If you have no idea what your cholesterol levels are, you’re not alone. The truth is, many people don’t know their numbers — but we all should.
Here’s what you need to know about cholesterol, how to get your cholesterol checked and how to prevent high cholesterol.
What cholesterol is
Cholesterol is a fat-like substance that circulates in our blood. It’s made by the liver and transported in the blood to cells, which use it for key functions such as building cell membranes and making hormones. Because of this, cholesterol is actually a good thing — unless someone has too much of it.
Excess cholesterol can build up in blood vessel walls and narrow them, increasing the risk of heart attack or stroke.
People can have excess cholesterol from a genetic condition passed on in their family called familial hypercholesterolemia. Other things like what you eat, how old you are, and whether or not you smoke — among many other factors — contribute to cholesterol levels. More on that shortly.
Good versus bad cholesterol
You’ve probably heard someone refer to “good” cholesterol and “bad” cholesterol before. Good cholesterol, also known as high-density lipoproteins or HDL, helps transport bad cholesterol from different parts of the body to the liver, helping prevent cholesterol buildup in arteries.
“A high level of good cholesterol can actually counteract bad cholesterol,” says Dr. Matthew Jaffy, a family medicine physician and associate medical director of UW Neighborhood Clinics.
Bad cholesterol, also known as low-density lipoproteins or LDL, is only bad in larger amounts — a little bit of it isn’t harmful, and everyone has some in their body.
One major factor that contributes to how much good or bad cholesterol someone has is the food they eat. Foods that heighten bad cholesterol are things that are high in saturated fats, like red meat and dairy products, and foods high in trans fats, like fried foods.
Eating some red meat and dairy can be part of a healthy diet, but Jaffy recommends cutting out trans fats entirely if possible.
Foods that help promote high levels of good cholesterol are foods that have lots of healthy fats, like salmon, olive oil and avocados.
How doctors determine risks for high cholesterol
There’s no single number that means someone has high cholesterol, Jaffy says. Though doctors often use 200mg/dL as a reference that total cholesterol (HDL, LDL and a portion of other types of cholesterol combined) shouldn’t exceed, that’s more of a starting point than a final answer.
“I have younger, healthy patients with cholesterol above 200, which is fine and we’re just monitoring it, but I have other patients where a number of 200 might be too high for them,” Jaffy says.
There usually aren’t any symptoms of high cholesterol, so doctors individually assess a patient’s risk based on several different factors, such as age and birth sex. Having high blood pressure or diabetes, being a smoker or having familial high cholesterol increases someone’s risk for high cholesterol.
To understand a patient’s individual risk, doctors input the patient’s risk factors into a database that compares their information to data from thousands of patients from past cholesterol-related research studies.
A higher risk would typically mean doctors would advocate for more aggressive treatment, Jaffy says. But ultimately it comes down to working one-on-one with the person.
“Although we do use these studies and these data, one thing I tell patients is, ‘You are an individual, we have to make a decision about what the formula is telling us versus what makes sense for your life,’” he says.
How (and why) to get your cholesterol checked
It’s pretty easy to find out your cholesterol numbers — all it requires is an ordinary blood test. You can do this via an at-home device that takes a blood sample, a kit that requires you to send your blood to a lab, or, of course, at your doctor’s office.
Whichever you choose, Jaffy recommends going over the results with your doctor.
“The interpretation of those numbers can require nuance, so it can be helpful to work with someone who has expertise, like a primary care doctor or specialist they have already,” he explains.
As we mentioned earlier, numbers alone can’t necessarily tell you whether you have high cholesterol. Understanding what your numbers mean for you as an individual by taking into account your health habits and preexisting medical conditions is the only way to truly determine risk.
The American Heart Association recommends getting your cholesterol checked every four to six years if you’re over age 20 and relatively healthy. If you’re older or have other risk factors, such as high blood pressure, it’s a good idea to get your cholesterol checked more often.
It’s also important not to make assumptions about your cholesterol, Jaffy says. Just because you’re young and healthy doesn’t automatically mean your cholesterol is low, especially since things like genetics can come into play.
“In residency, one of my classmates who was a young healthy guy and an avid cyclist was on cholesterol medication. It was a wake-up call,” he says.
How to prevent high cholesterol
Everyone can take steps to increase their good cholesterol and decrease their bad cholesterol, which will help prevent high cholesterol from developing or worsening.
“The first thing I always talk with people about for treatment is what is it that we can control? What behavioral choices can someone make to improve cholesterol?” Jaffy says.
One of the most important factors in having high levels of good cholesterol, Jaffy says, is exercise. It doesn’t matter what kind of exercise it is — walking, yoga, trail running or working out at home — as long as someone enjoys it enough to do it consistently.
What you eat is also important, both for lowering bad cholesterol and increasing good cholesterol. Eating lots of fruits and vegetables and choosing healthy fats over unhealthy ones is helpful, as is limiting foods high in saturated and trans fats.
For people who are overweight, losing weight can help lower cholesterol — though Jaffy wants people to know that it really depends on the individual and their overall health.
“I have patients who are overweight and have fantastic cholesterol, and I have patients who are overweight and have terrible cholesterol,” he says.
Quitting smoking or vaping can help lower or prevent high cholesterol, too.
For people who have genetic high cholesterol, these things are unfortunately less helpful (though still important for overall health). That’s because only some of the cholesterol in our blood comes from our behaviors — like what we eat and how often we exercise — whereas the rest comes from our body itself regardless of what we do, Jaffy says.
In this case or in the case of someone who already has high cholesterol, taking medication might be a good idea.
“Most patients with familial high cholesterol benefit from being on medication. There are lots of medications now that work well,” Jaffy says.
He also says he regularly gets questions about whether or not certain natural supplements can help. While he doesn’t discourage patients from trying something that is really important to them, he also doesn’t want them to get their hopes up.
“Some of those supplements do carry risks as well, so it’s definitely worth getting guidance from a doctor if they’re going to try something like that,” he explains.
The bottom line
Getting your cholesterol checked is important because high cholesterol has no symptoms but can lead to health problems like heart attack or stroke down the road. When you get your cholesterol numbers, it’s important to consult with your doctor because what is high for one person might be OK for someone else. And if you’re concerned about high cholesterol, there are plenty of ways — including eating healthy, exercising, quitting smoking and taking medication — that can help.