National Cholesterol Education Month

Cholesterol is a fatty material in all cells that is essential for producing hormones, vitamin D, and substances that aid digestion. The body produces all the cholesterol it requires, and cholesterol is found in certain animal food sources, including egg yolks, meat, and cheese.¹ 

The Role of Cholesterol

There are three main types of lipoproteins, which transport cholesterol and triglycerides through the bloodstream: high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL). HDL is considered “good” cholesterol because it transports cholesterol to the liver for removal. LDL and VLDL are often referred to as “bad” cholesterol, as high levels can lead to plaque buildup in the arteries; LDL primarily carries cholesterol, and VLDL primarily carries triglycerides.¹ 

HDL can lower the risk of heart attack and stroke, as well as other health issues. In contrast, LDL cholesterol deposits cholesterol in the blood vessels, potentially leading to blockages that increase the risk of cardiovascular and other health problems. Triglycerides, another type of fat in the blood used for energy, can also contribute to cardiovascular risk—especially when triglyceride levels are high and HDL levels are low.² 

Risk factors for High Cholesterol

Lifestyle factors. Risk factors for high cholesterol include a diet high in saturated fats, which are commonly found in red meat and dairy products. Physical inactivity is associated with an increased risk of unhealthy blood cholesterol, and smoking lowers HDL levels while raising LDL levels, especially in women. Excessive alcohol consumption—more than two drinks per day for men or one for women—can also contribute to high cholesterol. Stress can also contribute to high cholesterol via hormones, such as corticosteroids. Additionally, poor sleep quality or insufficient sleep can negatively impact cardiovascular health.^1,3

Genetics. Family history and genetics play a role in cholesterol levels. Familial hypercholesterolemia (FH) is an inherited disorder that leads to high cholesterol, and individuals with a family history of high cholesterol might have difficulty removing and breaking down LDL.^1,3

Health conditions. Various health conditions, such as chronic kidney disease, diabetes, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), polycystic ovary syndrome, and sleep apnea can increase the risk of high cholesterol.^1,3

Medications. Various medications can influence cholesterol levels, including beta-blockers, diuretics, immunosuppressive drugs, chemotherapy, retinoids, steroids, and drugs for arrythmia.³

Age and sex. Although unhealthy cholesterol levels can develop at any age, they are most frequently diagnosed in individuals between 40 and 59 years of age. This is often due to age-related changes in metabolism, wherein the liver becomes less efficient at removing cholesterol from the blood. Among adults aged 20 to 39 years, men are more likely than women to have high cholesterol. However, after menopause, women are at a greater risk of higher LDL levels and lower HDL levels.^1,3

Race and ethnicity. Cholesterol levels can vary across racial and ethnic groups. Non-Hispanic White individuals are more likely to have high total cholesterol compared to other groups. Asian Americans are at a greater risk for elevated levels of LDL. Hispanic Americans are more likely to have lower levels of HDL, whereas African Americans tend to have higher levels of HDL.^1,3

Complications of High Cholesterol

When there is too much cholesterol in the blood, it can combine with other substances to form plaque, which accumulates on the walls of the arteries, a condition known as atherosclerosis. Over time, atherosclerosis can cause coronary heart disease, which is the narrowing or blockage of the coronary arteries.¹ Atherosclerosis can lead to atherosclerotic cardiovascular disease (ASCVD), a group of atherosclerotic-related conditions including coronary artery disease, cerebrovascular disease, transient ischemic attack, angina, and peripheral artery disease.⁴

Maintaining Healthy Cholesterol

Individual cholesterol levels vary from person to person. The general recommendations for optimal cholesterol levels in adults are as follows:² 

• Total cholesterol: less than 200mg/dL
• LDL cholesterol: less than 100mg/dL
• HDL cholesterol: 60mg/dL or higher
• Triglycerides: less than 150mg/dL

Lowering LDL cholesterol can help stop plaque buildup in the arteries, and in some cases, might even help clear existing plaque; this lowers the risk of heart attack, stroke, and death.² 

Eating a healthy diet consisting of whole grains, fruits, vegetables, omega-3 fatty acids, and vegetable oils, along with limiting refined carbohydrates and saturated fats can help to maintain healthy cholesterol levels. Additional lifestyle habits, including regular physical activity, stress management, smoking cessation, limited alcohol intake, and getting enough quality sleep, can help maintain healthy cholesterol levels.² Various medications can be used to manage high cholesterol; examples include statins, cholesterol absorption inhibitors, niacin, and bile acid sequestrants.⁵

Sources

1. Cholesterol. Medline Plus. Updated 18 Mar 2025. Accessed 9 Oct 2025. https://medlineplus.gov/cholesterol.html
2. Cholesterol & your heart: what you need to know. National Heart, Lung, and Blood Institute. Sep 2022. Accessed 9 Oct 2025. https://www.nhlbi.nih.gov/resources/cholesterol-your-heart-what-you-need-know-fact-sheet
3. Blood cholesterol: causes and risk factors. National Heart, Lung, and Blood Institute. Updated 19 Apr 2024. Accessed 9 Oct 2025. https://www.nhlbi.nih.gov/health/blood-cholesterol/causes
4. Pahwa R, Jialal I. Atherosclerosis. StatPearls. Updated 8 Aug 2023. Accessed 9 Oct 2025. https://www.ncbi.nlm.nih.gov/books/NBK507799/
5. Cholesterol medicines. Medline Plus. Updated 5 May 2025. Accessed 9 Oct 2025. https://medlineplus.gov/cholesterolmedicines.html