You’re doing everything right: you’re eating well, exercising regularly, and maintaining a healthy weight. But when your lab results show that you have high cholesterol, it can be both confusing and upsetting, especially if your other numbers seem within range.
Can you be healthy and still have high cholesterol? We asked two doctors to explain the impact of cholesterol levels on your overall health and why they may be high when everything else in your life suggests you’re healthy.
*These interviews have been edited and condensed for clarity.
According to Nandini Nair, MD, a cardiologist at Penn State Health and professor in the Department of Medicine, you can have high cholesterol and still look healthy. This means you probably have normal blood pressure, blood sugar, weight, and fitness levels.
“Cholesterol is just one component of cardiovascular health,” says Nair. “However, high LDL cholesterol, or bad cholesterol, remains an important risk factor because it contributes to the buildup of plaque in the arteries over time, even in people who feel well and have no symptoms.”
In some people, high cholesterol is sometimes due to genetics, such as familial high cholesterol, rather than lifestyle factors, Kavita Sharma, MD, FACC, a noninvasive cardiologist at OhioHealth and a diplomate of the American Board of Clinical Lipidology, told HEALTH.
“These people can have very healthy lifestyle habits while having high LDL-C cholesterol and therefore an increased risk of cardiovascular disease,” Sharma said. “The ACC/AHA dyslipidemia guidelines recommend that patients with a history of familial hypercholesterolemia achieve an LDL-C goal of less than 100 mg/dL and possibly lower.”
She added that familial chylomicronemia syndrome (FCS) is another disorder that can occur with high triglyceride levels. In this case, high cholesterol is due to a loss of function of lipoprotein lipase, an enzyme important for removing triglyceride-rich lipoproteins.
“Healthy” generally means the absence of major cardiovascular risk factors or diseases, Nair said. “Think normal blood pressure, normal blood sugar, healthy weight, non-smoker, regular physical activity, no known heart or vascular disease, normal kidney function, and overall metabolic health. »
So a person can be considered generally healthy while having just one abnormal risk factor like high cholesterol, Nair said. “Clinicians are increasingly assessing overall cardiovascular risk rather than focusing on a single number. »
Generally, plant-based diets, the Mediterranean diet and the DASH diet are also associated with lower cholesterol levels and better health, Sharma said. “Moderate-to-vigorous-intensity aerobic exercise 150 minutes per week and upper- and lower-body resistance exercises twice per week (are also) recommended.”
According to Nair, not all types of high cholesterol carry the same risk. “Risk depends on factors such as age and family history (and) high lipids: LDL, triglycerides, lipoprotein(a), etc.”
Health care providers also look at cholesterol levels, how long they have been high, and what other risk factors are present. “For example, high LDL cholesterol is more strongly associated with atherosclerotic cardiovascular disease because it promotes plaque formation in the arteries,” she said.
Meanwhile, high HDL cholesterol (good cholesterol) has a different association and is traditionally considered protective, although HDL alone does not eliminate the risk. Nair. “A person with a slightly elevated LDL level and no other risk factors may have a significantly different risk profile than someone with the same LDL level who also has diabetes, hypertension or smokes,” Nair said.
Your doctor does not look at your cholesterol level in isolation. “(Your) cholesterol values are integrated with other factors to estimate cardiovascular risk,” Nair said.
Some factors incorporated into the risk assessment, according to Nair, may include:
- Your age
- Sex assigned at birth
- Total cholesterol and HDL cholesterol
- Blood pressure
- Diabetes status
- Smoking status
- Family history
- Kidney disease
- Other medical conditions
- Scoring of coronary artery calcium (CAC)
- Additional lipid markers
“Modern guidelines recommend calculating an individual’s short- and long-term cardiovascular risk and then using cholesterol levels as part of the decision-making process regarding lifestyle changes and possible drug treatment,” Nair said.
If you get a blood test and your results show high cholesterol, don’t panic. Instead, find out what your next steps might be.
Generally, if you have familial high cholesterol and a personal or family history of atherosclerotic cardiovascular disease (a chronic condition in which plaque builds up inside your arteries and narrows them), the goal is to lower your cholesterol levels, Sharma said. It could also reduce your risk of heart disease.
Even if you have few risk factors and your LDL cholesterol level is above 160 mg/dL, your doctor may still recommend taking steps to lower your cholesterol levels, Sharma said.
Overall, high cholesterol doesn’t automatically mean you’re at risk of heart attack or heart health problems. But it is a risk factor that you need to pay attention to and address. Talk to your doctor about what your cholesterol numbers mean for your heart health. They can tell you what steps can help you lower your cholesterol levels and reduce any risk factors you may have.
Gn Health
