The Truth About Cholesterol

Heart disease remains the number one cause of death in the United States. One of the risk factors that increases your risk of heart disease is high cholesterol, particularly LDL cholesterol. But, although cholesterol tends to take the blame as the cause of heart disease, it is actually just one of many factors that can put you at risk.

What is Cholesterol?

Cholesterol is a fatty, wax-like substance found in your body and bloodstream. It is either made by the liver or comes from the food you eat. There are two main types of cholesterol, LDL and HDL. LDL is considered “bad” cholesterol because it can build up in the arteries increasing risk of heart attack or stroke. HDL cholesterol is “good” cholesterol because it is responsible for clearing any build-up from the arteries.1

Cholesterol and Heart Disease

When there is too much cholesterol in the blood, it can start to be deposited along the artery walls. When this happens the arteries become thick and hardened, making it difficult for the blood to pass through. The narrowing of the arteries is called atherosclerosis. If one of these arteries becomes blocked, this can lead to a heart attack or stroke.

The American Heart Association and American College of Cardiologists publish guidelines every 5 years to help doctors manage cholesterol in hopes of lowering the risk of heart attack and stroke. The latest 2018 guidelines did have a focus on cholesterol management. The guidelines recommend that total cholesterol be maintained at 150 mg/dL and LDL at less than 100 mg/dL, unless there were other risk factors for heart disease.2

But, even these guidelines encourage physicians to look at the whole picture, including lifestyle, genetics, and other medical conditions before starting a statin to lower cholesterol levels. The reason for this is that heart disease risk is more than just about cholesterol and some research indicates that cholesterol may not be the biggest risk factor.  A 2016 review of 19 studies found that elderly people over 60 years old with high LDL cholesterol lived as long or longer than those with low LDL cholesterol.3

Lowering Your Risk

As the understanding of the connection between cholesterol and heart disease continues to grow, recommendations will certainly change over time. But, in the meantime, if you are concerned about your risk for heart disease, there are several things you can do.

First, see your doctor regularly to monitor your cholesterol, blood sugar, blood pressure, weight, and other risk factors. They can help you manage any conditions that can increase your risk.

Second, consider some lifestyle changes that can help improve the health of your heart. You might think you need to cut out all cholesterol from your diet to reduce your blood cholesterol, but new research has found that dietary cholesterol doesn’t impact blood cholesterol all that much. Instead, focus on eating more healthy fats and reducing your intake of saturated fats, which can increase cholesterol levels. A 2016 study found that just a few small changes, such as modifying the type of fat you eat, can significantly improve cholesterol.4

Other lifestyle factors such as smoking, exercise, and your body weight can also impact your risk for heart disease. Aim for at least 30 minutes of exercise daily and maintain a healthy weight. If you are a smoker, work with a professional to help you quit.

Cholesterol and heart disease risk is a complex issue. As researchers begin to learn more about how high cholesterol impacts the development of this disease, guidelines will improve. But, for now you should focus on living a healthy lifestyle to protect your heart and body.



  1. Questions about cholesterol? Here are some answers. American Heart Association, November 10, 2018.
  2. Journal of the American College of Cardiology. 2018 Nov.
  3. BMJ Open 2016;6:e010401.
  4. BJN. 2016;116:1383-1393.

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