High cholesterol affects as many as 93 million U.S. adults over the age of 20. As common as the condition may be, many people have misconceptions about what it is and how to manage it.

The following myths and clarifications offer insight into what cholesterol is and how it’s linked to cardiovascular health.

Most people with high cholesterol don’t have any symptoms. While some develop yellowish growths of cholesterol deposits on the skin called xanthomas, these growths usually don’t occur unless cholesterol levels are extremely high.

Many people only experience symptoms when they have complications from atherosclerosis, or narrowing of the arteries. High cholesterol commonly causes it.

In people with atherosclerosis, plaque made up of cholesterol, fatty substances, and other materials builds up in the arteries. As the plaque builds up, inflammation can occur.

As the arteries narrow from the plaque, blood flow decreases to the heart, brain, and other parts of the body. This can cause complications such as:

  • angina (chest pain)
  • gangrene (tissue death)
  • heart attack
  • stroke
  • kidney dysfunction
  • claudication, or pain in legs with walking

It’s a good idea to learn whether you have high cholesterol early on to reduce your risk for these complications. You can screen for high cholesterol easily with a simple blood test.

Cholesterol is a vital substance that helps the body function properly. The liver makes cholesterol to produce cell membranes, vitamin D, and important hormones.

Cholesterol moves through the body on lipoproteins (a combination of the lipid and its protein carrier), hence the names for the two main types of cholesterol:

  • LDL (low-density lipoprotein) is the “bad” cholesterol. It raises the risk of heart attack or stroke. Too much LDL can build up in the arteries, creating plaque and restricting blood flow. Lowering LDL reduces the risk of heart attack and stroke.
  • HDL (high-density lipoprotein) is the “good” cholesterol. It carries cholesterol back to the liver, which removes it from the body. High HDL levels can reduce the risk of stroke.

A cholesterol test reports:

  • total cholesterol
  • LDL
  • HDL
  • VLDL (very low-density lipoprotein)
  • triglycerides

When it comes to cardiovascular risk, your doctor is most concerned with LDL and VLDL, then with triglycerides, and finally with HDL.

There’s no universal target for blood cholesterol levels. Your doctor will look at your cholesterol numbers in the context of your other risk factors that indicate you may be at greater risk for heart disease.

Doctors typically consider above-optimal cholesterol levels to be:

  • total cholesterol of 200 mg/dL or more, or
  • LDL cholesterol of 100 mg/dL or more

These targets change if a person has higher risk for heart disease due to family history or other factors and hasn’t had a previous heart attack or stroke.

Doctors may not recommend the same treatment for two people with the exact same cholesterol levels. They instead create a personalized plan using a person’s:

  • cholesterol measurements
  • blood pressure
  • weight
  • blood sugar levels
  • prior history of atherosclerosis, heart attack, or stroke

These and other factors help your doctor determine what your cholesterol “targets” should be.

High cholesterol is a leading cause of heart disease. And heart disease is the number one cause of death among women, according to the Centers for Disease Control and Prevention (CDC). It affects women and men in about equal numbers.

Some conditions can affect cholesterol levels specifically for women, such as:

  • pregnancy
  • breastfeeding
  • hormonal changes
  • menopause

Certain risk factors, like having low HDL, are worse for women compared to men.

Exercise and diet are important factors that contribute to cholesterol levels. But there are other factors at play, including:

  • smoking or being around secondhand smoke
  • obesity or excessive weight
  • heavy alcohol use
  • genetic factors that result in high cholesterol

Two sources affect your blood cholesterol level:

  • what you eat
  • what your liver produces

Common cholesterol medications like statins reduce the amount of cholesterol your liver makes. But if you don’t eat a well-balanced diet, your cholesterol level can still go up.

Cholesterol is just one factor in an assessment of heart health. Statins can provide a false sense of security.

A 2014 study involving more than 27,800 people found that calorie and fat intake went up among people who used statins while it remained stable for those who did not use statins.

Body mass index (BMI) also increased among statin users.

Researchers now know that eating foods high in cholesterol doesn’t necessarily lead to high blood cholesterol levels.

A more direct culprit may be saturated fat. Foods that are high in cholesterol are also often high in saturated fat.

Still, dietary cholesterol can make a difference. A 2019 review of research found that each additional 300 milligrams of cholesterol or more per day was associated with higher risk of cardiovascular disease and death.

Counting any one nutrient isn’t the solution. To improve cardiovascular health, the American Heart Association’s 2019 science advisory suggests doctors focus on helping their patients improve their overall eating patterns.

That means eating more:

  • fresh fruits and vegetables
  • whole grains
  • legumes
  • nuts and seeds
  • lean meat

It also means cutting back on:

  • processed foods
  • packaged foods
  • fatty cuts of meat
  • full fat dairy

High cholesterol affects people of all body types and ages. Even fit people and those under 40 years old should get tested.

The American Heart Association recommends checking cholesterol levels even if you’re at low risk for heart disease.

The American Heart Association advises the following test schedule for people who don’t have a family history of heart disease or other risk factors for the condition:

  • one test between 9 and 11 years old
  • one test between 17 and 21 years old
  • one test every 4 to 6 years for people over 20, as long as risk remains low

The CDC and Department of Health and Human Services recommend more frequent testing for people who:

  • have heart disease
  • have a family history of high cholesterol or premature heart attacks or strokes
  • have diabetes
  • smoke

High cholesterol increases the risk of heart disease and its complications, including stroke and heart attack.

Your cholesterol levels are just one factor your doctor will use to create a personalized risk assessment and management plan for cardiovascular disease.

Regular monitoring, proper use of medications, and a healthy lifestyle can all help keep your cholesterol levels in check.