What Is Cholesterol?

Cholesterol is necessary for good health, but high cholesterol levels can increase your risk for heart disease.

Cholesterol is a waxy, fat-like substance that’s naturally produced in your body, primarily by your liver.

It’s in all the cells in your body and is essential to the production of hormones, vitamin D, and bile, which helps you digest your food.

Cholesterol is packaged inside an envelope of lipids (fat), with specific proteins on the inside to make up particles called lipoproteins.

Cholesterol is also found in foods, such as meat, dairy products, and eggs. When you eat too much of these foods, your liver produces more cholesterol.
Good Cholesterol vs. Bad Cholesterol

There are two type of cholesterol: “good” cholesterol, aka high-density lipoprotein (HDL), and “bad” cholesterol, known as low-density lipoprotein (LDL).

A high level of HDL may lower your risk of heart attack and stroke. HDL cholesterol helps your body remove LDL by carrying it from the bloodstream and artery walls to your liver, where it is broken down and excreted from the body.

LDL cholesterol, on the other hand, can cause more plaque to form in your arteries.

This thick, hard deposit can clog arteries and makes them harder in a condition called atherosclerosis, which can lead to a greater risk of heart attack or stroke.

Triglycerides are stored in your fat cells and, along with carbohydrates and protein, are an important energy source for your body.

Too many triglycerides, however, increases your risk for coronary artery disease.

Those who have heart disease, diabetes, a high cholesterol level, or are overweight are more likely to have higher levels of triglycerides.

Your Cholesterol Score

The amount of cholesterol you have in your body can be measured through a simple blood test, called a lipid profile or a lipid profile.

It’s recommended everyone have his or her cholesterol checked starting at age 20 and at least every five years after.

Your total cholesterol score is made up of your LDL and HDL numbers, plus 20 percent of the amount of triglycerides in your blood.

What Causes High Cholesterol?

Cholesterol is measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

Your cholesterol level is considered high if you have total cholesterol levels of 240 mg/dL or higher. It’s considered borderline when it’s between 200-239 mg/dL.

When your cholesterol is too high, plaque can develop on the walls of your arteries. This can make it difficult for your heart and brain to get all the blood they need.

When your heart is deprived of blood, you may have a heart attack, and when your brain doesn’t get enough, you may have a stroke.

High cholesterol (also called hypercholesterolemia) can be hereditary, but it’s also affected by your lifestyle choices.

Those with an unhealthy diet, who are overweight, and don’t exercise are more likely to have high cholesterol.

You’re also more likely to have high cholesterol if you smoke or drink heavily.

How Diet Affects Cholesterol

What you eat has a direct link to how high or low your cholesterol levels are. To lower your cholesterol levels, it’s important to:

Avoid foods high in dietary cholesterol. These include high-fat dairy products, processed foods, and meats, including beef, pork, lamb, skin-on poultry, and organ meats.
Eat more fiber. Whole grains, fruits, and vegetables can help lower your cholesterol levels.
Trade unhealthy fats for healthier ones. Limit the amount of trans fats and saturated fats in your diet. These are most often found in packaged foods, fast foods, butter, palm and coconut oils, and full-fat dairy (e.g., whole milk). Instead, opt for monounsaturated fats found in olive, peanut, and canola oils and nuts.

Cholesterol Levels

There are no symptoms of high cholesterol, so it’s important to check your cholesterol levels regularly.

Your cholesterol levels are determined by a blood test — the results are referred to as a lipid panel or lipid profile.

Your lipid panel is made up of three items: “good” cholesterol, aka high-density lipoprotein (HDL), “bad” cholesterol or low-density lipoprotein (LDL), and triglycerides.

It’s important to know your cholesterol levels, because high cholesterol can contribute to your risk of heart disease and stroke.

HDL Cholesterol

HDL cholesterol helps to remove LDL cholesterol from the bloodstream.

It carries LDL back to the liver where it can be broken down and flushed out of your body.

LDL Cholesterol

High levels of LDL cholesterol can cause plaque to build up in your arteries in a condition called atherosclerosis.

This can make your arteries harden and can block blood flow to both your brain and your heart.

Triglycerides

Triglycerides are a type of fat stored in your cells.

Your triglyceride levels are likely to be high if you eat a diet high in carbohydrates, are overweight, sedentary, and/or smoke.

A high level of triglycerides can contribute to your risk of atherosclerosis.

Cholesterol Test

The American Heart Association recommends everyone over the age of 20 have his or her cholesterol levels checked every four to six years, depending on other risk factors.

The test, called a lipid profile, is a simple blood test. It’s most accurate if you fast, refraining from eating or drinking anything besides water, for 12 hours prior to the test.

For this reason, most tests are performed in the morning.

What Your Cholesterol Numbers Mean

Ideally, you want your HDL score to be high, and your LDL and triglyceride scores to be low.

Cholesterol is measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.

Total cholesterol scores are considered best at 200 mg/dL or below; borderline from 200-239 mg/dL, and high at 240 mg/dL or above.
HDL is considered most healthy at 60 mg/Dl and above; good between 40-50 for men and 50-59 mg/dL for women; and poor below 40 mg/dL (men) and below 50 mg/dL (women).
LDL is considered healthy at 100-129 mg/dL; borderline high at 130-159 mg/dL, and high at 160 mg/dL or higher.
Triglycerides levels are best at 150 mg/dL or below; borderline high at 150-199 mg/dL and high at 200 mg/dL or above.

High Cholesterol (Hypercholesterolemia)

High cholesterol, also known as hypercholesterolemia, can increase your risk of stroke and heart attack.

When you have high levels of LDL and triglycerides and low levels of HDL, you are more likely to have a condition called atherosclerosis, in which plaque builds up in your arteries.

The plaque makes them less flexible and clogged, which can increase your risk of having a stroke or heart attack.

High Cholesterol Symptoms

There are no symptoms of high cholesterol.

You can have high cholesterol and not know it, which is why it’s important to have it checked regularly.

Cholesterol Medications

A number of drugs can help lower your cholesterol levels, either alone or in combination.

If lifestyle modifications alone don’t help to lower your cholesterol levels, your doctor may prescribe a cholesterol-lowering drug.

The best drug or combination of drugs for your cholesterol levels depends on your age, health, risk factors, and tolerance of the drugs.

Depending on your risk factors for heart disease and stroke, your doctor will set a goal number for your cholesterol.

The most commonly prescribed cholesterol drugs include:

Statins: Statins work by blocking a substance your liver needs to make cholesterol, which in turn causes your liver to remove cholesterol from your blood.

Statins may also potentially reverse coronary artery disease by helping your body reabsorb cholesterol from built-up deposits along the walls of your arteries.

Statin options include atorvastatin (Lipitor), rosuvastatin (Crestor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pitavastatin (Livalo), pravastatin (Pravachol), and simvastatin (Zocor).

Bile-acid-binding resins: Cholesterol is needed to make bile acids, a substance that aids in digestion.

Bile-acid-binding resins bind to bile acids, as the name suggests, triggering your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.

Bile-acid-binding resins include cholestyramine (Prevalite), colesevelam (Welchol), and colestipol (Colestid). They are typically prescribed along with a statin.

Cholesterol absorption inhibitors: These drugs limit the amount of dietary cholesterol your small intestine absorbs so it cannot be released into your bloodstream.

The drug ezetimibe (Zetia) can be used in combination with any of the statin drugs.

Combination cholesterol absorption inhibitor and statin: This combination drug limits the absorption of dietary cholesterol by your small intestine and the production of cholesterol by your liver.

The combination drug is ezetimibe-simvastatin (Vytorin)

Cholesterol and Diet

Your cholesterol levels are determined in part by genetics and by your lifestyle choices — especially diet.

Cholesterol is necessary for good health, and your body produces cholesterol.

It’s an essential component of all the cells in your body and is involved in producing hormones, vitamin D, and substances that are important for digestion.

Cholesterol is also found in many foods.

Because too much cholesterol increases your risk for heart disease and stroke, it’s important to follow a healthy diet.

How Diet Affects Cholesterol Levels

When you eat a diet high in saturated and trans fats, it can cause your body to overproduce cholesterol.

Aim to eat no more than 200 mg cholesterol a day as part of a healthy diet. (You’ll find it listed on a food’s nutrition label.)

Try to keep your saturated fat intake to less than 7 percent of your total calories.

High Cholesterol Foods

Limiting the amount of food that you eat that is high in cholesterol can help lower your overall cholesterol number.

Foods that are high in cholesterol include:

Full-fat and 2-percent dairy, including whole milk and cheese
Trans fat and saturated fats. Fast foods, packaged foods, and margarine are the biggest offenders. Look for trans fats listed on ingredient labels as “partially hydrogenated oils”
Organ meats such as liver, as well as beef, lamb, pork, and skin-on poultry
Coconut oil, palm oil, or cocoa butter
Egg yolks

In addition, you should avoid foods high in sugar. Sugar alone doesn’t raise your cholesterol levels, but being overweight does increase your risk of having high cholesterol.

Cholesterol-Lowering Foods

To lower your cholesterol, adding more of the following foods to your diet may help:

High-fiber foods: Foods high in soluble fiber, such as oatmeal and oat bran, quinoa, beans, prunes, and bananas, prevent the digestive tract from absorbing cholesterol.

The Food and Drug Administration recommends men eat 30 to 38 grams of fiber a day, and women between 18 and 50 years old eat 25 grams a day, and 21 grams a day for women 51 and older.

Fruits and vegetables: In addition to being high in fiber, fruits and veggies contain sterols, cholesterol-lowering compounds.

Lean meats: Opt for white meat of chicken and turkey, leaner cuts of beef, including sirloin and lean cuts of pork, such as tenderloin.

Always trim any excess fat before cooking and remove the skin from poultry. Broil or grill it to limit the amount of added fat.

Oily fish: Salmon, herring, and trout are all low in saturated fat and high in omega-3 fatty acids.

Bake, broil or grill fish (rather than frying or breading it) to cut down on added fats.

Monounsaturated and polyunsaturated fats: Not all fats are bad for you. In fact, healthy fats (olive, peanut, safflower, canola, and sesame oils) provide nutrients for your cells.

Use these healthy oils to make your own salad dressings and for cooking.

Healthy fats are also found in walnuts, almonds, cashews, and other nuts, as well as avocadoes.

Egg whites: The research on the risk of eating whole eggs has been confusing.

The general guideline is that healthy adults can safely eat up to seven whole eggs a week. Each egg contains 186 mg of cholesterol, and it’s all in the yolk.

If you’re concerned or are actively reducing your cholesterol intake, limit yourself to omelets, scrambled eggs, and other foods made only with egg whites (and no yolks).
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