Cholesterol comes in several different forms, some good and some bad. Many factors, including genetics, can play a role in the levels of cholesterol in your blood. If a close relative has high cholesterol, you’re more likely to have it yourself. However, many lifestyle factors, particularly diet and exercise, also affect levels of cholesterol.

Keep reading to learn more about risk factors for cholesterol and things you can do to manage your levels.

There are two main forms of cholesterol. The first, LDL cholesterol, is often called “bad” cholesterol. It’s considered unhealthy to have high levels of LDL cholesterol in your body. The other, HDL cholesterol, is sometimes referred to as “good” cholesterol. Higher levels of HDL cholesterol can be a sign of good health.

If your doctor tells you that you have high cholesterol, they’re usually referring to either high levels of LDL cholesterol or a high level of total cholesterol. Total cholesterol is also sometimes called serum cholesterol. It’s the sum of LDL and HDL cholesterol and 20 percent of your triglycerides. LDL cholesterol and total cholesterol can be used as indicators of your risk of developing cardiovascular disease and other complications.

Learn more: What is serum cholesterol and why is it important? »

A variety of risk factors contribute to unhealthy levels of cholesterol, including genetics, lifestyle choices, or a combination of the two.

Familial hypercholesterolemia vs. high cholesterol

If you have a close relative, such as a parent, sibling, or grandparent, who has high levels of cholesterol, you’re more likely to have it yourself. This is largely due to the passing on of genes from parents to children that increase levels of cholesterol in the blood, such as a gene that codes for a defective receptor. This is known as familial hypercholesterolemia.

Familial hypercholesterolemia is a form of inherited high cholesterol. People with this condition generally have higher cholesterol levels than people without this condition, despite lifestyle choices. That’s because people with this condition aren’t able to regulate cholesterol levels as efficiently as other people. People with familial hypercholesterolemia can’t control their cholesterol through diet and exercise alone, and may instead need to also use medication.

Having a genetic risk for high cholesterol doesn’t guarantee that you’ll have high cholesterol. It just means that you have an increased risk. Let your doctor know about your concerns. They can help you manage your cholesterol and monitor your levels so that if you do develop high cholesterol, you can begin treatment right away.

Obesity or large waist circumference

Some people are genetically predisposed toward obesity or a large waist circumference. Both can increase your risk for high cholesterol. Lifestyle factors also play a role in these two risk factors.

Obesity is defined as a body mass index (BMI) of 30 or higher.

A large waist circumference is 40 or more inches for men and 35 or more inches for women. Fat that accumulates in your waist increases your risk of elevated cholesterol and other cardiovascular complications.

Elevated blood sugar

High levels of glucose can increase LDL cholesterol and decrease HDL cholesterol. High levels of glucose in your blood can also damage the lining of arteries. That can increase your risk of fatty deposits building up in your arteries.

Like obesity and waist circumference, some people are more genetically predisposed toward high blood sugar. Lifestyle choices, like diets high in soda, candy, or other foods containing large amounts of sugar, can also contribute to high blood sugar levels.

Lifestyle factors

Some risk factors for high cholesterol can be completely controlled by lifestyle choices. These include diet, exercise, and smoking.

Eating a diet high in saturated and trans fats can increase your cholesterol levels. Foods high in these types of fats include:

  • red meat
  • full-fat milk and yogurt
  • fried foods
  • highly processed sweets

Exercise can increase your HDL cholesterol and decrease your LDL cholesterol. That means that adding exercise to your routine can help promote healthy levels of cholesterol in your body.

Aim for 150 minutes of moderate- to high-intensity aerobic exercise each week. You don’t have to initially start out exercising that much if you’re new to exercise. Instead, work your way up to that goal, and be sure to talk to your doctor before starting any new exercise routines. Additionally, add resistance exercises, such as weight lifting or yoga, into your exercise plan.

Smoking can have a negative impact on your heart health. That’s because tobacco damages the wall of your blood vessels. This makes it more likely for fat deposits to build up.

Talk to your doctor about smoking cessation programs that may work for your lifestyle. Sometimes you may need to try more than one method to stop smoking. Having a support group can help.

Learn more: 14 tips for quitting smoking »

High levels of unhealthy cholesterol can reduce the flow of blood through your vessels. Over time, this can increase the risk of developing the following conditions:

High levels of cholesterol are usually asymptomatic. To determine your cholesterol levels, you’ll need a blood test. Your primary care physician will draw your blood to check lipid levels. This is called a lipid panel, and it’s a standard procedure for most primary care physicians. Your results will typically include:

  • total cholesterol
  • HDL cholesterol
  • LDL cholesterol, sometimes including particle count in addition to total amount
  • triglycerides

For the most accurate results, you should avoid drinking or eating anything except water for at least 10 hours prior to the test. Generally, doctors use the following guidelines when interpreting the results of total cholesterol:

healthy total cholesterolbelow 200 mg/dL
at-risk total cholesterol200 to 239 mg/dL
high total cholesterolabove 240 mg/dL

Your doctor will also interpret the other numbers to get a more complete picture of your health.

When you should get tested

If you’re at low risk for high levels of cholesterol, you should start getting lipid panel screenings starting at age 40 for women and 35 for men. You should have your levels tested about every five years.

If you have more risk factors for cardiovascular disease and high cholesterol, you should start getting lipid panel screenings in your 20s, and at more frequent intervals. If the results show you have unhealthy levels of cholesterol or other lipids, your doctor will work with you to create a treatment and monitoring plan.

Genetic testing

If you think you may be at risk for familial hypercholesterolemia, your doctor may recommend genetic testing. Genetic testing can identify faulty genes and determine if you have familial hypercholesterolemia.

If you do test positive for familial hypercholesterolemia, you may need more frequent lipid panels.

Treating high cholesterol can be challenging, so you may need to use a combination of methods to manage your levels. These methods may include:

  • prescription drugs
  • managing other conditions, such as diabetes, that increase your risk
  • lifestyle changes

Here are some changes you can make to help reduce your risk for high cholesterol:

Healthy diet: Eating a diet high in fiber-rich grains, protein, and unsaturated fats will lower harmful LDL cholesterol. Focus on eating healthy foods such as:

  • green vegetables
  • lentils
  • beans
  • oatmeal
  • whole grain breads
  • low-fat dairy
  • low-fat meats, such as poultry

Avoid eating a lot of foods high in animal-based saturated fats, such as full-fat dairy, highly processed sweets, and red meat.

Exercise regularly: The surgeon general recommends 150 minutes of moderate- to high-intensity aerobic exercise each week. Additionally, consider adding in some resistance exercises to increase muscle mass.

Stop or reduce smoking: If you need help quitting smoking, talk to your doctor. They can recommend smoking cessation programs. It also helps to have a support group, so talk to a close friend or family member about your goal to quit smoking, and ask them to help offer encouragement and support.

Maintain a healthy body weight and low percentage of body fat: Try to aim for a BMI below 30. Additionally, men should aim for a body fat percentage below 25 percent and women below 30 percent. If you need to lose weight in the form of body fat, you should aim to establish a calorie deficit each day. A combination of a healthy diet and exercise routine help in maintaining a healthy weight or losing weight, if needed.

Limit alcohol consumption: Women should limit alcohol to no more than one drink per day, and men should limit it to no more than two drinks a day. One drink is considered 1.5 ounces of liquor, 12 ounces of beer, or 5 ounces of wine.

Your doctor may also recommend prescription drugs to manage cholesterol. These include statins, derivatives of niacin (Niacor), and bile acid sequesterants. If you’re taking any of these drugs, they should be used in addition to healthy lifestyle choices.

If you’re unable to control your cholesterol with lifestyle changes and medication, your doctor may need to perform apheresis or surgery to reduce levels of cholesterol. Apheresis is a technique that filters the blood, but it’s infrequently used.

High cholesterol may be caused by a variety of genetic and lifestyle factors. If not managed properly, it can lead to a variety of health complications. You can use various methods to optimize your cholesterol levels including:

  • a healthy diet
  • exercise
  • avoidance of substance misuse
  • medications prescribed by your doctor