Smoking encourages the buildup of plaques containing various substances in the arteries, including cholesterol. This can have serious implications for a person’s heart health.

Low-density lipoproteins (LDL), or “bad” cholesterol, can cause plaque buildup. Plaque comprises a combination of fat, cholesterol, and other substances that aggregate together and interrupt blood flow. Typically, smoking increases the level of LDLs in the bloodstream.

Smoking can also reduce the amount of high-density lipoproteins (HDL), or “good” cholesterol, in the bloodstream. HDL plays an important role in regulating cholesterol levels in general.

Either of these effects may lead to elevated cholesterol levels. Too much cholesterol may lead to increased risks of heart disease and stroke.

Keep reading to learn more about how smoking might cause high cholesterol.

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Cholesterol has a bad reputation, but as the American Heart Association (AHA) explains, it is not inherently bad. The body makes this waxy substance to form cells, vitamins, and hormones.

LDLs take cholesterol from the liver and transport it around the body, specifically to repair cell damage.

HDLs take cholesterol from the circulating blood and return it to the liver so that the body can remove it.

Problems can arise when cholesterol in the body becomes unregulated. People with high cholesterol may not always have symptoms. For this reason, an adult should typically have a professional check their cholesterol levels every 4–6 years. However, people who smoke may require more regular checkups.

Learn more about the typical ranges of cholesterol in the blood.

According to the Centers for Disease Control and Prevention (CDC), smoking causes 1 in 4 deaths from cardiovascular disease in the United States.

Smoking can have various damaging effects on the body, including:

  • lowering HDL cholesterol
  • increasing plaque buildup in blood vessels
  • damaging the walls of arteries

Damage to the artery wall can trigger cholesterol to travel to the area. In turn, this may potentially lead to blockages. Additionally, reduced HDL levels mean less cholesterol travels out of the bloodstream and back to the liver. Both actions may increase the body’s cholesterol levels.

According to a 2015 study, a substance called acrolein interferes with HDL’s ability to effectively transport cholesterol back to the liver. This can lead to plaque formation. Tobacco smoke contains high amounts of acrolein.

Additionally, the AHA specifically links carbon monoxide (CO) in cigarette smoke to increased cholesterol levels.

People who smoke inhale this toxic gas. Once it reaches the lungs, it travels into the bloodstream and reduces the amount of oxygen red blood cells can receive. All the while, the CO increases the number of cholesterol deposits in the arteries. Over time, these actions can lead to the hardening of the arteries.

Hardening of the arteries can cause heart and artery disease. Potentially, it could also cause a heart attack.

Is it a heart attack?

Heart attacks occur when there is a lack of blood supply to the heart. Symptoms include:

  • chest pain, pressure, or tightness
  • pain that may spread to arms, neck, jaw, or back
  • nausea and vomiting
  • sweaty or clammy skin
  • feeling of heartburn or indigestion
  • shortness of breath
  • coughing or wheezing
  • lightheadedness or dizziness
  • anxiety that can feel similar to a panic attack

If someone has these symptoms:

  1. Dial 911 or the number of the nearest emergency department.
  2. Stay with them until the emergency services arrive.

If a person stops breathing before emergency services arrive, perform manual chest compressions:

  1. Lock fingers together and place the base of hands in the center of the chest.
  2. Position shoulders over hands and lock elbows.
  3. Press hard and fast, at a rate of 100–120 compressions per minute, to a depth of 2 inches.
  4. Continue these movements until the person starts to breathe or move.
  5. If needed, swap over with someone else without pausing compressions.

Use an automatic external defibrillator (AED) available in many public places:

  1. An AED provides a shock that may restart the heart.
  2. Follow the instructions on the defibrillator or listen to the guided instructions.

The risk of coronary heart disease also increases in people who smoke and already have high cholesterol levels. Other contributing factors may also increase the risk of heart disease, such as high blood pressure and diabetes.

Quitting smoking is one of the best ways to improve cholesterol levels, heart health, and overall health.

Quitting can help reduce the level of LDLs in the bloodstream. At the same time, it can also increase the level of HDLs, which help the body remove cholesterol. This has a protective effect on the arteries.

Learn more about how a person can lower their cholesterol levels.

Quitting smoking provides a range of health benefits to a person beyond improving their heart health. As soon as a person stops smoking, their risk of heart disease and various other health problems begins to decrease.

The benefits of quitting also increase further over time. For example, the following changes can occur within the specified time periods after quitting smoking:

Time periodChanges
Within hoursThe heart rate normalizes, and toxic chemicals begin to leave the blood.
Within daysBreathing gets easier, and the senses of taste and smell improve.
Within weeksThe blood is less sticky, and the risk of a heart attack begins to decrease.
Within monthsCirculation improves, energy levels increase, and exercise gets easier.
Within a 1 yearCoughing and wheezing reduce as the lungs can inhale more air.
1–15 yearsThe risk of heart disease and heart attack decreases by one-half.
More than 15 yearsA person’s health returns to around the levels of someone who has never smoked.

Other positive effects may include healthier skin and reduced stress or anxiety.

The CDC and National Cancer Institute provide support to people who smoke and would like to try quitting. This includes 1-800-QUIT-NOW, which is the portal to a network of individual state quitlines.

These services can help someone access the following:

  • counseling
  • referrals to local programs
  • free or reduced-cost smoking cessation aids

People can also talk with their doctor. They may be able to recommend other services and support groups to help quit smoking.

Learn more about smoking cessation aids.

Smoking can reduce HDLs — “good” cholesterol — and increase LDLs —”bad” cholesterol — in the blood. Both actions can cause damage to blood vessels.

This damage causes blockages that narrow the arteries. In turn, this increases a person’s likelihood of developing cardiovascular diseases or stroke. People may experience a heart attack, which is a medical emergency requiring immediate attention from a doctor.

However, people can help manage their high cholesterol and reduce their risk of disease by quitting smoking.