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What Is the Difference Between Good and Bad Cholesterol?

Cholesterol has gotten a terrible reputation because of its contribution to cardiovascular disease. Cholesterol is a waxy substance essential for cell membrane formation and producing bile, vitamin D, and steroid hormones. About three-quarters of your body’s cholesterol is made in your liver, and the rest comes from your diet.

Excess cholesterol is deposited on the inner lining of your blood vessels, causing inflammation, damage, and atherosclerosis. When these plaques of waxy cholesterol and other fats rupture, blood clots can form on the damaged blood vessel lining, which can increase your risk for heart disease and strokes.

According to the Centers for Disease Control and Prevention, about 35% of U.S. adults have elevated cholesterol levels, with 10% having high cholesterol levels.1

What Is Good Cholesterol?

High-density lipoproteins (HDLs) are one of the two primary types of cholesterol. Increased HDL cholesterol levels benefit your health because HDL cholesterol travels through the bloodstream and picks up cholesterol left on the blood vessel walls. It transports this excess cholesterol back to the liver.

Because HDL cholesterol removes excess cholesterol from blood vessel walls, having high HDL cholesterol levels is good for your health.

Genetic factors, diet, smoking, increased body mass index, and physical inactivity can reduce HDL cholesterol.2,3,4

Sources

Consume unsaturated fats, vegetable oils, and nuts to boost your HDL cholesterol levels. A high-fiber, plant-based diet is an excellent choice.

A heart-healthy diet that increases HDL cholesterol includes:

  • Avocados
  • Oatmeal
  • Nuts
  • Olive oil
  • Fruits
  • Vegetables
  • Fatty fish
  • Soy

Health Impacts

Healthy HDL cholesterol levels protect your cardiovascular system by removing excess cholesterol from your bloodstream and blood vessels. This can reduce your risk of blood clots, heart disease, and strokes.

How To Boost Your Good Cholesterol

If your HDL cholesterol levels are too low, consider whether you can make improvements in any of the following lifestyle factors:

  • Consume a healthy diet: Choose foods low in saturated and trans fats; avoid processed foods and sugar.
  • Manage your weight: If you are overweight or have obesity, talk to your doctor about how to best manage your weight. Carrying excess abdominal weight is a risk factor for heart disease.
  • Exercise: Try to do at least 30 minutes of moderate-to-vigorous exercise daily. Choose fun activities and make them an important part of your daily routine.
  • Stop smoking: If you smoke or are exposed to second-hand smoke, this can lower your HDL levels. If you cannot quit smoking, talk to your doctor about a smoking cessation plan.
  • Limit alcohol consumption: Alcohol is high in calories, and it may lower HDL levels.

What Is Bad Cholesterol?

Low-density lipoprotein, often referred to as “bad cholesterol,” contributes to blood vessel disease. LDL cholesterol carries cholesterol from the liver to body cells, including the ones lining blood vessel walls. When cholesterol accumulates in these cells, it causes plaques. This is called atherosclerosis.

When plaques form on the lining of blood vessels, the vessel narrows. The plaque may rupture if inflamed, increasing the risk of a blood clot developing. If a blood clot forms and travels to the heart or the brain, it can cause a heart attack or a stroke.

Sources

Most LDL cholesterol is produced in the liver. Foods that can contribute to increased LDL cholesterol include saturated and trans fats and highly processed foods.

Avoid or minimize consumption of foods such as:

  • Red meat
  • Organ meats
  • Full-fat dairy products
  • Coconut and palm oil
  • Processed foods
  • Fried foods
  • Some margarines
  • Chips
  • Crackers
  • Baked goods
  • Hot dogs, sausages, and bacon
  • Coconut oil

Eggs and shellfish may increase LDL cholesterol in some people.

High cholesterol foods

Health Impacts

Increased LDL cholesterol increases your risk of heart disease. Metabolic disease, obesity, type 2 diabetes, high blood pressure, and high cholesterol share similar risk factors and can all increase your risk for cardiovascular disease.

There is a strong correlation between obesity and heart disease because obesity is typically associated with insulin resistance, high blood pressure, and high cholesterol. Carrying excess weight can also put a strain on the heart.

In this complete guide to hypertension, you may note that high blood pressure, like high cholesterol, is a silent disease that affects blood vessels and can increase your risk of heart disease, including cardiac arrests and heart attacks.

Tips for Lowering Bad Cholesterol

Tips for lowering bad cholesterol are similar to the ones for raising HDL cholesterol. Choose a heart-healthy diet and make physical activity part of your daily life. Choose one of the many new and upcoming wearable devices that can help you track your weight, calorie consumption, and exercise.

Even a five-pound weight loss can significantly affect your cardiovascular health. Walking throughout the day is one of the easiest heart-healthy exercises you can choose. Start slow. Increase your pace and walking incline as you gain confidence and fitness. Of course, before starting any exercise program, talk to your doctor to verify whether you have any exercise restrictions.

Lipid panel blood tests

Understanding Cholesterol Levels

Cholesterol levels are measured when you send a blood sample to your lab. Your blood sample is evaluated, and the results are reported as part of a lipoprotein panel.

If you are age 19 or younger:

  • Have your cholesterol checked between the ages of 9 and 11
  • Have your cholesterol rechecked every 5 years

If you are age 20 or older:

Men:

  • Under age 45: have cholesterol checked every 5 years
  • Between 45 and 65: have your cholesterol checked every 1 to 2 years

Women:

  • Under age 55: have your cholesterol checked every 5 years
  • Age 55 to 65: have your cholesterol checked every 1 to 2 years

Total Cholesterol

Total cholesterol is HDL level + LDL level + 20% triglyceride level.

  • Desirable total cholesterol: Less than 200 mg/dL
  • Borderline high total cholesterol: 200–239 mg /dL
  • High total cholesterol: 240 mg/dL and above

Optimal triglyceride levels are <150 mg/dL

Your total cholesterol level is one measurement your doctor can use to predict your heart disease and stroke risk. If your risk is elevated, your doctor may recommend lifestyle changes to decrease your cholesterol levels and medications if it remains high.

HDL (good cholesterol)

Optimal HDL cholesterol levels vary by sex:

  • Men: Optimal ≥ 40 mg/dL; Low ≤ 40 mg/dL
  • Women: Optimal ≥ 50 mg/dL; Low ≤ 50 mg/dL

Losing excess weight, increasing physical activity and exercise, reducing consumption of refined carbohydrates and saturated fats, stopping smoking, and ensuring your blood sugar is within normal limits can help increase your HDL cholesterol levels.

LDL Cholesterol

According to Medline Plus, LDL cholesterol levels are considered:

  • Optimal: less than 100 mg/ dL
  • Near or above optimal: 100-129 mg/dL
  • Borderline high: 130-159 mg/dL
  • High: 160-189 mg/dL
  • Very high: 190 mg/dL and above
A patient consulting with a doctor

When To Seek Treatment

If you have had your cholesterol levels checked and they are not optimal, reach out to a doctor on the TelegraMD platform to discuss your risk for heart disease, get an online diagnosis, and, if appropriate, receive an online prescription to lower your cholesterol and reduce your risk of heart disease.

Over the last few decades, the link between cholesterol and heart disease has been questioned. Many researchers believe that the relationship between cholesterol and heart disease is not as direct as it may seem.

Telehealth is a perfect option for busy people who want to stay on top of their health. It is easy to schedule an appointment to receive expert advice, and most likely, the consultation will cost less than an in-person visit.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References

1. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8). https://doi.org/10.1161/cir.0000000000001123

2. Stadler JT, Marsche G. Obesity-related changes in high-density lipoprotein metabolism and function. Int J Mol Sci. 2020 Dec;21(23):8985. doi:10.3390/ijms21238985

3. Ruiz-Ramie JJ, Barber JL, Sarzynski MA. Effects of exercise on HDL functionality. Curr Opin Lipidol. 2019 Feb;30(1):16-23. doi:10.1097/MOL.0000000000000568

4. He BM, Zhao SP, Pen ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013 Nov;114(11):2431-6. doi:10.1002/jcb.24581