The Healthspan Map · Cardiovascular

High cholesterol / dyslipidemia

Named for High cholesterol / dyslipidemia

Evidence naming High cholesterol / dyslipidemia directly — 28 sources.In the order the Map holds them: strongest evidence first. That is a statement about the evidence, not about what matters most.
Nutrient or leverDirectionStrengthEvidence typeWhat was foundSource
Cardio (moderate + intervals)Do thisStrongRCT / meta-analysisAerobic exercise raises HDL and lowers triglycerides; combined training also lowers LDL.Exercise & lipid profile meta (opens in a new tab)
Saturated fatDon't overdoStrongEstablished clinicalSaturated fat raises LDL cholesterol; guidelines advise under 7% of energy for high-risk individuals.Lifestyle & lipids (Endotext) (opens in a new tab)
Saturated fatDon't overdoStrongSystematic reviewSaturated fat raises LDL cholesterol; guidelines advise under 7% of energy for high-risk individuals.Effect of Interventions Aimed at Reducing or Modifying Saturated Fat Intake on Cholesterol, Mortality and Cardiovascular Events, Ann Intern Med 2026 (opens in a new tab)
Strength (resistance)Do thisStrongRCT / meta-analysisResistance training lowers LDL and triglycerides and raises HDL (LDL down 6-16 mg/dL in trials; a 148-RCT meta confirms exercise improves the lipid profile).Exercise training & blood lipids meta (opens in a new tab)
Total FiberEat enough ofStrongRCT / meta-analysisSoluble fiber lowers LDL and total cholesterol (LDL about -8 mg/dL across 181 RCTs) by binding bile acids; oats, psyllium and pectin work similarly.Soluble fiber & lipids meta (opens in a new tab)
Trans fatDon't overdoStrongReview / narrativeTrans fats raise LDL and lower HDL - the worst dietary fat for the lipid profile.Lifestyle & lipids (Endotext) (opens in a new tab)
Trans fatDon't overdoStrongRCT / meta-analysisTrans fats raise LDL and lower HDL - the worst dietary fat for the lipid profile.Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol: a meta-analysis of 60 controlled trials, Am J Clin Nutr 2003 (opens in a new tab)
Added SugarsDon't overdoModerateReview / narrativeAdded sugars and refined carbohydrate raise triglycerides and lower HDL.Lifestyle & lipids (Endotext) (opens in a new tab)
Alcohol — cut backDo thisModerateReview / narrativeAlcohol raises triglycerides (harmful in hypertriglyceridemia); any HDL rise does not offset cardiovascular risk.Lifestyle & lipids (Endotext) (opens in a new tab)
Anchor foodsWatch thisModerateReview / narrativeOats, legumes, nuts and soy foods lower LDL cholesterol; building meals around them helps.Lifestyle & lipids (Endotext) (opens in a new tab)
BMIWatch thisModerateReview / narrativeExcess weight, especially visceral fat, drives atherogenic dyslipidemia (higher triglycerides, lower HDL); weight loss improves the lipid profile.Lifestyle & lipids (Endotext) (opens in a new tab)
Body Roundness IndexWatch thisModerateReview / narrativeBody-shape indices capturing central adiposity flag dyslipidemia risk.Lifestyle & lipids (Endotext) (opens in a new tab)
Cardio / VO2maxWatch thisModerateRCT / meta-analysisHigher cardiorespiratory fitness is associated with a healthier lipid profile - the marker behind the exercise effect on cholesterol.Exercise training & blood lipids meta (opens in a new tab)
Colours a dayWatch thisModerateReview / narrativeVegetables, fruit and whole grains supply fiber and plant compounds that support healthy cholesterol.Lifestyle & lipids (Endotext) (opens in a new tab)
Cook real foodDo thisModerateReview / narrativeCooking real food lets you swap saturated fats for unsaturated oils, the key dietary lever for LDL.Lifestyle & lipids (Endotext) (opens in a new tab)
Daily movement baselineDo thisModerateRCT / meta-analysisRegular physical activity improves the lipid profile.Exercise & lipid profile meta (opens in a new tab)
EPA/DHA (omega-3)Eat enough ofModerateReview / narrativeOmega-3 (EPA/DHA) substantially lowers triglycerides in a dose-dependent way, though very high doses can slightly raise LDL.Lifestyle & lipids (Endotext) (opens in a new tab)
Polyunsaturated fatEat enough ofModerateReview / narrativeReplacing saturated fat with polyunsaturated fat lowers LDL cholesterol - one of the most reliable dietary changes for lipids.Lifestyle & lipids (Endotext) (opens in a new tab)
Sugary drinks & snacks — cut backDo thisModerateReview / narrativeSugary drinks and refined carbs raise triglycerides and lower HDL.Lifestyle & lipids (Endotext) (opens in a new tab)
Tobacco / vaping — quitDo thisModerateReview / narrativeSmoking lowers HDL and oxidizes LDL, worsening cardiovascular risk; quitting raises HDL.Lifestyle & lipids (Endotext) (opens in a new tab)
Ultra-processed food — cut backDo thisModerateReview / narrativeA whole-food diet low in refined and processed foods improves lipids.Lifestyle & lipids (Endotext) (opens in a new tab)
Waist-to-height ratioWatch thisModerateReview / narrativeCentral adiposity is linked to higher triglycerides and lower HDL; reducing it improves lipids.Lifestyle & lipids (Endotext) (opens in a new tab)
Waist-to-hip ratioWatch thisModerateReview / narrativeVisceral fat is linked to atherogenic dyslipidemia beyond overall weight.Lifestyle & lipids (Endotext) (opens in a new tab)
CholesterolDon't overdoEmergingReview / narrativeDietary cholesterol has a modest effect on blood cholesterol - smaller than saturated fat - so it is a secondary lever.Lifestyle & lipids (Endotext) (opens in a new tab)
Monounsaturated fatEat enough ofEmergingReview / narrativeMonounsaturated fats (olive oil, nuts) modestly improve lipids when they replace saturated fat.Lifestyle & lipids (Endotext) (opens in a new tab)
Movement (breaking up sitting)Do thisEmergingRCT / meta-analysisReducing sedentary time supports healthier lipids.Exercise & lipid profile meta (opens in a new tab)
Screens before bed — cut backDo thisEmergingCohort / observationalLeisure screen time and sedentary behaviour cluster with adverse lipids and metabolic risk.Screen time & CVD (UK Biobank) (opens in a new tab)
Water / hydrationDo thisEmergingReview / narrativeChoosing water over sugary drinks helps triglycerides.Lifestyle & lipids (Endotext) (opens in a new tab)

Held for the whole Cardiovascular system

These rows name no single condition. The Map records them against the whole body system, so they are shown separately rather than folded in.

Evidence held for the Cardiovascular system — 68 sources.In the order the Map holds them: strongest evidence first. That is a statement about the evidence, not about what matters most.
Nutrient or leverDirectionStrengthEvidence typeWhat was foundSource
Blood pressureWatch thisStrongRCT / meta-analysisEach 20/10 mmHg higher usual blood pressure roughly doubles the risk of death from stroke and ischemic heart disease.Lewington et al., Lancet 2002 (Prospective Studies Collaboration) (opens in a new tab)
Blood pressureWatch thisStrongRCT / meta-analysisLowering blood pressure significantly reduces coronary heart disease, stroke, heart failure and cardiovascular death.Blood-pressure-lowering meta-analysis, Lancet 2016 (opens in a new tab)
Cardio / VO2maxWatch thisStrongRCT / meta-analysisCardiorespiratory fitness is a quantitative predictor of all-cause mortality and cardiovascular events; each 1-MET higher fitness lowered risk substantially.Kodama et al., JAMA 2009 (meta-analysis) (opens in a new tab)
Cardio / VO2maxWatch thisStrongCohort / observationalHigher treadmill-measured fitness was inversely associated with mortality with no observed upper limit; the least-fit had multiples of the death risk of the fittest.Mandsager et al., JAMA Network Open 2018 (n=122,007) (opens in a new tab)
Cardio / VO2maxWatch thisStrongRCT / meta-analysisHigher treadmill-measured fitness was inversely associated with mortality with no observed upper limit; the least-fit had multiples of the death risk of the fittest.Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis, JAMA 2009 (opens in a new tab)
MagnesiumEat enough ofStrongEstablished clinicalDeficiency causes abnormal heart rhythms and coronary spasm; low status is linked to hypertension and cardiovascular disease.NIH ODS – Magnesium (opens in a new tab)
Movement (breaking up sitting)Do thisStrongRCT / meta-analysisTotal sitting above ~6-8 h/day increased cardiovascular mortality risk.Patterson et al., Eur J Epidemiol 2018 (meta-analysis) (opens in a new tab)
Movement (breaking up sitting)Do thisStrongRCT / meta-analysisSitting time raised mortality, an effect substantially attenuated by 60-75 min/day of moderate activity.Ekelund et al., Lancet 2016 (harmonised meta-analysis, >1 million adults) (opens in a new tab)
Movement (breaking up sitting)Do thisStrongRCT / meta-analysisSitting time raised mortality, an effect substantially attenuated by 60-75 min/day of moderate activity.Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality?, Lancet 2016 (opens in a new tab)
PhosphorusDon't overdoStrongEstablished clinicalHyperphosphatemia (chiefly in kidney disease, worsened by phosphate additives) drives vascular and soft-tissue calcification, arteriosclerosis and cardiovascular mortality; general-population high intake shows similar associations.NIH ODS / StatPearls – Hyperphosphatemia (opens in a new tab)
PhosphorusDon't overdoStrongEstablished clinicalHyperphosphatemia (chiefly in kidney disease, worsened by phosphate additives) drives vascular and soft-tissue calcification, arteriosclerosis and cardiovascular mortality; general-population high intake shows similar associations.NIH Office of Dietary Supplements — Phosphorus (opens in a new tab)
PotassiumEat enough ofStrongEstablished clinicalHypokalemia delays cardiac repolarization, predisposing to arrhythmias (ectopy, atrial fibrillation, VT/VF) and, when severe, cardiac arrest/sudden death.StatPearls – Hypokalemia (opens in a new tab)
PotassiumDon't overdoStrongEstablished clinicalHyperkalemia causes ECG changes (peaked T waves, widened QRS, loss of P wave) and life-threatening arrhythmias/cardiac arrest; from food alone it is rare unless kidney function is impaired or with K-sparing drugs/salt substitutes.NIH ODS / StatPearls – Hyperkalemia (opens in a new tab)
PotassiumDon't overdoStrongEstablished clinicalHyperkalemia causes ECG changes (peaked T waves, widened QRS, loss of P wave) and life-threatening arrhythmias/cardiac arrest; from food alone it is rare unless kidney function is impaired or with K-sparing drugs/salt substitutes.NIH Office of Dietary Supplements — Potassium (opens in a new tab)
Resting heart rateWatch thisStrongRCT / meta-analysisEach 10 bpm higher resting heart rate raised cardiovascular disease risk 15%, coronary heart disease 7%, heart failure 18% and stroke 6%.Aune et al., Nutr Metab Cardiovasc Dis 2017 (87 studies) (opens in a new tab)
Resting heart rateWatch thisStrongRCT / meta-analysisEvery 10 bpm increment in resting heart rate was associated with 8% higher cardiovascular mortality.Zhang et al., CMAJ 2016 (46 studies, 1.25 million adults) (opens in a new tab)
Saturated fatDon't overdoStrongRCT / meta-analysisHigher saturated-fat intake (via raised LDL) increases atherosclerotic cardiovascular disease; AHA advises <6% of calories (current US intake ~10.7%).AHA Presidential Advisory (opens in a new tab)
SeleniumEat enough ofStrongEstablished clinicalSevere deficiency causes Keshan disease, an endemic cardiomyopathy (heart failure, arrhythmia) in selenium-poor regions of China; selenium supplementation sharply reduced it.NIH ODS / Keshan disease literature (opens in a new tab)
SeleniumEat enough ofStrongEstablished clinicalSevere deficiency causes Keshan disease, an endemic cardiomyopathy (heart failure, arrhythmia) in selenium-poor regions of China; selenium supplementation sharply reduced it.NIH Office of Dietary Supplements — Selenium (opens in a new tab)
SodiumDon't overdoStrongRCT / meta-analysisExcess sodium raises risk of cardiovascular disease and stroke, chiefly via blood pressure.NIH DRI / sodium-reduction meta-analyses (opens in a new tab)
SodiumDon't overdoStrongRCT / meta-analysisExcess sodium raises risk of cardiovascular disease and stroke, chiefly via blood pressure.Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials, BMJ 2013 (opens in a new tab)
Thiamin (B1)Eat enough ofStrongEstablished clinicalWet beriberi causes high-output heart failure with edema, cardiomegaly and tachycardia.StatPearls – Thiamin (opens in a new tab)
Tobacco / vaping — quitDo thisStrongEstablished clinicalSmoking causes coronary heart disease, stroke, heart failure and peripheral arterial disease.US Surgeon General report / CDC (opens in a new tab)
Tobacco / vaping — quitDo thisStrongEstablished clinicalTobacco and e-cigarette aerosol drive endothelial dysfunction, thrombosis and atherosclerosis; smokers face 2-3x cardiovascular death risk and vaping is not harmless to vessels.Smoking/e-cigarette cardiovascular studies (opens in a new tab)
Tobacco / vaping — quitDo thisStrongEstablished clinicalTobacco and e-cigarette aerosol drive endothelial dysfunction, thrombosis and atherosclerosis; smokers face 2-3x cardiovascular death risk and vaping is not harmless to vessels.US Surgeon General — The Health Consequences of Smoking (opens in a new tab)
Trans fatDon't overdoStrongRCT / meta-analysisIndustrial (artificial) trans fat has no safe level and clearly raises CVD; WHO and FDA have moved to eliminate it. Small amounts occur naturally in ruminant dairy/meat.Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol: a meta-analysis of 60 controlled trials, Am J Clin Nutr 2003 (opens in a new tab)
Added SugarsDon't overdoModerateCohort / observationalA higher share of calories from added sugar is associated with substantially increased cardiovascular-disease mortality; sugary drinks also raise blood pressure.Added-sugar CVD-mortality cohorts (opens in a new tab)
Alcohol — cut backDo thisModerateRCT / meta-analysisEach 100 g/week higher alcohol raised stroke risk 14%, heart failure 9% and fatal hypertensive disease 24%.Wood et al., Lancet 2018 (599,912 drinkers, 83 studies) (opens in a new tab)
BMIWatch thisModerateEstablished clinicalObesity raises cardiovascular disease risk via hypertension, dyslipidemia and diabetes.Obesity clinical review (opens in a new tab)
Biotin (B7)Don't overdoModerateEstablished clinicalHigh supplemental biotin caused a falsely LOW troponin result and a missed heart attack — the FDA reported one death; also distorts NT-proBNP and many hormone assays.FDA Safety Communication (2017) – Biotin (opens in a new tab)
Blood oxygen (SpO2)Watch thisModerateRCT / meta-analysisChronic hypoxemia and nocturnal desaturation strain the heart, raising cardiovascular risk."Association Between Obstructive Sleep Apnea and Cardiovascular Risk: A Systematic Review and Meta-Analysis", Medicina 2025 (opens in a new tab)
Body Roundness IndexWatch thisModerateCohort / observationalBRI showed a U-shaped association with all-cause mortality, with elevated cardiovascular risk at high values.BRI and mortality (JAMA Network Open 2024) (opens in a new tab)
CalciumEat enough ofModerateEstablished clinicalSevere hypocalcemia causes cardiac arrhythmias (QT prolongation).NIH ODS – Calcium (opens in a new tab)
CalciumDon't overdoModerateRCT / meta-analysisSome research links calcium SUPPLEMENTS (not dietary calcium) to increased cardiovascular disease risk and vascular calcification; evidence is contested.NIH ODS – Calcium (supplement meta-analyses) (opens in a new tab)
ChlorideEat enough ofModerateEstablished clinicalHypochloremia (via alkalosis) can predispose to ventricular arrhythmias.Critical-care chloride review (PMC10995984) (opens in a new tab)
ChlorideDon't overdoModerateEstablished clinicalHyperchloremia is associated with decreased cardiac output and impaired myocardial contractility; with sodium/fluid excess it contributes to hypertension, edema and heart failure.Critical-care chloride review (PMC10995984) (opens in a new tab)
CholineDon't overdoModerateMechanisticHigh intake causes hypotension (the critical adverse effect; UL 3,500 mg set on this) and raises TMAO, which is dose-dependently linked to higher cardiovascular-disease risk.NIH ODS / IOM DRI – Choline (opens in a new tab)
CholineDon't overdoModerateEstablished clinicalHigh intake causes hypotension (the critical adverse effect; UL 3,500 mg set on this) and raises TMAO, which is dose-dependently linked to higher cardiovascular-disease risk.NIH Office of Dietary Supplements — Choline (opens in a new tab)
Consistency (the weekly dose)Do thisModerateEstablished clinical150-300 min/week moderate aerobic activity plus muscle-strengthening 2x/week lowers cardiovascular mortality and incident hypertension.WHO Guidelines on Physical Activity 2020 (opens in a new tab)
Consistency (the weekly dose)Do thisModerateRCT / meta-analysisMuscle-strengthening activity was associated with 10-17% lower cardiovascular disease risk, additive to aerobic activity.Momma et al., British Journal of Sports Medicine 2022 (meta-analysis) (opens in a new tab)
Folate (B9)Eat enough ofModerateCohort / observationalDeficiency raises homocysteine, contributing to vascular endothelial dysfunction and cardiovascular/stroke risk.StatPearls – Folate (opens in a new tab)
Grip strengthWatch thisModerateCohort / observationalGrip strength predicted cardiovascular and all-cause mortality more strongly than systolic blood pressure.Leong et al., Lancet 2015 (PURE study) (opens in a new tab)
Grip strengthWatch thisModerateCohort / observationalLower grip was associated with higher cardiovascular incidence and mortality and improved an office-based risk score.Celis-Morales et al., BMJ 2018 (UK Biobank) (opens in a new tab)
Inner circle (close ties)Watch thisModerateRCT / meta-analysisDeficient social relationships raised coronary heart disease and stroke risk.Valtorta et al., Heart 2016 (meta-analysis) (opens in a new tab)
IronDon't overdoModerateEstablished clinicalIron deposition in the heart causes cardiomyopathy and arrhythmias.NIH ODS – Iron (hemochromatosis) (opens in a new tab)
Loneliness — reduceWatch thisModerateRCT / meta-analysisPoor social relationships raised coronary heart disease risk 29% and stroke risk 32%.Valtorta et al., Heart 2016 (meta-analysis) (opens in a new tab)
MagnesiumDon't overdoModerateEstablished clinicalVery high doses (laxatives/antacids or renal failure) cause hypermagnesemia → hypotension, irregular heartbeat, and, rarely, cardiac arrest (fatal cases reported).NIH ODS – Magnesium (opens in a new tab)
Sleep durationWatch thisModerateRCT / meta-analysisBoth short and long sleep are associated with coronary artery disease, heart failure, stroke, and cardiovascular and all-cause mortality.Sleep-duration and cardiovascular disease meta-review + Mendelian randomization (opens in a new tab)
Sleep durationWatch thisModerateRCT / meta-analysisBoth short and long habitual sleep were associated with higher all-cause mortality.Cappuccio et al., Sleep 2010 (all-cause mortality meta-analysis) (opens in a new tab)
Sleep regularityWatch thisModerateCohort / observationalEach 1-hour increase in night-to-night sleep-duration variability raised major cardiovascular events 19% (myocardial infarction 23%, stroke 17%).Huang et al., UK Biobank (accelerometer, n=86,219) (opens in a new tab)
Sleep regularityWatch thisModerateCohort / observationalGreater sleep regularity (Sleep Regularity Index) was associated with lower all-cause, cardiovascular and cancer mortality; regularity predicted mortality more strongly than duration.Cribb et al., eLife 2023 (UK Biobank, n=88,975) (opens in a new tab)
SodiumEat enough ofModerateCohort / observationalA U-shaped relationship: both low-normal sodium/hyponatremia and hypernatremia are associated with higher CVD events and mortality in older adults.Cohort study (PMC4714622) (opens in a new tab)
Total FiberEat enough ofModerateCohort / observationalLow fiber intake is associated with higher cardiovascular-disease and all-cause mortality risk.Fiber literature (opens in a new tab)
Upper-body strength (push-ups)Watch thisModerateCohort / observationalMen able to do >40 push-ups had far lower 10-year cardiovascular incidence than those doing <10 (5% vs 15%); push-up capacity predicted CVD better than a submaximal treadmill test.Yang et al., JAMA Network Open 2019 (n=1,104 men, 10-yr) (opens in a new tab)
Upper-body strength (push-ups)Watch thisModerateEstablished clinicalPush-up capacity - a simple, no-cost measure - meaningfully stratified future cardiovascular risk in active adult men.American College of Cardiology journal scan (2019) (opens in a new tab)
Upper-body strength (push-ups)Watch thisModerateCohort / observationalPush-up capacity - a simple, no-cost measure - meaningfully stratified future cardiovascular risk in active adult men.Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men, JAMA Netw Open 2019 (opens in a new tab)
Vitamin DDon't overdoModerateEstablished clinicalExcess is associated with soft-tissue and vascular calcification and cardiac arrhythmias.NIH ODS / IOM (opens in a new tab)
Vitamin DDon't overdoModerateEstablished clinicalExcess is associated with soft-tissue and vascular calcification and cardiac arrhythmias.NIH Office of Dietary Supplements — Vitamin D (opens in a new tab)
Vitamin KEat enough ofModerateEstablished clinicalVitamin K-dependent proteins inhibit vascular mineralization; low status is associated with arterial (vascular) calcification and cardiovascular disease.LPI / NIH ODS – Vitamin K (opens in a new tab)
Vitamin KEat enough ofModerateEstablished clinicalVitamin K-dependent proteins inhibit vascular mineralization; low status is associated with arterial (vascular) calcification and cardiovascular disease.NIH Office of Dietary Supplements — Vitamin K (opens in a new tab)
Waist-to-height ratioWatch thisModerateCohort / observationalHigher WHtR predicted cardiovascular hospitalization and all-cause and obesity-related mortality.WHtR and mortality prospective cohort, Frontiers in Nutrition 2025 (opens in a new tab)
Waist-to-hip ratioWatch thisModerateCohort / observationalWaist-to-hip ratio was more strongly and consistently related to myocardial infarction than BMI across all ethnic groups (odds ratio 2.52, top vs bottom quintile).INTERHEART study (waist-to-hip ratio, 52 countries) (opens in a new tab)
Waist-to-hip ratioWatch thisModerateCohort / observationalHigher waist-to-hip ratio was associated with all-cause and cardiovascular mortality in adults with diabetes.Taiwan diabetes cohort (n=34,686) (opens in a new tab)
alpha-Linolenic acid (omega-3)Eat enough ofModerateCohort / observationalHigher omega-3 intake is associated with lower cardiovascular risk (arrhythmia control, lower triglycerides/BP); low intake forgoes this protection.Omega-3 cardiovascular literature (opens in a new tab)
alpha-Linolenic acid (omega-3)Don't overdoModerateRCT / meta-analysisHigh-dose omega-3 supplementation modestly increases the risk of atrial fibrillation in recent randomized trials.High-dose omega-3 trials (opens in a new tab)
Breath (how you breathe)Watch thisEmergingRCT / meta-analysisVoluntary slow breathing lowers resting heart rate and blood pressure and raises baroreflex sensitivity.Voluntary slow-breathing HR/BP meta-analysis, 2017 (opens in a new tab)
FlexibilityWatch thisEmergingMechanisticPoor trunk flexibility is associated with arterial stiffness, a cardiovascular risk marker (musculoskeletal-vascular link).Yamamoto et al., Am J Physiol Heart Circ Physiol 2009 (opens in a new tab)
Warmth & quality of tiesWatch thisEmergingCohort / observationalSatisfaction with relationships at age 50 predicted physical health at 80 better than cholesterol.Harvard Study of Adult Development (opens in a new tab)