Cholesterol 101: Keeping it Under Control

Cholesterol is one of those things that people tend to be aware of but don’t always fully understand. For example, most people know that cholesterol is a major risk factor in heart disease. They may also know that there’s good and bad cholesterol. However, not everybody understands what makes cholesterol good or bad, and, more importantly, how and why you need to manage the different kinds. 

To close that knowledge gap and get you on a path to better health, let’s review the basics of cholesterol.

Let’s start with what cholesterol is and where it comes from.

Simply put, cholesterol is a type of lipid. Found throughout your body and in your blood, lipids  are fatty, waxy compounds that help with important body functions (e.g., building cells, making vitamins, storing energy, etc.). In addition to cholesterol, other types of lipids—namely triglycerides—have a big impact on your heart health (more on that later).

Cholesterol comes from one of two sources: your liver or from foods you eat. The primary food sources of cholesterol are animal proteins and certain oils, such as coconut oil and palm oil.

As it turns out, your liver makes all the cholesterol your body needs. However, the extra cholesterol we ingest actually prompts the liver to make more cholesterol. It’s that extra-consumed, extra-produced cholesterol that leads to problems.  

Now that we know where cholesterol comes from, let’s look at what cholesterol does.

This is where things get a little tricky. In much of the same way that there are two sources of cholesterol, there are two types of cholesterol. The “good” cholesterol is referred to as HDL (high-density lipoprotein). This kind of cholesterol helps to remove extra cholesterol from your bloodstream. A handy little cheat for remembering HDL is the good cholesterol is to think of the H as standing for “helpful.”   

The other type of cholesterol is LDL (low-density lipoprotein). This is the “bad” cholesterol. In this case, think of the “L” as standing for “Lousy” or “Lazy.” Unlike its counterpart, LDL does not remove cholesterol from the bloodstream. In fact, LDL doesn’t do much but hang around the bloodstream causing plaque to build up in your blood vessels and making your heart work harder. Too much LDL can lead to heart disease and stroke.

Cholesterol builds up slowly over time, often showing no symptoms until you have a heart attack or stroke. The only way to know how much cholesterol you have is through a blood test, called a fasting lipid profile. For this test, you need to fast for 12 hours beforehand.

In addition to revealing your LDL and HDL levels, this test will also reveal your trygliceride levels. This is important as a combination of high levels of triglycerides with low HDL and/or high LDL levels can increase your risk for health problems, such as heart attack.  

While ideal levels of each type of cholesterol vary by age, your sex assigned at birth, and certain health conditions, across the board you want your levels of LDL to be low and your HDL to be high.

If your test reveals you have too much LDL, there are steps you can take to reverse the numbers and lower your risk of heart disease and stroke. These include:

Eat a heart-healthy diet: Scaling back on meat and trans-fat consumption (found in fried and packaged foods and many baked goods) and increasing your fiber intake (think seeds, nuts, grains) can go a long way to getting your LDL numbers down

Exercise daily: Because HDL levels drop when you live a sedentary lifestyle, meaning less cholesterol is being removed from your blood stream, exercise is key to cholesterol control. The American Heart Association recommends people aim for a minimum of 150 minutes of moderate intensity exercise per week to lower LDL levels. 

Take medication as prescribed: Because cholesterol levels are somewhat hereditary, you may need medication even if you exercise and eat well. Talk to your doctor about daily medication to bring your numbers into a healthy range. 

Quit smoking and vaping: Quitting is one of the most important things you can do to improve your overall health because vaping and smoking cigarettes can lower HDL levels. Meaning less cholesterol is being removed from your blood stream.

By taking control of your cholesterol, you’re also taking control of your health and reducing your risk of heart disease, stroke, and heart attack. If you have questions about cholesterol, your risks, and options, talk to your healthcare provider.

Scott Rogge, MD, FACC, is the Medical Director at Southwestern Vermont Medical Center Cardiology.