Cholesterol, a fatlike substance, travels around in your bloodstream in high-density lipoproteins (HDL) and low-density lipoproteins (LDL):

  • HDL is known as “good cholesterol” because it picks up cholesterol and takes it back to the liver for disposal.
  • LDL carries cholesterol to the parts of your body that need it. It’s sometimes referred to as “bad cholesterol” because if you have too much of it in your bloodstream, it can cling to the walls of your arteries, eventually clogging them.

Narrowed or blocked arteries can prevent blood from reaching your heart, brain, or other organs. This can lead to stroke, heart attack, or even heart failure.

Your liver produces all the cholesterol you need. But you can also get a lot of cholesterol from food.

In general, high levels of HDL and low levels of LDL help reduce the risk of heart disease.

For decades, research has indicated that diet and cholesterol play a role in heart health. More recent research suggests that the connection may be more complex than has been thought.

The association between cholesterol and heart disease

The 2010 Dietary Guidelines for Americans specifically limited dietary cholesterol to no more than 300 milligrams per day. While the 2015–2020 Dietary Guidelines for Americans doesn’t include a specific limit, it still strongly recommends eating as little dietary cholesterol as possible. It mentions studies and trials that have produced strong evidence that healthy eating patterns that are low in dietary cholesterol can reduce the risk of heart disease in adults.

An eight-week study published in 2016 stated that elevated LDL is an established risk factor for heart disease and that dietary fatty acids play a significant role in the development of heart disease. The researchers found that making minor dietary changes (in this case, replacing a few regularly eaten foods with better fat-quality alternatives) reduced cholesterol and could potentially reduce future risk of heart disease.

Researchers raise questions

Newer research questions the role cholesterol plays in the development of heart disease.

A systematic review published in 2016 found that people over 60 years old who have high LDL cholesterol live as long or longer than people with low LDL. The researchers suggest reevaluating the guidelines for heart disease prevention in older adults.

It’s worth noting that this review has some limitations. The team chose studies from only one database and only those published in English. The review didn’t look at HDL cholesterol levels, other health or lifestyle factors, or use of cholesterol-lowering medications.

More research on cholesterol, particularly dietary cholesterol, needs to be done. Even so, it’s clear that diet plays an important role in heart health and overall health.

Trans fats and saturated fats

Trans fats raise your LDL cholesterol and lower your HDL cholesterol. Both of these changes are associated with increased risk of heart disease, according to the American Heart Association. Trans fats also offer no nutritional value.

Partially hydrogenated oils (PHOs) are the main source of trans fat in our diets. They’re found in many types of processed foods.

In 2018, the U.S. Food and Drug Administration (FDA) made a final determination that PHOs aren’t safe for human consumption. They’re now being phased out of our food supply. In the meantime, try to avoid food that lists PHOs or trans fats on the label.

Saturated fats are another source of LDL cholesterol and should be consumed sparingly. Foods containing saturated fats include:

  • sweet treats and pastries such as donuts, cakes, and cookies
  • red meat, fatty meat, and highly processed meat
  • shortening, lard, tallow
  • many fried foods
  • whole-fat dairy products such as milk, butter, cheese, and cream

These high-cholesterol foods, along with processed and fast foods, can contribute to weight gain and obesity. Being overweight or obese raises your risk of heart disease as well as other health conditions.

Healthier options

These foods may help lower LDL, raise HDL, and manage your weight:

  • oats and oat bran
  • barley and other whole grains
  • beans and lentils including navy, kidney, garbanzo, and black-eyed peas
  • nuts, including walnuts, peanuts, and almonds
  • citrus fruits, apples, strawberries, and grapes
  • okra and eggplant
  • soybeans
  • fatty fish such as sardines, mackerel, and salmon
  • olive oil

Healthy cooking tips

  • Use canola, sunflower, or safflower oil in place of butter, shortening, or lard.
  • Grill, broil, or bake instead of frying.
  • Trim the fat off meats and remove skin from poultry.
  • Use a rack to drain fat off meat and poultry cooked in the oven.
  • Avoid basting with fat drippings.

Having high blood cholesterol is one risk factor for heart disease. Other risk factors include:

  • high blood pressure
  • diabetes and prediabetes
  • family history of heart disease
  • preeclampsia during a pregnancy
  • being overweight or obese
  • physical inactivity
  • unhealthy diet
  • smoking

Your risk for heart disease increases with age. For women, the risk rises after menopause.

Your chance of developing heart disease rises with each additional risk factor. Some factors, like age and family history, are out of your control. Others, like diet and exercise, are within your control.

Untreated, heart disease can lead to a variety of complications including:

  • heart damage due to lack of oxygen
  • irregular heartbeat (arrhythmia)
  • stroke
  • heart attack
  • heart failure

You need to work closely with your doctor to monitor your condition. If you need medications to control high blood pressure, cholesterol, diabetes, or other problems, take them exactly as directed. Tell your doctor about any new symptoms.

Along with healthy lifestyle changes, this can help improve your overall outlook.

Here are a few things you can do to lower your risk of developing heart disease:

  • Watch your weight. Being overweight tends to make your LDL rise. It also puts added strain on your heart.
  • Get active. Exercise can help control your weight and improve your blood cholesterol numbers.
  • Eat right. Choose a diet high in vegetables, fruits, and whole grains. Nuts, seeds, and legumes are also heart-healthy foods. Opt for lean meats, skinless poultry, and fatty fish over red or processed meat. Dairy products should be low fat. Avoid trans fats altogether. Choose olive, canola, or safflower oils over margarine, lard, or solid shortening.
  • Don’t smoke. If you currently smoke, talk to your doctor about smoking cessation programs.
  • Get an annual checkup, especially if you have a family history of heart disease. The sooner you discover you may be at risk, the sooner you can take action to help prevent heart disease.