Functional Foods for Cholesterol Management: A Review of the Mechanisms, Efficacy, and a Novel Cholesterol-Lowering Capacity Index

Cardiovascular disease (CVD) remains the leading cause of death worldwide, with elevated low-density lipoprotein cholesterol (LDL-C) as a major risk factor. Beyond medications, dietary interventions and functional foods offer significant cholesterol-lowering potential. This article provides a comprehensive review of functional foods and nutraceutical ingredients that help to reduce cholesterol levels and introduces the novel Cholesterol-Lowering Capacity Index (CLCI), designed to quantify and communicate the efficacy of such foods. In doing so, it summarizes key functional components, including plant sterols/stanols, viscous fibers, soy protein, red yeast rice, berberine, polyphenols (e.g., bergamot extract, garlic), and others, highlighting their mechanisms of action and the typical LDL-C reductions observed in clinical studies. Strategies for the design of next-generation cholesterol-lowering foods are discussed, such as combining multiple bioactives for synergistic effects, personalized nutrition approaches, and novel food processing techniques to enhance bioavailability. Building on these strategies, the CLCI is then proposed as a practical scoring system, analogous to the glycemic index for blood sugar, that integrates the evidence-based potency of ingredients, effective dosing, and synergistic interactions into a single metric. A methodology for the calculation of the CLCI is presented, alongside potential applications in food labeling, clinical guidance, and dietary planning.