What are the main causes of high cholesterol, and can diet alone effectively manage it?

High cholesterol can be caused by a combination of factors, including genetics, a diet high in saturated and trans fats, lack of physical activity, obesity, smoking, and certain medical conditions like diabetes or hypothyroidism. While a heart-healthy diet is a cornerstone of management, it may not be sufficient on its own for everyone. Many individuals also require lifestyle changes like regular exercise, weight management, and sometimes medication to reach healthy cholesterol levels

Cholesterol Levels: What You Need to Know

Understanding your cholesterol levels is essential for managing your heart health, as high levels can lead to dangerous arterial blockages.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk of coronary artery disease and other heart diseases.

How do you measure cholesterol levels?

A blood test called a lipoprotein or lipid panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your:

Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
Triglycerides. This is another type of fat in your blood that can raise the risk of heart disease, especially in women.

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Talk with your healthcare provider about what your cholesterol numbers should be, as the best levels for you may depend on your age, race, blood pressure, weight, family history, and more.

Anyone age 19 or younger

Total Cholesterol: Less than 170 mg/dL
Non-HDL: Less than 120 mg/dL
LDL: Less than 110 mg/dL
HDL: More than 45 mg/dL

Men age 20 or older

Total Cholesterol: Less than 200 mg/dL
Non-HDL: Less than 130 mg/dL
LDL: Less than 100 mg/dL
HDL: Greater than or equal to 60 mg/dL is best. Levels less than 40 mg/dL are considered low.

Women age 20 or older

Total Cholesterol: Less than 200 mg/dL
Non-HDL: Less than 130 mg/dL
LDL: Less than 100 mg/dL
HDL: Greater than or equal to 60 mg/dL is best. Levels less than 50 mg/dL are considered low.

A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

How often should I get a cholesterol test?

Recommendations depend on your age, risk factors, and family history:

Age 19 or younger: First test between ages 9 to 11, then every 5 years. Some children may start at age 2 if there is a family history of high cholesterol, heart attack, or stroke.
Ages 20 to 65: Younger adults should test every 5 years. Men ages 45 to 65 and women ages 55 to 65 should test every 1 to 2 years.
Older than 65: Should be tested every year.

What affects my cholesterol levels?

Factors you can change include:

Diet: Saturated fat and cholesterol in food raise blood cholesterol. Reducing saturated fat—found in red meats, full-fat dairy, chocolate, and processed foods—helps lower levels.
Weight: Being overweight or having obesity are risk factors for heart disease and increase cholesterol.
Lack of physical activity: Not being active is a risk factor for heart disease.
Smoking: Cigarette smoking lowers your HDL cholesterol.

Factors you cannot change include:

Age: Levels tend to rise as you get older.
Sex: Men have a greater risk between ages 20 and 39; after menopause, a woman's risk increases.
Family history: Genes partly determine how much cholesterol your body makes.
Race or ethnicity: Certain groups have increased risks, such as Asian Americans (higher LDL) and non-Hispanic White people (higher total cholesterol).

How can I lower my cholesterol?

You can lower your cholesterol through heart-healthy lifestyle changes, including a healthy eating plan, weight management, and regular physical activity. If lifestyle changes are insufficient, your provider may prescribe medicines, such as statins, though you should continue lifestyle modifications while taking medication.