Cholesterol Education: What Is High Cholesterol and Tips to Lower It

06 February 2025

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In this blog, we examine the basics of cholesterol, take a look at high cholesterol and explore practical steps to take to ensure your cholesterol levels support a healthy heart and lifestyle. We talk with Ryan Norris, D.O., a cardiologist and board-certified lipidologist at the INTEGRIS Health Heart Hospital, to learn more.

“It is easy to focus on the numbers, but it is most important to know your Atherosclerotic Cardiovascular Disease (ASCVD) risk. This can be performed by using a risk calculator which you can find on the web (ASCVD Risk Estimator + (acc.org) or with an app (ASCVD Risk Estimator Plus). Applying this calculator to patients aged 40-75 years is the most crucial step and must be taken when determining whether a patient would benefit from statin (medical) therapy or dietary and lifestyle modification alone. If you are younger than 40 or older than 75, there are other things that can be done to further estimate risk and determine the need for therapy, but this needs to be discussed with a health care professional” Norris says.

The basics on cholesterol

The big picture: Cholesterol is a waxy, fat-like substance found in the cells of your body that helps build cell membranes, produce hormones and synthesize vitamin D. The liver produces all the cholesterol the body needs, but it can also be obtained from dietary sources, particularly animal products such as meat, dairy and eggs.

Cholesterol travels through the bloodstream in particles called lipoproteins, which are combinations of fats (lipids) and proteins.

There are two primary types of lipoproteins that carry cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL is often referred to as "bad" cholesterol.

High levels of LDL in the blood can accumulate on the walls of arteries, forming plaque.
This buildup narrows and hardens the arteries, a condition known as atherosclerosis, which increases the risk of heart disease and stroke.

HDL, meanwhile, is known as "good" cholesterol.

HDL helps transport cholesterol away from the arteries and back to the liver, where it's processed and removed from the body.
This process helps reduce the buildup of cholesterol in the arteries, lowering the risk of heart disease.

The facts about high cholesterol

What to know: High cholesterol is a common health issue in the U.S., affecting millions of adults and significantly increasing the risk of heart disease and stroke. Despite its prevalence, high cholesterol often goes undiagnosed and untreated.

Nearly 94 million U.S. adults older than 20 have total cholesterol levels higher than 200 mg/dL, which is considered borderline high, according to the CDC.

Additionally, about 28 million Americans have high cholesterol over 240 mg/dL.
For comparison, a healthy cholesterol level is less than 200 mg/dL.
Healthy LDL levels are less than 100 mg/dL.
Healthy HDL levels are less than 40 mg/dL for men and 50 mg/dL for women.
Genetic disorders are considered when the LDL is > 190mg/dL or when triglycerides are >1000mg/dL. When these issues are identified you need to see a specialist right away because your risk of premature CVD is much higher.

The likelihood of having high cholesterol increases with age.

High cholesterol is more common in adults over the age of 45 for men and 55 for women.

Men typically have higher cholesterol levels than women until around age 55.

After menopause, women's LDL cholesterol levels often rise.

While genetics can play a role, various lifestyle and behavioral choices can lead to high cholesterol.

Consuming high amounts of saturated and trans fats found in fried foods, processed snacks and red meat can raise cholesterol levels.
Excess weight can increase LDL cholesterol while decreasing HDL cholesterol.
Physical inactivity can lead to weight gain and lower HDL cholesterol levels.
Smoking lowers HDL cholesterol and damages blood vessels, making them more susceptible to cholesterol buildup.

Certain ethnic groups have higher rates of high cholesterol compared to other groups.

Mexican American men, in particular, have been found to have higher rates of high cholesterol compared to other Hispanic subgroups and non-Hispanic whites.
While African American adults generally have slightly lower total cholesterol levels, they’re more prone to high blood pressure and diabetes, which can complicate cholesterol levels.

Is it time for a screening? The National Heart, Lung and Blood Institute recommends cholesterol screening every five years for younger adults. Men between the ages of 45 to 65 and women between the ages of 55 and 65 should receive screenings every one to two years. All older adults should receive annual cholesterol screenings.

What happens when you have high cholesterol?

At a glance: Balancing LDL and HDL cholesterol is vital for heart health. Imbalanced levels can cause atherosclerosis, where arteries harden or clog. This reduces blood flow and raises the risk of cardiovascular diseases such as coronary artery disease, heart attack and stroke.

High cholesterol alone typically doesn't cause symptoms.

Over time, though, the buildup of cholesterol and other substances in the arteries can cause serious problems.
It’s a significant risk factor for heart disease, which is the leading cause of death in the U.S.

When high levels of cholesterol accumulate in the arteries, many health issues can arise.

Atherosclerosis occurs when cholesterol leads to the hardening and narrowing of arteries, restricting blood flow.
Coronary artery disease occurs when cholesterol levels reduce blood flow to the heart, causing chest pain (angina).
Heart attacks are more likely if cholesterol build up causes a complete blockage of blood flow to a part of the heart muscle.
Strokes are also more likely if build ups cause blockages to the brain.
Peripheral artery disease develops when cholesterol restricts blood flow to limbs, leading to pain and mobility issues.
High blood pressure happens when narrowed arteries force the heart to work harder.
Aneurysms occur when weakened artery walls bulge or balloon, and they can rupture if they grow too large.

Tips to lower cholesterol

Why it matters: Lowering cholesterol levels involves adopting several key lifestyle changes. These modifications not only aid in managing cholesterol but also significantly enhance overall heart health, reducing the risk of cardiovascular diseases.

Eating healthier is a top priority for those looking to lower their cholesterol.

Focus on a diet rich in fruits, vegetables, whole grains, lean proteins and healthy fats.
Additionally, limit intake of saturated fat, trans fat and red meat.
The Mediterranean diet combined with high consumption of olive oil (1L/week for a family of four) has been demonstrated to have the lowest rates of cardiovascular disease.

Regular exercise helps boost heart health and also lowers LDL cholesterol and boosts HDL cholesterol.

Aim for at least 150 minutes of moderate activity (e.g. accomplishing a two-mile walk in 30 minutes; five days weekly), including cycling, swimming, running or a brisk walk.

Weight management can help reduce plaque build ups in blood vessels.

Even losing five to 10 percent of your total body weight can have a positive impact on cholesterol levels.

Quit smoking and reduce alcohol intake.

Giving up smoking can improve HDL cholesterol levels.
Consuming alcohol in moderation also helps manage cholesterol levels.

For some people, lifestyle changes alone may not be sufficient and various medications are available to manage cholesterol.

Statins are the most commonly prescribed cholesterol-lowering drugs, and they work by blocking a substance your body needs to make cholesterol.
Bile acid sequestrants bind to bile acids in the intestine, which makes the liver use excess cholesterol to make more bile acids.
Cholesterol absorption inhibitors limit the absorption of dietary cholesterol in the small intestine.
PCSK9 inhibitors help the liver absorb more LDL cholesterol.

Next steps: Regularly checking your cholesterol levels is a vital step in maintaining a healthy lifestyle and preventing heart disease. Don't wait for symptoms to appear – be proactive. Schedule a primary care visit and ask your doctor about a cholesterol screening.