LDL cholesterol can block an artery. Lowering it protects your heart.
Watch what happens inside an artery when LDL cholesterol builds up — and then see how low your LDL should go after a heart attack or stroke.
A healthy artery — blood flows freely.
LDL cholesterol particles drift in with the blood.
Lowering LDL lowers the risk — here's how low to go.
The 55 rule
After a heart attack or a stroke, the risk of another one is high — and LDL cholesterol is one of the strongest levers you control. Three things to do:
Take a statin every day
A statin is a cholesterol pill that helps your liver clear LDL cholesterol out of your blood. It only works while you take it — every day, even when you feel perfectly well.
Get your LDL under
55 mg/dL (1.4 mmol/L)That is the goal after a heart attack or stroke — lower than the target for people who have never had an event.
Cut it by at least half
−50% or moreWherever your LDL started, bring it down by at least half. Both goals count: under 55 mg/dL (1.4 mmol/L) and at least 50% lower than your starting number.
Guideline goal: European Society of Cardiology / European Atherosclerosis Society, Guidelines for the Management of Dyslipidaemias (2019; focused update 2025) — after a heart attack or stroke you are at very high risk, with an LDL goal under 55 mg/dL (1.4 mmol/L) and a reduction of at least 50%.
How treatment lowers LDL
Lowering LDL is not guesswork. Each step has been measured in large trials with hundreds of thousands of people.
Start with a strong statin
A strong (high-intensity) statin lowers LDL by about half — roughly a 50% drop from where you started. For many people after a heart attack or stroke, that single daily pill does most of the work.
Your LDL is checked again after starting, to see whether you have reached both parts of the goal: under 55 mg/dL (1.4 mmol/L), and at least half of your starting value.
If LDL stays above 55 mg/dL (1.4 mmol/L), add more
If a statin alone doesn't get your LDL under 55 mg/dL (1.4 mmol/L), your doctor can add ezetimibe — a second, well-tolerated pill that blocks cholesterol absorption from food — and, if needed, other medicines beyond that.
Staying above goal is not a dead end. It is a reason to add a step, not to give up on the goal.
Every 39 points (1 mmol/L) lower LDL reduces cardiovascular risk by about 20%. In the large trial overviews by the Cholesterol Treatment Trialists, each 39 mg/dL (1 mmol/L) drop in LDL meant about 20% fewer heart attacks, strokes, and vascular deaths — in relative terms. Lower LDL, fewer events, in study after study.
The fat that raises LDL
Here is the surprise: it is not mainly the cholesterol in food that raises the cholesterol in your blood. The big drivers are saturated fat — and trans fat.
Saturated fat is the big lever
Saturated fat makes your liver produce more LDL and clear less of it out of your blood — so LDL climbs. The main sources are butter, fatty and processed meats, cheese and other full-fat dairy, coconut and palm oils, and fried foods and pastries.
Cutting back on saturated fat is one of the most powerful food changes you can make for your LDL.
Trans fat is worse still
Trans fat does double damage: it raises LDL and lowers HDL — the “healthy” cholesterol that helps protect your arteries.
Check ingredient lists and avoid anything that lists “partially hydrogenated oils” — that is trans fat by another name.
What about cholesterol in food itself?
For most people, the cholesterol in food itself — in foods like eggs and shrimp — raises blood cholesterol only a little. It is the saturated fat that so often travels with it that does most of the harm.
Fiber helps carry cholesterol out
Soluble fiber — found in oats, beans, and apples — helps carry cholesterol out of your body instead of letting it back into your blood. A bowl of oats is a small daily habit with a real job to do.
Practical swaps that lower LDL
- Butter olive oil or canola oil
- Fatty red meat and processed meats fish, beans, or skinless chicken
- Full-fat dairy low-fat dairy
- Fried snacks and pastries nuts, oats, or fruit
Don't stop your statin
The most dangerous moment comes when the pill is working and you feel fine. Here is what happened in a French study of about 120,000 people turning 75, looking at those with diabetes over roughly 3 years:
In relative terms, stopping meant about 32% higher risk of a heart attack, stroke, or heart hospitalization. In absolute terms, that is about 1 extra event for every 42 people who stopped — harm you can count, not just a percentage.
If you are pregnant, breastfeeding, or planning a pregnancy — or you become pregnant while taking this pill — tell your doctor right away. The pill is usually paused during pregnancy, and the plan is revisited after the baby comes.
Know your number
Type in your LDL from before treatment (or your most recent result). The checker does the simple arithmetic behind the 55 rule — nothing is stored or sent anywhere.
Try your own number — the goals update as you type.
Half of your starting LDL of 130 mg/dL (3.4 mmol/L).
Under 55 mg/dL (1.4 mmol/L) — the European guideline goal for very high risk.
Your target: under 55 mg/dL (1.4 mmol/L) — it is the lower of the two numbers, so it covers the 50% cut as well.
Blast the LDL
LDL particles are drifting toward the artery wall. Tap or click each one to zap it with a statin ray before it sticks and builds plaque. Watch out for saturated-fat foods — and grab the healthy power-ups when they float by.
How to play: LDL blob = +10 points. Shoot a saturated-fat food (burger, butter, fries) for +15 — but if it reaches the wall, it spawns extra LDL. Tap a healthy power-up (oats, fish, nuts, olive oil) to fire a fiber sweep that clears several LDL particles at once.
For families
Cholesterol runs in families — and so does heart disease. A parent's heart attack or stroke is information for the whole family, not just the patient.
Help the patient hit the goal
Ask the two questions that matter: "What's your LDL?" (it should be under 55 mg/dL (1.4 mmol/L)) and "Did you take your pill today?" A daily pill is easy to forget and easy to quietly stop — a family that asks keeps it going.
Get your own number checked
If you are an adult child of someone who had a heart attack or stroke, have your own cholesterol checked and tell your doctor about your family history. High cholesterol has no symptoms — the first sign can be the event itself. Knowing your number early is the advantage your parent didn't have.
Go deeper — the sister sites
Heart Cholesterol is one of a family of free sites. The evidence behind every number on this page lives at SourceMed.
The evidence library behind these numbers — SourceMed: every claim pinned to its trial, free for patients, clinicians, and AI assistants.
sourcemed.io Heart DetectiveHeart Detective: for families and kids — diabetes and the heart, with games that teach the whole family.
heartdetectivekids.org Kids HEARTS DetectiveKids HEARTS Detective: kids helping protect a parent's heart after a heart attack or stroke.
kidsheartsdetective.org