Although regular aerobic exercise helps improve a person’s blood lipid profile, athletes can have high cholesterol. Diet, lifestyle factors, and genetics can contribute to cholesterol levels.

Excess cholesterol increases an individual’s risk of heart disease, stroke, and other health conditions. High cholesterol typically means levels of 200 milligrams per deciliter (mg/dl) and above.

While cholesterol levels generally increase with age, doctors recommend screening in childhood. If a screening test indicates an individual has high cholesterol, their doctor may recommend lifestyle changes and medications to lower their levels.

Read more to learn about high cholesterol in athletes, how it can affect athletic performance, treatment options, and more.

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According to the Centers for Disease Control and Prevention (CDC), high cholesterol affects around 12% of people over 20 years in the United States. Although it is a common condition, research into the effects of high cholesterol on athletic performance is scarce.

However, the CDC notes that large-scale population studies confirm that high blood cholesterol raises the risk of heart disease and stroke.

Sudden cardiac death (SCD) is the most common medical cause of sudden death in athletes. A 2016 study estimates it occurs in between 1 in 40,000 and 1 in 80,000 athletes per year. Among competitive athletes, these deaths often occur in young and otherwise healthy individuals.

The same study states that SCD is more common in older athletes during regular sports, affecting around 21 per 1 million participants annually.

The most common cause of SCD in older athletic populations is coronary artery disease. Therefore, high cholesterol may contribute to SCD in athletes.

High cholesterol in endurance athletes is possible. However, the opposite is usually true in very active individuals.

Typically, regular aerobic exercise increases HDL, or “good” cholesterol, and decreases LDL, or “bad” cholesterol. These effects vary depending on a person’s health, their diet, and the type of activity they do.

However, high levels of training combined with a high fat ketogenic diet may produce different results.

A 2018 study compared ultra endurance runners consuming low carbohydrate, high fat diets to those consuming high carbohydrate diets. The researchers found that total cholesterol, LDL cholesterol, and HDL cholesterol were significantly higher in the low carbohydrate diet group. They also had lipoprotein profiles consistent with higher insulin sensitivity.

Despite their high levels of exercise, they still had higher cholesterol levels.

The researchers said one possible explanation for this may be that athletes adopting ketogenic diets experience changes in their liver’s cholesterol pool. This means they then maintain greater circulating cholesterol levels.

Laboratories measure cholesterol in a lipoprotein panel test that shows a person’s cholesterol levels in mg/dl.

Total cholesterol

Total cholesterol is the measure of overall blood cholesterol. It combines LDL cholesterol and HDL cholesterol.

For adults, levels are classified as:

CategoryTotal cholesterol
healthy<200 mg/dl
borderline high200–239 mg/dl
high>239 mg/dl

In addition to age and gender, an individual’s ethnicity can affect their cholesterol levels.

For example, the prevalence of high total cholesterol of 240 mg/dl or higher is:

  • 14.8% in non-Hispanic white women and 10.9% for men
  • 9% in Hispanic women and 13.1% for men
  • 10.3% in Black women and 10.6% for men
  • 10.3% in non-Hispanic Asians and 11.3% for men

LDL cholesterol

LDL often goes by the term bad cholesterol as it causes plaque formation in the arteries.

For adults, levels are classified as:

CategoryLDL cholesterol
healthy<100 mg/dl
borderline high130–159 mg/dl
high160–189 mg/dl
very high>190 mg/dl

HDL cholesterol

HDL cholesterol helps remove LDL cholesterol from the bloodstream. Therefore, it also goes by the term good cholesterol.

Healthy levels are 40 mg/dl or higher in adult males, 50 mg/dl or higher in females, and 45 mg/dl in children and adolescents under age 19. Doctors classify below 40 mg/dl as low and 60 mg/dl as high in adults.

Cholesterol levels typically increase as an individual gets older.

Therefore, screening recommendations increase in line with age. Doctors recommend people get screened per the following guidelines:

  • Children age 19 or younger: First screening between ages 9–11 years and repeated every 5 years. Doctors may recommend screening as early as age 2 years if the family has a history of high cholesterol or cardiovascular disease risk factors.
  • Age 20–45: Screening every 5 years.
  • Males age 45–65: Screening every 1–2 years.
  • Females age 55–65: Screening every 1–2 years.
  • Older than 65: Yearly screenings.

Usually, males have higher cholesterol levels than females. In females, cholesterol levels rise after menopause.

People can reduce their cholesterol levels with a combination of lifestyle changes and medications.

Lifestyle changes

A doctor may recommend an individual make the following lifestyle changes:

  • Heart-healthy eating: This involves limiting dietary sources of saturated and trans fats and encourages eating a range of nutritious foods such as fruits, vegetables, whole grains, and lean meats. Some research shows the Mediterranean diet may help reduce cholesterol in people with high cholesterol.
  • Weight management: If an individual is overweight, reducing body fat may lower LDL cholesterol. This is particularly important for those with metabolic syndrome. However, it is important to note that being overweight does not mean a person has high cholesterol.
  • Doing physical activity: Experts recommend 30 minutes of physical activity every day.
  • Managing stress: Chronic stress can increase LDL cholesterol and decrease HDL cholesterol.
  • Quitting smoking: People who stop smoking may notice their HDL cholesterol increases, lowering harmful LDL cholesterol.


If individuals cannot sufficiently lower their cholesterol through lifestyle changes, a doctor may recommend medications. Options include:

  • statins to prevent the liver from making cholesterol
  • bile acid sequestrants to decrease dietary fat absorption
  • cholesterol absorption inhibitors to decrease dietary cholesterol absorption and lower triglycerides
  • nicotinic acid to lower LDL cholesterol and triglycerides and increase HDL cholesterol

There are many myths about cholesterol. People may have some common misconceptions, including:

  • All cholesterol is bad: This is untrue. Some forms of cholesterol or essential for health, and the body needs cholesterol to make hormones and build cells. Although LDL cholesterol is bad and increases the risk of heart disease and stroke, HDL cholesterol helps the body metabolize LDL cholesterol, reducing heart disease and stroke risk.
  • People who exercise cannot have high cholesterol. As stated earlier, this is also untrue. Although being physical activity can reduce a person’s cholesterol, diet and other lifestyle factors can still cause athletes to have high cholesterol.
  • A person can tell if they have high cholesterol. This is a myth. High cholesterol usually has no signs or symptoms, and an individual may not know they have it until they have a heart attack or stroke.
  • A person does not need cholesterol medication if they exercise. Although many people can achieve healthy cholesterol levels with these measures, other individuals also need medications such as statins. These include individuals with familial hypercholesterolemia (FH), cardiovascular disease, and diabetes.

Although active people usually have lower cholesterol levels, athletes can have high cholesterol. In particular, a high fat, low carb diet has been linked to higher cholesterol levels in ultra endurance athletes.

High cholesterol increases the risk of heart disease, which is an underlying factor in sudden cardiac death among athletes. If an individual has high cholesterol levels, their doctor may recommend lifestyle changes and medication.