High cholesterol and weight: What to know

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There are two types of cholesterol: low-density lipoprotein (LDL) cholesterol, which people may refer to as “bad” cholesterol, and high-density lipoprotein (HDL), or “good,” cholesterol.

A high LDL level may increase plaque buildup in the arteries, leading to heart disease.

However, an optimal HDL level may reduce the risk of heart disease. HDL transports cholesterol from the arteries to the liver, where the liver can break it down and eliminate it.

According to the American Heart Association (AHA), high cholesterol can affect people of any weight. However, being overweight may raise the risk of high cholesterol by causing LDL cholesterol levels to increase and HDL levels to decrease.

Research indicates that a weight loss of 5–10% of body weight may significantly reduce LDL cholesterol levels in people at higher risk of cardiovascular issues. Another study suggests that a weight reduction of just 1–3% may improve HDL cholesterol levels.

Some people inherit high cholesterol, in which case, it is known as familial hypercholesterolemia.

However, people can take steps to prevent the other causes of high cholesterol, which include:

• eating a diet high in saturated and trans fats, sodium, added sugars, and processed foods
• smoking or exposure to secondhand tobacco smoke
• excess body weight
• a sedentary lifestyle and lack of physical activity
• metabolic syndrome, which is a collection of risk factors that may increase the risk of heart disease, stroke, and diabetes

High cholesterol does not usually cause any symptoms. However, if people have very high levels, they may have fatty bumps on the skin and gray-white rings around the corneas of the eyes.

These symptoms are more common in people who have familial hypercholesterolemia.

A doctor can check cholesterol levels by performing a blood test known as a lipid profile. In some cases, they might ask the person to fast for 9–12 hours before taking the test.

A lipid profile reveals the levels of total, LDL, and HDL cholesterol in the body, as well as the levels of triglycerides, a type of fat.

According to the National Heart, Lung, and Blood Institute, doctors use the following ranges to determine whether a person’s cholesterol levels are high:

Total cholesterol

• desirable: less than 200 milligrams per deciliter (mg/dl)
• borderline high: 200–239 mg/dl
• high: 240 mg/d or above

LDL cholesterol

• optimal: less than 100 mg/dl
• close to or above optimal: 100–129 mg/dl
• borderline high: 130–159 mg/dl
• high: 160–189 mg/dl
• very high: 190 mg/dl or above

HDL cholesterol

• protective against heart disease: 60 mg/dl and above
• medium risk: 40–59 mg/dl
• serious risk factor for heart disease: less than 40 mg/dl

Some people have risk factors that raise their likelihood of having high cholesterol levels, but many of these risk factors are modifiable. They include:

Genetics

People of any age with a family history of high cholesterol or early heart disease may have an increased risk of high cholesterol.

Weight

Obesity is a risk factor for high cholesterol. Having excess body weight may increase LDL cholesterol and lower HDL cholesterol.

Smoking

Smoking may increase the risk of high cholesterol. The carbon monoxide in cigarette smoke may cause increased deposition of cholesterol within the arteries, which can cause them to harden and raise the risk of heart disease.

Nicotine may also increase the risk of heart disease by causing the arteries to narrow.

Other factors

Other risk factors for high cholesterol include:

• metabolic syndrome
• chronic kidney disease
• chronic inflammatory conditions, including psoriasis and rheumatoid arthritis
• HIV
• menopause before the age of 40 years
• preeclampsia during pregnancy
• a sedentary lifestyle

Doctors may recommend that people take steps to help maintain healthy cholesterol levels by:

• increasing physical activity — the AHA recommend 150 minutes a week of moderate intensity aerobic exercise, such as cycling, swimming, or brisk walking
• quitting smoking and avoiding exposure to secondhand smoke
• eating a healthy diet, including a range of fresh fruits and vegetables, whole grains, nuts, lean poultry, and fish
• limiting red meat, processed foods, sodium, added sugars, fried foods, and saturated and trans fats

For some people, a doctor may prescribe medication in addition to recommending lifestyle and dietary changes. Statins are the most common medication for lowering LDL cholesterol and reducing the risk of heart disease.

According to the AHA, everyone over the age of 20 years should see their doctor for a cholesterol check every 4–6 years.

The AHA also recommends that young people have a cholesterol check once between the ages of 9 and 11 years and once between the ages of 17 and 21 years.

It is important that people see their doctor if they have a family history of high cholesterol and are experiencing symptoms.

High cholesterol can increase the risk of heart disease. High cholesterol can affect people of any weight, age, and sex. Individuals with a family history of high cholesterol might also inherit high levels.

High cholesterol risk factors include:

• smoking
• excess body weight
• a sedentary lifestyle
• a diet high in saturated fats

Eating a healthy diet, exercising regularly, and maintaining a healthy weight may help reduce high cholesterol. Sometimes, people may also need medication such as statins.