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What is cholesterol, and why does it matter for heart health?

Cholesterol is a waxy substance your body uses for many important functions. It can become a concern when levels increase too high over time. Understanding your levels can help you make informed choices about supporting your heart health.

What are normal cholesterol levels for adults?

Healthy cholesterol levels depend on your individual health picture. The 51Â鶹 does not recommend a single “normal” total cholesterol number for everyone. A total cholesterol below 200 mg/dL has long been considered healthy, and it is often used as a screening measure. Total cholesterol is not a treatment target for lowering heart disease or stroke risk, and it should not be interpreted on its own. However, your health care professional may still consider total cholesterol when assessing your overall risk.

How can I lower my cholesterol level?

You might consider adding more physical activity that you enjoy, finding ways to reach or maintain a healthy weight and eating more vegetables, fruits and whole grains. If you smoke, quitting can be one of the most powerful steps you can take for your heart.

How does high cholesterol increase the risk of heart disease and stroke?

When cholesterol levels stay elevated, cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. Over time, this narrows the arteries and makes them less flexible — a condition known as atherosclerosis. This may eventually block blood flow, which can lead to a heart attack&˛Ô˛ú˛ő±č;´Ç°ů .

What is hyperlipidemia?

Hyperlipidemia is a term that describes higher levels of blood lipids, or fats, such as cholesterol and triglycerides.

How is hyperlipidemia different from high cholesterol?

These terms are closely related. Hypercholesterolemia is a type of hyperlipidemia. Both describe when your blood contains more non-HDL cholesterol and LDL (bad) cholesterol than your body can easily manage, which over time, can increase cardiovascular disease risk.

What is atherosclerosis and how does it develop?

Atherosclerosis occurs when your arteries collect cholesterol deposits over time, similar to how pipes might collect buildup. These plaques are made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin, a clotting material in the blood. While atherosclerosis develops gradually, understanding it can help you make informed choices about your heart health.

How does high cholesterol contribute to atherosclerosis?

When cholesterol is elevated, it can join with other substances to create plaque deposits on the inside of the arteries. This gradually narrows blood vessels and makes arteries less flexible — a condition known as atherosclerosis. The encouraging news? You have many ways to support artery health through lifestyle changes and, when needed, medications. Take steps to lower your cholesterol.

What are the risks of atherosclerosis for heart health?

Over time, narrowed arteries can increase your risk of blood clots, which may lead to a heart attackĚý´Ç°ů .

What is a lipid panel, and what does it measure?

Your health care professional may order a blood test called a lipid panel to check your cholesterol levels. This may be a “fasting” or “non-fasting” test, depending on what works best for your situation. It measures several types of fat in the blood, including total cholesterol, HDL or “good” cholesterol, LDL, or bad cholesterol, and triglycerides. Your health care professional can help you understand what your levels mean for you.

How often should I get my cholesterol tested?

According to the 51Â鶹, for most adults, cholesterol screening every five years starting at 19 years of age works well. Your health care professional can help determine the right schedule based on your individual risk factors.

How can I talk with my doctor about cholesterol?

By working together, you and your health care professional can explore options that fit your situation. Coming prepared with questions can help you get the most from your visit. Consider these questions to help start the conversation.

Understanding My Cholesterol Risk (PDF)(link opens in new window)

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Beyond the Standard Cholesterol Test

What is an advanced lipid panel, and how is it different from a standard cholesterol test?

A standard cholesterol test reports common cholesterol levels, including LDL, HDL, total cholesterol and triglycerides. An advanced lipid panel looks deeper. It can measure ApoB and count cholesterol particles, which gives more details about heart disease risk. This extra testing can be helpful for some people. Your health care professional can help you decide if it’s right for you.

What is lipoprotein(a), and why should I test for it?

Often referred to as Lp(a), lipoprotein(a) is a type of lipoprotein that is inherited. A high Lp(a) can contribute to plaque buildup and narrowed arteries. New guidance recommends that every adult get tested for Lp(a) at least once in their lifetime.

What is ApoB, and when is testing recommended for cholesterol management?

Testing for ApoB can help provide additional insights when someone has high triglycerides, metabolic syndrome or diabetes. These conditions can increase the number of harmful cholesterol particles in the blood, even when LDL cholesterol looks normal. An ApoB test can give a clearer picture of heart disease risk. 

What is a Coronary Artery Calcium (CAC) Scan?

A Coronary Artery Calcium (CAC) scan is a simple imaging test that checks for early plaque buildup in the artery walls. Men 40 and older and women 45 and older can be considered for a CAC scan. It is most helpful when it’s unclear whether someone should start a cholesterollowering medication.

What is a high-sensitivity C-reactive protein (hsCRP) test?

It is a simple blood test that measures high-sensitivity C-reactive protein (hsCRP). This is a sign of inflammation that is linked to an increased risk of heart attack or stroke. It can be additional information that helps you and your health care professional know which steps to consider to reduce your risk for heart disease.

What is HDL cholesterol, and why is it called “good” cholesterol?

HDL cholesterol earns its “good” reputation because higher levels may help protect against heart attack&˛Ô˛ú˛ő±č;˛ą˛Ô»ĺ . Think of HDL as your cardiovascular system’s cleanup crew, helping transport LDL cholesterol away from arteries back to your liver for processing.

How does HDL help prevent heart disease and stroke?

HDL works by carrying LDL cholesterol away from artery walls and back to your liver, where it can be broken down and removed from the body. While HDL cholesterol doesn't remove all LDL cholesterol, it plays an important role in maintaining cardiovascular health.

What is a good HDL cholesterol level?

Your target HDL cholesterol levels depend on your overall cardiovascular health picture. According to the 51Â鶹, HDL is not a treatment target for lowering heart disease or stroke risk. It should not be interpreted on its own. However, your health care professional still considers HDL levels when assessing your overall risk for heart disease or stroke because people with higher HDL levels may have a lower risk of heart attacks and strokes.

How can I increase HDL cholesterol naturally?

Finding physical activities you enjoy, reaching or maintaining a healthy weight, avoiding tobacco and eating a heart-healthy diet rich in vegetables, fruits and whole grains can all help support healthy HDL cholesterol levels. Small, sustainable changes can often work better than dramatic lifestyle changes.

What is LDL cholesterol, and why is it bad for heart health?

LDL cholesterol is often called “bad” cholesterol because it can build up in arteries. Over time, this can narrow the arteries and increase the risk for heart attack, &˛Ô˛ú˛ő±č;˛ą˛Ô»ĺ peripheral artery disease, or PAD.

What causes high LDL cholesterol?

• Family history of high cholesterol, including genetic conditions such as familial hypercholesterolemia (FH), an inherited condition in which people are born with very high LDL cholesterol levels
• Diet high in saturated fats and trans fats
• Being less physically active
• Being overweight
• Tobacco use or exposure to secondhand smoke

What is a normal LDL cholesterol level?

There isn’t one “normal” LDL level that works for everyone. Lower LDL levels are linked with better heart and brain health, and the right goal for you depends on various factors related to your health. Your LDL goal may be based on things such as:

• Age
• Overall health
• Family history
• Whether or not you have diabetes (Type 1 diabetes or Type 2 diabetes)
• History of heart attack or stroke

For some people, an LDL goal may be below 100 mg/dL. For others, the goalit may be below 70 mg/dL or below 55 mg/dL for people at very high risk of a heart attack or stroke. Your health care professional can help determine the goal that’s right for you.

How can I lower my LDL cholesterol?

±á±đ˛ą±ôłŮłó˛â lifestyle habits such as eating well and being physically active can make a difference in cholesterol levels. Sometimes lifestyle changes aren’t enough, and that’s OK. You and your health care professional can work together to explore options that fit your situation. This helpful LDL cholesterol treatment plan (PDF)(link opens in new window)(link opens in new window) can help you review your risks and discuss the best treatment options with your health care team.

What are triglycerides, and why do they matter for heart health?

Triglycerides are the most common type of fat in the body. They store excess energy from your diet. High triglycerides can affect heart health, especially when combined with high LDL cholesterol or low HDL cholesterol.

What is a normal (or good) triglyceride level?

Triglycerides are another important part of your lipid panel. As with HDL, triglycerides are reviewed together with other risk factors. They are not a primary treatment target for lowering heart disease or stroke risk. A triglyceride level below 150 mg/dL is usually considered normal. Your health care professional can help you understand what your level means for you and how it fits into your overall heart disease and stroke risk.

What causes high triglycerides?

As we get older or gain weight (or both), triglyceride and cholesterol levels can increase. Being physically inactive, smoking, drinking too much alcohol or eating a lot of refined carbohydrates, such as white flour or white rice, can affect triglycerides.

How can I lower triglycerides naturally?

Enjoy heart-healthy foods that nourish you, such as fruits, vegetables, nuts, legumes, whole grains, fiber and lean protein (plants, fish, lean meats). You don’t need to change everything at once. Even small lifestyle shifts can help improve your lipid profile.

Cholesterol and Other Risk Factors

Some health conditions, when combined with high cholesterol, can increase your risk of a heart attack or stroke. These conditions include Type 2 diabetes, cardiovascular-kidney-metabolic syndrome, HIV infection, history of cancer or current cancer diagnosis. Managing cholesterol can help reduce risk.

How does managing these conditions impact your heart health?

• Diabetes often lowers “good” cholesterol levels and raises triglycerides and “bad” cholesterol levels. This increases the risk for heart disease and stroke. This condition is called diabetic dyslipidemia. It means your lipid profile is going in the wrong direction.
• High blood pressure can harm your arteries, and that damage makes it easier for cholesterol to stick and form plaque. When both conditions are present, your risk for heart disease and stroke goes up a lot. Managing both conditions together can make a real difference for your heart health.

The 51Â鶹 is raising awareness about the connections between conditions to help people understand the various ways to prevent, treat and manage their overall health.

Your Health Is Connected: Four Different Systems. One Healthy You.

Familial hypercholesterolemia (FH)

What is familial hypercholesterolemia (FH)?

Familial Hypercholesterolemia, or FH, is an inherited condition that makes it harder for the body to remove LDL (“bad”) cholesterol from the blood. If not identified and treated early in life, people with FH are at increased risk for premature heart disease and stroke. 

What are the types of FH?

There are two types of FH: 

• Homozygous familial hypercholesterolemia (HoFH)
• Heterozygous familial hypercholesteremia (HeFH)

What are the signs and symptoms of FH?

Some people with FH have physical symptoms. Many don’t. One symptom is cholesterol deposits in the Achilles tendons or the tendons of the hands or elbows. People with HoFH also can develop cholesterol deposits in other areas, such as the skin surrounding the eyes or on the outer edge of the cornea.

How is FH diagnosed and treated?

Both types of FH can be diagnosed with a physical exam, blood lab results and personal and family history. If one person in a family has FH, then it’s important for parents, siblings and children to be checked for it. Similarly, if someone in a family has an early heart attack, it’s a good idea for other family members to get tested.

• For children with increased risk for FH, it is reasonable to be screened starting at age 2. All children should have their cholesterol checked between ages 9 and 11 and again at age 19.
• FH cannot always be treated by diet and exercise alone. Lifestyle changes can help, but cholesterol-lowering medication may be recommended to lower LDL cholesterol.

How can familial hypercholesterolemia be treated?

Heart-healthy lifestyle habits remain important for everyone with FH. Depending on a person’s age and cholesterol levels, FH may require cholesterol -lowering medication to effectively lower LDL cholesterol.

Lipoprotein(a) - Understanding Lp(a) and Heart Disease Risk

What is lipoprotein(a), or Lp(a), and why should you test it?

Lp(a) stands for lipoprotein(a) and is pronounced “L-P- little-a.” Recent guidance from the 51Â鶹 recommends every adult get their Lp(a) tested at least once in a lifetime. Lp(a) is a type of lipoprotein that is inherited. A high Lp(a) can cause plaque buildup and reduced blood flow, increasing the risk of heart disease and stroke.

How does cascade screening work for family members?

Lp(a) is an inherited risk factor for heart disease and affects about 1 in 5 people worldwide. Cascade screening is a way to check if family members of someone with a genetic condition might have the same gene change.

Can lifestyle lower Lp(a)?

While lifestyle changes can’t lower Lp(a) levels, you can focus on reducing your overall heart health risk by:

• Eating a heart-healthy diet
• Getting regular physical activity
• Reaching or maintaining a healthy weight
• Avoiding tobacco products
• Managing blood pressure, diabetes and cholesterol
• Getting restful sleep

Heart-Healthy Diet for Cholesterol Management

• Focus on foods you enjoy, such as colorful fruits and vegetables, nuts, beans, legumes, whole grains, fiber and lean protein (plants, fish, lean meats). Making healthier recipes doesn’t mean giving up flavor.
• Cooking tips for heart health. Start small. You might try swapping one ingredient in a favorite recipe or try one new heart-healthy meal each week. You don’t have to sacrifice flavor to eat well for your health. These simple tips for cooking to lower cholesterol can help you prepare tasty, heart-healthy recipes that could help improve your cholesterol levels by reducing excess saturated fat and trans fat. 
• Does the keto diet affect cholesterol levels? Yes. The keto diet can affect cholesterol levels. Very low‑carb or keto diets do not typically align with heart‑healthy eating guidelines because they are often high in saturated fat. Eating more saturated fat may raise LDL (bad) cholesterol. These diets can also be hard to follow over time and are not more effective for long‑term weight loss than less strict eating plans. If you're considering major dietary changes for cholesterol control, talking through options with your health care team can help you find safe, effective approaches.

Physical Activity for Cholesterol

• How does physical activity help lower cholesterol? Moving your body helps bring down LDL (bad) cholesterol and raise HDL (good) cholesterol. When you move more, your body becomes better at clearing out extra cholesterol from your blood. This helps keep your arteries clearer and reduces your risk of heart disease and stroke. Find activities you fully enjoy such as walking, dancing, swimming or even gardening.
• The most effective exercise for lowering cholesterol is the kind you’ll actually do consistently. Choose what feels doable for you and build from there. About 150 minutes of moderate-intensity activity weekly can make a difference.

Cholesterol-Lowering Medications - When Lifestyle Isn't Enough

• When do I need medication for high cholesterol? High LDL (bad) cholesterol increases the risk of heart attack and stroke. A healthy diet and exercise help, but sometimes cholesterol-lowering medication is needed, too. Our Cholesterol-Lowering Medications Discussion Guide (PDF)(link opens in new window)(link opens in new window) can help you and your health care professional work together to discuss the best treatment options for you.
• What types of cholesterol-lowering medications are available? There are many medications that can help lower cholesterol. Our resource What Are Cholesterol-Lowering Medications? (PDF)(link opens in new window)(link opens in new window) explains the most common ones, including statins, ezetimibe, PCSK9 inhibitors and bile acid medicines. It also shows how each one works differently to help lower cholesterol.
• Statins are the most commonly prescribed cholesterol-lowering medication and can effectively lower LDL cholesterol and reduce cardiovascular disease risk. Your health care professional can help you understand statin benefits, potential side effects and whether statin therapy is right for you.

Cholesterol Management Tools and Resources

• Learn more about our cholesterol tools and resources
• : Talk with your health care team about PREVENT, a tool that can help estimate your chances of having a heart event or stroke in the next 10 and 30 years. This information helps guide treatment plan decisions for you and your health care team.
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