Everything to Know About Cholesterol
Medically reviewed by Jeffrey S. Lander, MD
Cholesterol is a fatty substance that is made by the liver and found in certain foods like meat and dairy. While cholesterol is an essential building block for cells in the body, too much cholesterol in the blood can cause health problems.
Certain cholesterol contributes to plaque buildup in arteries, which increases the risk of heart disease and stroke. Both lifestyle changes and medications can help to improve your cholesterol.
What Is Cholesterol?
Cholesterol is a fatty substance the body uses to make cell membranes, certain hormones, vitamin D, and bile. Your liver makes cholesterol, but you can also consume it through certain foods. Cholesterol is carried in the blood within particles called lipoproteins.
Dietary cholesterol is the cholesterol found in foods, which include animal products. Additionally, some plant-derived foods and oils are high in saturated and trans fats, which can indirectly increase cholesterol levels by stimulating the liver to make more cholesterol.
The following foods can increase blood cholesterol levels:
Meat, such as beef, lamb, and pork
Butter, ghee, and lard
Cream and full-fat milk
Cheese
Coconut and palm oils
Processed foods that are high in trans fat
Types of Cholesterol
Cholesterol is carried in the blood in particles called lipoproteins. These particles are named according to the proteins on their surface, and they have different roles in transporting cholesterol in the body. Blood tests measure the types of cholesterol in the body to provide information about your cardiovascular disease risk.
High-Density Lipoprotein (HDL)
HDL is known as "good cholesterol." It brings cholesterol from different parts of the body back to the liver, where it can then leave the body through bile. High HDL may decrease the risk of heart disease.
Low-Density Lipoprotein (LDL)
LDL is known as "bad cholesterol." Elevated levels of LDL are strongly linked to atherosclerosis, or plaque build up in the arteries, and heart disease risk.
Total Cholesterol
Total cholesterol is the sum of the various types of cholesterol subtypes in the blood, including HDL and LDL. The standard optimal level of total cholesterol for adults is less than 150 mg/dL.
What Happens When Cholesterol Is High?
Cholesterol is measured with a blood test called a lipid panel, which provides the amount of total cholesterol, LDL, HDL, and triglycerides. High cholesterol is a condition of elevated total cholesterol or LDL cholesterol, which is linked to higher risk of heart disease.
Dyslipidemia is another term that more broadly means abnormal cholesterol levels. Along with high LDL, it also includes low HDL, which is another marker of increased cardiovascular disease risk.
When cholesterol is abnormal, cholesterol plaques can form in the arteries. You can think of arteries like pipes, and cholesterol as gunk that clogs a pipe. Over time, as more cholesterol builds up, the blood vessels can narrow and impair blood flow to organs. Unstable plaques can rupture, leading to heart attacks and strokes.
While lab tests can show if your cholesterol is in a normal range, your overall risk of heart disease may be more important than your cholesterol numbers.
Your healthcare provider can calculate your 10-year or lifetime atherosclerotic disease risk. This is done using a calculator that considers cholesterol numbers as well as factors like age, sex, race, smoking history, and history of hypertension.
This information is then used to determine whether intensifying lifestyle modifications or starting medications may be needed to help lower your risk.
How to Improve Your Cholesterol
If you have been diagnosed with abnormal cholesterol or dyslipidemia, there are ways to improve your cholesterol. Lowering total cholesterol and LDL can be beneficial, as can raising your HDL. Your healthcare provider may suggest implementing lifestyle changes, medications, or both.
Dyslipidemia is often due to a combination of genetics, diet, and lifestyle. However, certain medical conditions and even medications can contribute to abnormal cholesterol levels:
Thyroid dysfunction
Kidney problems like chronic kidney disease and nephrotic syndrome
Cushing's disease
Diabetes
Medications like corticosteroids, oral contraceptives, immunosuppressants, seizure medications, antipsychotics, HIV medications, and more
If your cholesterol levels are found to be abnormal, your healthcare provider will consider underlying conditions or medications that may require attention as part of your treatment plan.
Lifestyle Changes
Lifestyle changes can have a big impact in lowering cholesterol, as well as healthy effects on blood pressure, mood, and overall health. These include:
Getting regular exercise
Decreasing alcohol intake
Maintaining a healthy weight
Eating a heart-healthy diet, rich in fruits and vegetables, whole grains, nuts, and limited in processed foods and saturated fats. Foods such as fish, avocados, and walnuts can provide healthy alternative sources of fats compared to red meats and processed foods that have high levels of saturated and trans fats, respectively.
Exercise has many beneficial effects, and specifically can lower LDL and raise HDL. The American Heart Association recommends at least 150 minutes of moderate intensity exercise per week or 75 minutes of vigorous exercise per week.
Moderate intensity exercise includes things that get your heart rate up:
Brisk walking
Doubles tennis
Dancing
Cycling (<10mph)
Vigorous exercise includes:
Singles tennis
Running
Cycling (>10 mph)
Medications
Your healthcare provider might recommend medication in addition to lifestyle changes to further lower cardiovascular disease risk. Statins are the primary medications used to treat elevated cholesterol and have a great effect in lowering heart disease risk.
Statins are generally well tolerated and affordable. Other medications to lower cholesterol include:
Zetia (Ezetimibe)
Bile acid sequestrants like Prevalite (Cholestyramine) and Welchol (Coleseveram)
Nexletol (Bempedoic acid)
PCSK9 inhibitors like Praluent (Alirocumab) and Repatha (Evolocumab)
Leqvio (Inclisiran)
A Quick Review
Cholesterol is a fat-like substance in the blood that has an essential role in the body. However, high levels of LDL and total cholesterol, and low levels of HDL can be harmful. Abnormal cholesterol levels, known as dyslipidemia, contribute to heart disease risk.
You can improve your cholesterol through lifestyle changes like getting regular exercise, quitting smoking, and eating a heart-healthy diet. Medications are another powerful tool to improve cholesterol and lower the risk of cardiovascular disease.
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