2022, Kelly et al. 2021]. The health effects of 100% fruit juice are less certain [Bhandari et al. 2024, Pan et al. 2022, Buziau et al. 2022], and 100% fruit juice is clearly better [Scheffers et al. 2022] than sugar-sweetened beverages ("soft drinks" such as Coca Cola) [Bhandari et al. 2024, Huang et al. 2023, Liu et al. 2023, Sun et al. 2023, Ding et al. 2022, Neelakantan et al. 2021, Yin et al. 2021]. But fruit juice cntains hardly any fibre, it can favour weight (body fat) gain [Nguyen et al. 2024, Chen et al. 2023], and it might have other unfavourable cardiometabolic effects (independent of weight gain) [Xu et al. 2023]. However, small amounts of fruit juice (e.g., up to ~200 ml per day) are OK for most people (and might even be slightly beneficial) [Rosell & Nyström 2024, Xie et al. 2024, Liu et al. 2023, D'Elia et al. 2021, Khan et al. 2019]. Artifically sweetened beverages might be as bad as sugar-sweetened beverages [Pan et al. 2022, Li et al. 2022, Zhang et al. 2021].
• Make sure you are getting plenty of sunshine (if possible) [Maarse et al. 2020, Gorman et al. 2019], and make sure you are getting enough vitamin D (see point 3 here) [Elsheikh et al. 2024, Thams et al. 2022].
• Try eating a little bit more protein (tofu, tempeh, beans, chickpeas, nuts, seeds, seitan, etc.) [Kirkpatrick et al. 2023, Wernicke et al. 2023]. Unlike plant protein sources, animal-based protein sources do not seem to be beneficial for cholesterol levels [Meng et al. 2021, Zhao et al. 2020, Mitchell et al. 2019]. 
• Eat more fibre [Guarneiri et al. 2024, Ghavami et al. 2023, Schoeneck & Iggman et al. 2021, Anggadiredja et al. 2020]. Fibre is found in all "whole" non-animal foods like whole grains, legumes, fruit, vegetables (don't forget "vegetable fruits" such as tomatoes, cucumber, bell peppers, etc. - easy to eat raw and tasty in salads or as snacks ... and "vegetable fruits" such as courgettes [zucchini] and aubergines [eggplants] - nice to have cooked/baked), nuts, seeds, 100% nut/seed butters, and mushrooms) [Kirkpatrick et al. 2023]. About 5–15 g soluble fibre daily may lower LDL cholesterol about 3–5% [Mirzai & Laffin 2023].
• Eating oat flakes (rolled oats) can lower cholesterol levels [Li et al. 2024, Amerizadeh et al. 2023, Llanaj et al. 2022, Hui et al. 2019]. Barley flakes may have a similar cholesterol-reducing effect to oat flakes [Guarneiri et al. 2024, Tosh & Bordenave 2020] but some found barley to be ineffective [Hui et al. 2019].
• Eating ground flaxseeds (linseeds) can also slightly lower cholesterol levels [Xi et al. 2023, Schoeneck & Iggman 2021, Hadi et al. 2020]. Flaxseed may not effectively lower cholesterol levels in people with established coronary artery disease (but they still have other beneficial effects) [Sabet et al. 2024].
• Exercise (physical activity; it doesn't have to be "sports") regularly and try to sit less (reduce sitting time: get up, stand up). If you do have to sit for long periods of time, try to break up the sitting time by getting up regularly and moving around a little bit (go to the bathroom, get some water/tea etc., get up and stretch, look out the window - find an excuse) [Murphy et al. 2019]. Exercise can somewhat lower cholesterol levels and has other benefits for cardiovascular health [Niu et al. 2024, Mendoza et al. 2022, Chen et al. 2021, Wood et al. 2021, Muscella et al. 2020].

The following can probably also lower your bad cholesterol:

• Try using dried amla powder (100% dried amla berry powder; ~1/2 to 1 teaspoon per day) [Brown et al. 2023 (most intervention studies, including Kapoor et al. 2019 and Upadya et al. 2019, were conducted with amla extract), Setayesh et al. 2023, Gopa et al. 2012 (amla juice powder), Akhtar et al. 2011 (amla fruit powder), Jacob et al. 1988 (50 g/day of raw amla berry)]. Amla powder may taste very sour. But some amla powder is not sour. It doesn't have much of a taste at all and you easily can add it to smoothies, muesli, sauces, etc. And you won't be able to taste it much. Note that some people have reported that amla powder tastes disgusting and that it gave them heartburn. I suspect that this depends on the amla powder you have - I have never noticed anything. Amla powder is traditionally used in Indian cooking (sometimes called "amalaki").  
• Try using a low-dose zinc supplement: I would suggest about 5 (to 10) mg/day. If you have a higher dose supplement, just break it into pieces. For example, a 25 mg zinc supplement tablet - break it into five pieces roughly, or bite a little piece off. More is not better. Don't take too much zinc. Generally, zinc supplementation may moderately lower cholesterol levels (non-HDL-cholesterol [Ghaedi et al. 2023, Heidari Seyedmahalleh et al. 2023, Nazari et al. 2023, Asbaghi et al. 2020, Khazdouz et al. 2020] and/or LDL cholesterol [Ghaedi et al. 2023, Heidari Seyedmahalleh et al. 2023, Pompano and Boy 2021, Asbaghi et al. 2020, Ranasinghe et al. 2015]). However, not all studies confirm a cholesterol-lowering effect of zinc supplementation [Suh et al. 2022, El Dib et al. 2015, Hughes & Samman 2006]. The effect might be especially seen in men with marginal zinc status [Khajeh et al. 2024 (shown in men with type 2 diabetes)].
• Intermittent fasting has been shown to decrease cholesterol levels in some studies [Patikorn et al. 2021, Meng et al. 2020] but some other studies found no clear effect [Enríquez Guerrero 2021, Schwingshackl et al. 2021].
• Avoid unfiltered coffee ("Turkish coffee") - it seems to increase cholesterol levels [Schoeneck and Iggman et al. 2021].
• Use turmeric regularly (~1/2 teaspoon per day) for cooking or to make "yellow soya milk" (or in whatever way you like) [Dehzad et al. 2023, Schoeneck and Iggman et al. 2021, Azhdari et al. 2019, Yuan et al. 2019, Quin et al. 2017].
• Regularly eat healthy soya foods (tofu, soya milk, tempeh, soya flour, no/low-added-sugar soya yogurt, etc.). Soya has been shown to moderately lower cholesterol levels [Qi et al. 2024, Zhou et al. 2024, Asbaghi et al. 2022, Mohammadifard et al. 2021, Schoeneck and Iggman et al. 2021, Moradi et al. 2020, Blanco Mejia et al. 2019] (and it may have other cardiovascular benefits too). About 25 g of soya protein (maybe also soya protein powder) per day seems to lower LDL cholesterol levels by about 5 mg/dl [Blanco Mejia et al. 2019]. Others have suggested that an intake of 25–50 g soya protein daily can lower LDL cholesterol ~3–5% [Mirzai & Laffin 2023]. 200 g of relatively firm tofu have about 28 g of soya protein. A higher intake of soya foods is also associated with actual lower cardiovascular disease risk [Lu et al. 2024].
• Eat lupin beans. They have also shown to moderately decrease cholesterol levels [Cicero et al. 2017] but there aren't many studies yet [Fernández Castillo et al. 2023].
• Drink green tea regularly. It moderately lowers cholesterol levels [Li et al. 2024, Osadnik et al. 2022, Neyestani & Nikooyeh 2022, Schoeneck and Iggman et al. 2021, Liu et al. 2020, Xu et al. 2020] (and has other benefits too). Some have suggested that drinking 2.5 cups daily (equivalent to at least 200 mg green tea catechins) may lower LDL cholesterol about 2–5% [Mirzai & Laffin 2023]. Not all studies have shown a cholesterol-reducing effect of green tea, however [Igho-Osagie et al. 2020].
• Eat lots of tomatoes (raw and/or cooked). This can somewhat lower cholesterol levels [Li et al. 2020, Schoeneck and Iggman et al. 2021]. Again, not every single study has shown this to be effective [Zamani et al. 2023]. 
• You can also eat sea buckthorn (Hippophae rhamnoides) products such as sea buckthorn fruit pulp/puree or oil. A small number of studies indicate that it may lower cholesterol [Geng et al. 2022, Olas 2016, Vashishtha et al. 2017]. However, this effect is quite uncertain [Larmo et al. 2009, Huang et al. 2020, Zhou et al. 2020]. Many studies didn't use sea buckthorn pulp or juice but rather sea buckthorn oil or capsules [Geng et al. 2022].
• Try drinking hibiscus tea. It does not only seem to lower blood pressure in many people but it also seems to lower LDL cholesterol ("bad cholesterol") levels [Ellis et al. 2022, Boushehri et al. 2020, Bule et al. 2020, Zhang et al. 2020].
• Eating vinegar with meals (for example, in dressings) may decrease cholesterol levels [Tehrani et al. 2023, Hadi et al. 2023, Jafarirad et al. 2023, Cheng et al. 2020].
• Black cumin seeds (Nigella sativa), which can be used as a spice in cooking, might also lower cholesterol levels moderately [Rounagh et al. 2024, Shabani et al. 2024, Hallajzadeh et al. 2020]. Some studies did, however, not observe an effect of black cumin on cholesterol levels [Tang et al. 2021].
• Eating oat bran can lower cholesterol levels [Zhu et al. 2023, Hui et al. 2019] but large amounts might have to be consumed (~25 g/day [Anderson et al. 1990], ~40 g/day [Raimondi de Souza et al. 2016], 35-50 g/day [Berg et al. 2003], ~50 g/day [Ho et al. 2016, Uusitupa et al. 1992 (~10 g beta-glucan/day; improvement was statistically non-significant)], ~60 g/day [Nyman et al. 2020, Kerckhoffs et al. 2003, Lepre and Crane 1992, Davidson et al. 1991], ~70 g/day [Braaten et al. 1994], ~80 g/day [Gerhardt and Gallo 1998, Davidson et al. 1991], ~95 g/day [Kestin et al. 1990], ~100 g/day [Kristensen and Bügel 2011], ~110 g/day [Anderson et al. 1991], ~120 g/day [Whyte et al. 1992], amount not stated [Gold and Davidson 1988]) has also been shown to lower cholesterol levels [Jane et al. 2019] (in people with typical, relatively low-fibre diet [~15-25 g/day]) but whether this also works for people who already have a high-fibre diet (everyone should) is less certain [Bremer et al. 1991]. Some studies did not show an effect of oat bran on LDL or non-HDL cholesterol levels [Robitaille et al. 2005 (28 g/day), Noakes et al. 1996 (~90-120 g/day), Stewart et al. 1992 (~50 g/day), Leadbetter et al. 1991 (30, 60, or 90 g/day), Swain et al. 1990 (~90 g/day), Demark-Wahnefried et al. 1990 (~50 g/day)]. At an intake of >80 g/day, regular oatmeal (rolled oats) may have a very similar effect to the same amount of oat bran [Davidson et al. 1991]. Oat beta-glucan supplements (~6 g/day of oat beta-glucans [Queenan et al. 2007, Amundsen et al. 2003]) appear to have a similar effect on LDL cholesterol levels to oat bran but a large number of capsules (based on commonly available supplements) would have to be taken daily. Psyllium husks [Jovanovski et al. 2018] may have a similar effect to oat bran [Jane et al. 2019]. 
• Garlic or garlic extracts might (slightly to moderately) lower cholesterol levels [Varade et al. 2024, Fu et al. 2023, Li et al. 2023, Xiaohui et al. 2023, Osadnik et al. 2022, Cicero et al. 2021, Kheirmandparizi et al. 2021, Wan et al. 2019]. About 3 g of fresh crushed garlic per day (equivalent to ~10 mg allicin daily) may LDL lower cholesterol about 5% [Mirzai & Laffin 2023]. Garlic likely has other health benefits too [Ried 2020].
• Artichoke leaf extract supplements might lower LDL cholesterol levels about 5% [Liu et al. 2024, Osadnik et al. 2022, Cicero et al. 2021].
• Berberine supplements lower cholesterol levels (moderately to strongly) [Hernandez et al. 2024, White et al. 2024, Blais et al. 2023, Osadnik et al. 2022, Cicero et al. 2021, Hu et al. 2020] (some suggest 0.5 g three times daily can lower LDL cholesterol levels ~10–20% [Mirzai & Laffin 2023]). Berberine can have additional protective effects on the cardiovascular system [Luo et al. 2023, Nie et al. 2024] but so far not many large studies (especially randomized-controlled trials) have been coducted. Current studies indicate that berberine supplements are safe and effective [Blais et al. 2023, Yang et al. 2023, Nie et al. 2024]. The cholesterol-lowering effect of berberine seems to be increased by combining it with silymarin (extracted from milk thistle, Silybum maranium) [Hernandez et al. 2024].
• Probiotics might also slightly lower cholesterol levels. Consumung 10 million CFU (colony forming units) daily may lower LDL cholesterol by ~3–5% [Mirzai & Laffin 2023].
  
  
  
  

What about bergamot supplements?

The use of bergamot supplements (Citrus bergamia) seems to considerably lower cholesterol levels [Osadnik et al. 2022, Sadeghi-Dehsahraei et al. 2022, Cicero et al. 2021]. But there aren't many studies yet.

What about phytosterol-fortified margarine?

The use of phytosterol-enriched margarine (there are vegan brands) to lower cholesterol is still controversial [Scholz et al. 2022]. It is likely to lower cholesterol levels (2–3 g daily lower LDL cholesterol 7–10% [Mirzai & Laffin 2023]) and it is currently recommended as an option for this purpose by the European Atherosclerosis Society [Visseren et al. 2021, Mach et al. 2020, Gylling et al. 2014], but some researchers have criticized this recommendation because they suspect that high-dose phytosterols in fortified foods might be harmful, i.e., that they promote atherosclerosis rather than preventing it [Zhao et al. 2023, Scholz et al. 2022]. Human studies, however, have been reported to indicate the saftey of physterol-fortified foods for the LARGE majority of humans (but not those with a rare disease called sitosterolemia) [Poli et al. 2021, Ghaedi et al. 2020, Kaur & Myrie 2020]. For example, muscle pains (as sometimes observed with statin treatment) or abnormal liver function were not observed in humans [Cicero et al. 2017]. Nevertheless, some cohort studies have shown a positive association between phytosterol blood levels and adverse outcomes (e.g., heart attack) [Makhmudova et al. 2021].

What about red yeast rice supplements?

Red yeast rice is basically the natural version of statins [Buzzelli et al. 2024]. They contain the same statin molecule (monacolin K, same as Lovastatin). They are effective (up to 15–30% LDL cholesterol reduction) and are often recommended for cholesterol lowering [Buzzelli et al. 2024, Mirzai & Laffin 2023, Cicero et al. 2021b] (statins typically lower LDL cholesterol by 25–60%). Muscle pain or liver toxicity seem "to be extremely rare compared to the occurrence with statins, which is rare to common" [Norata & Banach 2024]. Safety concerns relate to batch-to-batch variability in monacolin (statin) content and the potential presence of contaminants [Buzzelli et al. 2024, Mirzai & Laffin 2023]. If these supplements are used, only "approved citrinin-free products" should be taken (citrinin can damage the kidneys [Cicero et al. 2021b]) [Buzzelli et al. 2024].

The 2021 guidelines by the European Atherosclerosis Society state: "Red yeast rice supplements are not recommended and may even cause side-effects." [Visseren et al. 2021]

The 2021 guidelines by the American Heart Association do not mention red yeast rice (or phytosterols) [Lichtenstein et al. 2021].

The European Food Safety Authority (EFSA) has stated: "On the basis of the information available and several uncertainties highlighted in this opinion, the Panel was unable to identify a dietary intake of monacolins from RYR that does not give rise to concerns about harmful effects to health [...]." [EFSA et al. 2018]

In Japan, at least 80 deaths have been reported to be linked to certain red yeast rice supplements [New York Times (28 June 2024)].

Triglyceride levels

This will likely lower your blood triglyceride levels:

Blood triglyceride levels should be measured in fasting blood samples, i.e., your should not eat anything in the morning (it's OK to drink water) and then have a blood sample taken. Only after the blood test, you should eat.

Fasting blood triglyceride levels are considered high if they are >150 mg/dL (i.e., >1.69 mmol/L) or, more strictly, if they are >135 mg/dL (>1.52 mmol/L).

• Reduce your intake of "free sugars": all types of added sugars (refined sugar, brown sugar, syrups, ...) and foods with a lot of added sugar, syrup, fruit juice concentrate, honey, etc. [Writing Committee et al. 2021]. Keep your fruit juice intake low [Kelly et al. 2021]. Avoid "juice drinks". Avoid sugar-sweetened beverages. Avoid "energy drinks".  
• Reduce your intake of refined grains (white flour, white bread, white rice, added starch such as cornstarch [maize starch], potato starch, tapioca, etc.).[Marshall et al. 2020].
• Focus on healthy carbs: whole grains, sweet potatoes, fruit [Buziau et al. 2022], and legumes [Marshall et al. 2020, Chawla et al. 2020].
• Avoid excessive fruit or dried fruit intake - don't eat "20 bananas a day" [Sun et al. 2023].
• Make sure you are getting an adequate amount of the plant-based omega-3 fatty acid-rich foods: flaxseed (linseed) oil, ground flaxseeds (linseeds), chia seeds, rapeseed (canola) oil, or walnuts - and consider taking a vegan (microalgae-based) EPA/DHA supplement. For amounts of these foods and the supplement, see here (under point 5). If you follow, all/most the advice here and eat plenty of cold-pressed linseed (flaxseed) oil or cold-pressed rapeseed (canola) oil, it's very uncertain whether a EPA/DHA supplement will be beneficial for your arteries and heart health. In fact, DHA may not be helpful at all (or even harmful) while EPA appears to be helpful - but there are very view (hardly any) vegan EPA-only supplements currently available. And eating plenty of linseed oil (rich in the "short"-chain omega-3 fatty acid alpha-linolenic acid [ALA]) may increase your EPA blood levels in a similar way to an EPA-only or EPA/DHA supplement. Particularly, for those with high triglyceride levels and a high cardiovascular risk, EPA-only supplements are generally recommended.

This may also lower your triglycerides:

• Try intermittent fasting [Meng et al. 2020].
• Take a low-dose zinc supplement (see above) [Khajeh et al. 2024 (in men with type 2 diabetes), Heidari Seyedmahalleh et al. 2023 (in people with type 2 diabetes), Nazari et al. 2023,  Asbaghi et al. 2020 (in people with type 2 diabetes), El Dib et al. 2015].
• Use turmeric regularly (~ 1/2 teaspoon per day; see above).

It is also frequently recommended to reduce the intake of alcohol or (if triglycerides are very high) to not drink alcohol at all, to exercise regularly, to lose body weight (body fat), and (if triglycerides are very high) to keep fat intake moderate to low [Writing Committee et al. 2021]. 

More comments

Note: this is not a perfect list. It also mostly just focuses on dietary approaches.

Note: lowering your cholesterol and/or triglycerides is a means to an end, i.e., the goal is to lower cardiovascular disease risk (including the risk of heart attack and stroke). Example: tofu may only have a very modest cholesterol-lowering effect, but at the same time it will also have some other (at least modest) beneficial effects on your arteries. So, it's good for your arteries (and heart and brain) in more than one way. Another example: dark chocolate is relatively high in saturated fatty acids, but, at least if consumed in moderate amounts, it may actually slightly lower cardiovascular disease risk.

Note: there are many things you can do to lower your cardiovascular disease risk. A healthy diet is good but not everything. Don't smoke, of course. But also avoid smoke (passive smoking) and air pollution. Relax more (stress kills), work less (too much work kills), laugh more, move more. Try to also avoid noise pollution (especially at night - use ear plugs if needed) and get some good sleep.

Note: a healthy vegan (or other type of plant-based diet) is beneficial for cardiovascular disease risk - not just in terms of cholesterol-lowering effects. You should make sure to take a vitamin B12 supplement (see here under point 1) because vitamin B12 deficiency will also increase your cardiovascular risk (by increasing homocysteine levels or maybe in other ways).

Note: everyone should make sure to get enough omega-3 fatty acids (see above, and see here under point 5). Linseed (flaxseed) oil is a particularly rich source of plant-source omega-3s.

Note: if your cholesterol and/or cardiovascular disease risk is very high, you may also require cholesterol-lowering medication (statins, ezetimibe, PCSK9 inhibitors, and/or bempedoic acid) - a medical doctor/cardiologist should advise you in this regard. Get nutrition advice from a nutrition scientist. Get medical advice (including blood tests, and diagnosis, if applicable) from a medical doctor. Be aware that some people (a small minority) high what is called familial hypercholesterolemia (called "FH" in medical slang)  - about 1 in 250 or 1 in 300 people have this, roughly. If you have this, you need to take medication (statins etc.) - the most perfect dietary approaches will not be enough. If you do not want to take statins, discuss the possibility of taking "red yeast rice" with your family physician/cardiologist. Red yeast rice bascially contains "natural statins". "Natural" should not be confused with "totally safe". See the note about red yeast rice above.

Definitions

What is "total cholesterol"? What are other relevant blood markers for cardiovascular disease risk?

Total cholesterol:
Basically, total cholesterol is made up of: LDL cholesterol + HDL cholesterol + remnant cholesterol.
(Common abbreviation for total cholesterol: TC)

Measured LDL cholesterol: 

LDL cholesterol is "bad cholesterol" - really all cholesterol is "bad". Frequently, LDL cholesterol is not actually measured but only calculated (see below). The measured LDL cholesterol value is typically quite a bit higher than the calculated LDL.
(Common abbreviation: LDL-C or LDL-c)

Calculated LDL cholesterol:

See above; bad cholesterol. Calculated LDL is typically calculated with the Friedewald formula, based on total cholesterol, HDL cholesterol, and triglycerides: LDL-C ​= ​total cholesterol - HDL cholesterol - (triglycerides/5) for mg/dL ["-" is a minus; "/" is "divided by"] [Pradhan et al. 2020]
(Common abbreviation: LDL-C or LDL-c)

Non-HDL cholesterol:

The term "non-HDL cholesterol" is literally what the name says: "total cholesterol" - "HDL cholesterol" ["-" is a minus].
(Common abbreviation: nonHDL-C or nonHDL-c)

Your doctor will likely not give you this value, but you can calculate it yourself (see above).

Remnant cholesterol:

Again, the name practically says what it is: all the rest apart from LDL cholesterol and HDL cholesterol. So the calculation is: total cholesterol - LDL cholesterol - HDL cholesterol ["-" is a minus]. I would use the "measured LDL cholesterol" for calculating, if you have it. But basically, the lower the remnant cholesterol is, the better!
Note that this number may be 0 or even negative (lower than 0) because it's just a calculated number.
(Common abbreviation: REM-C or REM-c)

Again, your doctor will likely not give you this value, but you can calculate it yourself (see above).

HDL cholesterol:

This is the so-called "good" cholesterol. But that does not mean "the higher the better". The cholesterol in HDL cholesterol is not good for your arteries at all. It is the HDL particles that carry the HDL cholesterol that can be good. It should be noted that HDL cholesterol levels tend to be a bit lower with a healthy plant-based diet, which is unlikely to be a disadvantage. The reason for this may just be that the HDL functionality is higher (i.e. "the HDL particles work better"). HDL cholesterol levels are not considered a causal factor of atherosclerosis. It is more important to focus on lowering the bad cholesterol, i.e., LDL cholesterol, non-HDL cholesterol, and remnant cholesterol levels.

Note: there are other way to create subgroups of cholesterol (for example, very low density lipoprotein [VLDL], small dense LDL, subtypes of HDL, etc.). But this is less relevant here.

Triglycerides (TAG):
This is not a type of cholesterol. Nothing to calculate - your doctor will give you this number.
Note that with cholesterol values it may not matter too much if you are "in a fasted state" (haven't eaten anything) when the blood sample is taken, except for calculated LDL (as the calculation includes TAG). With TAG, however, this is really important, i.e., you should eat dinner in the evening, then sleep and eat nothing all night long, and then go to your doctor (or whoever takes the blood sample) in the morning. Only after having the blood sample taken, you can eat breakfast. Drinking water or tea beforehand is OK.

How fast can cholesterol levels change?

I would say it makes sense to have your cholesterol levels tested again about two months (but at least four weeks [Nishi et al. 2023, Khaw et al. 2018]) after you have made the abovementioned dietary changes. That does not mean that health-promoting changes aren't happening earlier. Beneficial changes might be happening even within a few days or one week [Mazidi et al. 2016].

Precision

Note that the numbers your doctor will give you are typically not extremely precise. So you should interpret these values to be a more of a rough estimate.

Official guidelines

Also see the "Heart-Healthy Eating – Plant-Based Style" guidelines (2021) by the National Lipid Association (USA).