All About Cholesterol

It’s easy to feel confused about cholesterol. Too much cholesterol is bad, right? But what does that really mean?

Let’s break down what cholesterol is, why it matters, and what we should do about it.

What is cholesterol?

Cholesterol is a waxy, fatty substance that occurs naturally in the body. Blood cholesterol is needed to build cells and make hormones, but you only need a small amount of fat in your diet to make enough cholesterol to stay healthy. Dietary cholesterol is found in animal foods, including meat, seafood, poultry, eggs, and dairy products.

The fat and cholesterol you eat are absorbed in the intestine and transported to the liver. The liver converts fat into cholesterol, and releases cholesterol into the bloodstream.

There are two main types of cholesterol:

• low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol that can increase your risk for heart attack or stroke)
• high-density lipoprotein (HDL) cholesterol (the “good” cholesterol that can lower your risk for heart attack or stroke)

Why does it matter?

High levels of bad LDL cholesterol are linked to atherosclerosis, which is the accumulation of cholesterol-rich fatty deposits that can cause arteries to the heart to become blocked, causing coronary artery disease and heart attacks. When atherosclerosis blocks arteries that supply blood to the brain, it can cause a stroke.

People with high levels of “good” HDL cholesterol are less likely to develop cardiovascular disease. But people can also have both high HDL and high LDL cholesterol levels—and that’s not so good, either.

High LDL (bad) cholesterol levels don’t generally cause symptoms until they are a problem, such as contributing to heart attack or stroke. That’s why it’s important to get your cholesterol checked.

Who should get checked?

Everyone, according to the U.S. Centers for Disease Control and Prevention. The CDC recommends:

• Most healthy adults should have their cholesterol checked every 4 to 6 years.
• People who have heart disease, diabetes, or a family history of high cholesterol need to get their cholesterol checked more often.
• Children should have their cholesterol checked at least once between ages 9 and 11.
• Adolescents should have their cholesterol checked between ages 17 and 21.

Check with your healthcare provider for recommendations that are specific to your health situation.

Understand your reading

Cholesterol tests involve a simple blood test, called a lipid panel or lipid profile. You may be told to fast before your test, which means not eating, drinking certain beverages and taking medications 9 to 12 hours before the cholesterol test.

Harvard Health experts recommend that you and your doctor should decide what personal goal numbers you should strive for. In general, the ideal “bad” cholesterol LDL level is less than 70 milligrams per deciliter (mg/dL), but if you do not have cardiovascular disease and no risk factors for it, an LDL cholesterol level of 100 – 130 mg/dL may be acceptable.

People with lower levels of “good” HDL—below 40 mg/dL—are more likely to develop atherosclerosis, heart disease and stroke. A triglyceride level of under 150 mg/dL is a good goal, according to Harvard Health.

Prevention and treatment

The American Heart Association and your healthcare provider can offer good advice for lowering your bad cholesterol levels and increasing your good cholesterol levels.

Lifestyle changes can help bring your numbers into line. Try:

• Getting more exercise. A sedentary lifestyle lowers HDL (good) cholesterol.
• Improving your diet. The best way to lower your cholesterol is to reduce your intake of saturated fat and trans fat. A heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish, nuts and non-tropical oils while limiting red and processed meats, sodium and sugar-sweetened foods and beverages. Try the DASH diet or follow a Mediterranean eating plan.
• Quitting smoking. There are many free resources to help.
• Limiting alcohol: One or two drinks per day or less.

A healthy lifestyle can help prevent and treat high cholesterol, but if the bad numbers won’t budge, you and your health care professional may discuss adding medication to help improve your cholesterol and lower your risk of having a heart attack or stroke.

ProTip: Lifestyle changes can be the most affordable and effective ways to lower LDL (bad) cholesterol, but if you are prescribed medication to help manage cholesterol levels, talk to your healthcare provider about whether lower-cost generic drug options are right for you.