What causes high cholesterol?
The main causes of high cholesterol relate to your lifestyle and include:
- Diet: A diet high in saturated and trans fats causes your bad cholesterol level to rise
- Physical inactivity: Regular exercise helps you lose weight, lowers triglycerides, and raises HDL (good ) cholesterol
- Smoking: Cigarette smoking raises LDL (bad) cholesterol and triglycerides and lowers HDL (good) cholesterol17
- Overweight and obesity: Being overweight or obese tends to increase your LDL cholesterol and lower your HDL cholesterol.18 Having fat in the belly area (a waistline above 35 inches) is also linked to high cholesterol and triglycerides.19
Other factors outside of your control that affect cholesterol levels are:
- Older age: As you get older, your levels of total and LDL (bad) cholesterol rise
- Heredity: High cholesterol can run in families. About 1 in 500 Americans have a type of inherited high cholesterol called familial hypercholesterolemia. This leads to very high levels of LDL (bad) cholesterol and a very high risk of having a heart attack at a young age.
How does my diet affect my cholesterol and triglyceride levels?
Eating too much saturated fat and trans fats increases your bad cholesterol levels. Saturated fats are found mainly in meat and dairy products. Trans fats are made through a chemical process called hydrogenation, which essentially turns healthier fats into unhealthy ones. Trans fats are found in fried foods, some margarines, baked goods (e.g., cookies and doughnuts), and snack foods. Since January 2006, trans fats are listed on food labels; foods that list “partially hydrogenated vegetable oils” contain trans fats.
Your triglycerides rise when you overeat or drink too much alcohol; the excess calories are converted into triglycerides to be stored as fat in the body. Some research suggests that a very high carbohydrate diet (more than 60% of total daily calories) may cause your triglyceride level to go up and your HDL (good) cholesterol to fall. This does not seem to happen if the high-carb diet is also rich in fiber and monounsaturated fat (e.g., olive and sunflower oils) or part of a healthy lifestyle that includes regular exercise.20-23
How is high cholesterol treated?
High cholesterol is always first treated with diet and exercise. If you are concerned about developing high cholesterol, you should follow a heart healthy diet that limits saturated fat, sodium, and cholesterol intake. If you already have heart disease or high cholesterol, you should try the Therapeutic Lifestyle Changes (TLC) diet, which cuts saturated fat and cholesterol even more. The American Heart Association recommends that if you have a high level of bad cholesterol, you should get less than 7% of your daily calorie intake from saturated fats and consume less than 200 milligrams of cholesterol per day.24 It is also important to exercise at least 30 minutes on most, preferably all, days of the week. Exercise aids weight loss, helps lower your triglycerides, and boosts your HDL (good) cholesterol.25, 26 Losing weight lowers levels of total and bad cholesterol and triglycerides.27 If you smoke, you should stop.
What if I need medicine for high cholesterol levels?
Diet and exercise are not always enough to lower cholesterol. If you need additional help, your healthcare provider may prescribe a cholesterol-lowering medication. If you are prescribed medication, it is still important to follow a diet low in saturated fat and cholesterol, exercise, and manage your weight. The main goal of cholesterol-lowering medications is to lower your LDL (bad) cholesterol level enough to reduce your risk of getting heart disease or having a heart attack.
There are several types of drugs available for cholesterol-lowering and you may have to take more than one. These include statins (e.g., Lipitor), bile acid resins (e.g., Welchol), and cholesterol absorption inhibitors (e.g., Zetia). Statins are the best medications for lowering LDL (bad) cholesterol in men and women. Nicotinic acid or niacin, and fibrates (e.g., Tricor) are used to raise HDL (good) cholesterol.
Does lowering my cholesterol reduce my risk for heart disease?
Yes. Studies show that lowering high levels of total and bad cholesterol reduces a woman's risk of having a heart attack or dying from heart disease.28 Lowering triglycerides and raising levels of good cholesterol also seems to reduce your risk.7 It is difficult to tease out whether changes in triglycerides and good cholesterol alone are beneficial or if other improvements in risk factors that tend to occur at the same time, including weight loss and reductions in total and bad cholesterol, are really responsible.