Cholesterol: The Good, the Bad, and the Ugly

September 2020

Getting a cholesterol test is simple. Making sense of the results can be more complex.

You’re likely to wind up with a confusing array of numbers: total cholesterol, “good” cholesterol (high-density lipoprotein, HDL), “bad” cholesterol (low-density lipoprotein, LDL), and possibly triglycerides (another fat in the blood).

Your healthcare provider can help you make sense of it all, but consider focusing on LDL, or “bad,” cholesterol. This fatty substance can lead to the buildup of plaque, a thick, hard deposit in artery walls. Without intervention, plaque can clog arteries leading to the heart and brain, putting you at serious risk for a heart attack or stroke.

Down with the bad

American Heart Association guidelines say research doesn’t support “healthy” and “unhealthy” LDL ranges that apply to everyone. However, your provider may recommend treatment with lifestyle changes or medicine based on your gender, race, age, health history, and other heart-disease risk factors.

To help bring LDL down:

• Follow a heart-healthy diet. Control your intake of saturated and trans fats. Eat more soluble fiber found in beans and oatmeal.

• Maintain a healthy weight. Weight loss can benefit both LDL and HDL levels.

• Get regular physical activity. If possible, engage in aerobic exercise, such as brisk walking, cycling, or swimming laps. Get at least 150 minutes (2hours and 30 minutes) of moderate-intensity aerobic activity every week. Break down the 150 minutes into as many smaller sessions as needed.

• Quit smoking.

• Take cholesterol medicine if lifestyle changes aren’t enough. 

Up with the good

Meanwhile, don’t ignore HDL. The “good” cholesterol appears to protect against heart attack by slowing the growth of plaque in the arteries. That means you want this number to go up.

Some things you can do to lower bad cholesterol also tend to raise good cholesterol. For example, HDL tends to increase if you lose weight, increase your physical activity, and quit smoking.

And what about triglycerides? They’re another indicator of heart disease risk. Your level is likely to be high if you’re overweight, have diabetes or metabolic syndrome, eat a very high carbohydrate diet, or have a very high alcohol intake.

Cholesterol is part of a series of factors that affect your risk for heart disease, such as age, family history, smoking, diabetes, high blood pressure, and being overweight. All of these risk factors work together.