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 previously thought.

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

  • HDL: This is known as “good cholesterol” because it picks up cholesterol and takes it back to the liver for disposal.
  • LDL: This 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.

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.

Narrowed or blocked arteries can prevent blood from reaching your:

  • heart
  • brain
  • other organs

This can lead to:

Read on to learn more about the connection between cholesterol levels and heart disease.

The 2020–2025 Dietary Guidelines for Americans don’t include specific limits to dietary cholesterol, but it still strongly recommends eating as little cholesterol as possible. The amount you consume shouldn’t compromise your nutritional health, though.

A 2020 study on red meat consumption and heart disease found that the two were associated. More specifically, it found evidence that replacing red meat with plant protein sources can lower LDL cholesterol levels.

Foods high in cholesterol are often also high in saturated fats. These may have an inflammatory effect and affect the microbiome, so these may be drivers of worse outcomes rather than the cholesterol content itself.

Conflicting research

But your risk for heart disease is more complex than just controlling your cholesterol levels. Specifically, a 2019 study from the American Heart Association (AHA) shows that dietary cholesterol might not be as big a driver of heart disease risk as once thought.

Another study from 2019 suggests that evidence for consumption of red processed meat and a lowered risk of heart disease is low.

It’s worth noting that this study was a meta-analysis of observational cohort studies, meaning it can only find association, not causation. Very few randomized controlled studies have been conducted.

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

Trans fats will raise your LDL cholesterol and lower your HDL cholesterol. Both of these changes are associated with an increased risk of heart disease.

Meat and dairy products contain natural trans fats — formed during the partial hydrogenation of vegetable fat — and were previously found in many types of processed foods due to the addition of partially hydrogenated oils (PHOs).

Trans fats offer no nutritional value and are often found in many types of processed foods.

The Food and Drug Administration (FDA) determined that PHOs are not safe for human consumption. As of 2018, PHOs are no longer added to food.

In the meantime, try to avoid food that lists PHOs or trans fats on the label.

Saturated fats

Saturated fats are another source of increased LDL cholesterol and should be consumed sparingly.

Foods containing saturated fats include:

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

These high cholesterol foods, along with processed and fast foods, can contribute to weight gain and obesity.

Having overweight or obesity raises your risk of heart disease as well as other health conditions.

Healthier options

It’s important to note that well-balanced dietary habits, not just the selection of individual nutrients, can help decrease your risk of heart disease.

According to the AHA, choosing to incorporate some of the following foods in your diet may help lower LDL, raise HDL, and manage your weight:

  • whole grain foods, such as:
    • brown rice
    • whole grain pasta
    • whole grain bread
  • variety of fruits and vegetables
  • fat-free and low fat milk products, or plant-based milk
  • skinless poultry and lean meats
  • fatty fish, such as:
    • salmon
    • trout
    • albacore tuna
    • sardines
  • plant-based sources of protein, including:
    • nuts and seeds
    • tofu
    • beans, peas, and lentils
    • quinoa
  • nontropical vegetable oils, such as olive oil

If you do choose to consume red meat, opt for selections labeled “loin” or “round.”

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 traditional risk factors, according to the AHA, include:

  • high blood pressure
  • diabetes and prediabetes
  • having overweight or obesity
  • smoking
  • family history of heart disease
  • metabolic syndrome
  • chronic kidney disease
  • chronic inflammatory conditions, such as:
    • rheumatoid arthritis
    • psoriasis
    • HIV or AIDS
  • history of preeclampsia or early menopause
  • higher than usual lab tests, such as triglycerides or ankle-brachial index

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, exercise, and physical activity, are within your control.

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

  • Watch your weight: Excess weight is associated with higher LDL levels. It also puts an 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. Opt for lean meats, skinless poultry, and fatty fish over red or processed meat. Avoid trans fats altogether. Choose nontropical vegetable oils and avoid:
    • margarine
    • lard
    • solid shortening
  • Avoid smoking, or try a smoking cessation program: If you currently smoke, talk with your doctor about smoking cessation programs.
  • Get an annual checkup: If you have a family history of heart disease, annual checkups are important. The sooner you discover you may be at risk, the sooner you can take action to help prevent heart disease.

High levels of low-density lipoproteins, or LDL cholesterol, and low levels of high-density lipoproteins, or HDL cholesterol, can increase your risk for heart disease. HDL is often referred to as “good” cholesterol, while LDL is often referred to as “bad” cholesterol.

Some risk factors, like genetics and your age, you can’t control. But other factors like diet, exercise, and avoiding smoking, you can control to reduce your risk.

If left 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.