You may have heard the terms “lipids” and “cholesterol” used interchangeably, and assumed they meant the same thing. The truth is a little more complicated than that. Lipids are fat-like molecules that circulate in your bloodstream. They can also be found in cells and tissue throughout your body.

There are several types of lipids, of which cholesterol is the best-known. Cholesterol is actually part lipid, part protein. This is why the different kinds of cholesterol are called lipoproteins. Another type of lipid is a triglyceride.

Your body needs some lipids to remain healthy. Cholesterol, for instance, is in all your cells. Your body makes the cholesterol it needs, which in turn helps your body produce:

  • certain hormones
  • vitamin D
  • enzymes that help you digest food
  • substances needed for healthy cell function

You also get some cholesterol from the diet in animal-based foods, such as:

  • egg yolks
  • full-fat dairy
  • red meat
  • bacon

Moderate levels of cholesterol in your body are fine. High levels of lipids, a condition known as hyperlipidemia, or dyslipidemia, raise your risk of heart disease.

The two main types of cholesterol are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL cholesterol

LDL is considered the “bad” cholesterol because it can form waxy deposits called plaques in your arteries. Plaque makes your arteries stiffer. It can also clog your arteries, creating less room for blood to circulate. This process is called atherosclerosis. You may have also heard it referred to as “hardening of the arteries.”

Plaques can also rupture, spilling cholesterol and other fats and waste products into your bloodstream. In response to a rupture, blood cells called platelets rush to the site and form blood clots to help contain the foreign objects now in the bloodstream.

If the blood clot is big enough, it can completely block blood flow. When this happens in one of the heart’s arteries, called coronary arteries, the result is a heart attack. When a blood clot blocks an artery in the brain or an artery carrying blood to the brain, it can cause a stroke.

HDL cholesterol

HDL is known as the “good” cholesterol because its main job is to sweep LDL out of your bloodstream and back to the liver.

When LDL returns to the liver, the cholesterol is broken down and passed from the body. HDL represents only about 1/4 to 1/3 of cholesterol in the blood.

High levels of LDL are associated with a higher risk of heart attack and stroke. Higher levels of HDL, on the other hand, are associated with lower heart disease risks.

Triglycerides

Triglycerides help store fat in your cells that you can use for energy. If you overeat and don’t exercise, your triglyceride levels can rise. Excessive alcohol consumption is also a risk factor for high triglycerides.

Like LDL, high triglyceride levels appear to be linked to cardiovascular disease. That means they may raise your risk of heart attack and stroke.

A simple blood test can reveal your levels of HDL, LDL, and triglycerides. The results are measured in milligrams per deciliter (mg/dL). Here are the typical goals for lipid levels:

LDL< 130 mg/dL
HDL> 40 mg/dL
triglycerides< 150 mg/dL

However, rather than focusing on specific numbers, your doctor may recommend a variety of lifestyle changes to help lower your overall risk of heart disease.

The traditional way of calculating LDL cholesterol took total cholesterol minus HDL cholesterol minus triglycerides divided by 5. However, researchers at Johns Hopkins found this method to be inaccurate for some people, causing LDL levels to appear lower than they actually were, especially when triglycerides were over 150 mg/dL. Since then, researchers have developed a more complex formula for this calculation.

It’s a good idea to have your cholesterol levels checked every few years, unless your doctor recommends more frequent checks. If you’ve already had a heart attack or stroke or have heart attack risk factors such as high blood pressure, diabetes, a history of smoking, or a family history of heart disease, you may be advised to have your cholesterol checked yearly or even more frequently.

Your doctor may also want to do a regular cholesterol check if you’ve recently started a medication to help lower LDL to see if the drug is working.

LDL levels tend to rise as people age. The same isn’t true for HDL levels. A sedentary lifestyle can lead to lower HDL levels and higher LDL and total cholesterol numbers.

Dyslipidemia is a serious risk factor of heart disease, but it’s treatable for most people. Along with diet and lifestyle changes, people with high LDL levels often need medication to help keep LDL levels within a healthy range.

Statins are among the most widely used medications to help control cholesterol. These drugs are usually well-tolerated and very effective. There are several types of statins on the market. Each one works a little differently, but they’re all designed to lower LDL levels in the bloodstream.

If you’re prescribed a statin, but have side effects such as muscle aches, tell your doctor. A lower dose or a different type of statin may be effective and lessen any side effects.

You may need to use statins or another cholesterol-lowering drug for life. You shouldn’t stop taking the medication unless instructed by your doctor, even if you’ve reached your cholesterol goals.

Other medications that help lower LDL and triglyceride levels can include:

  • bile acid-binding resins
  • cholesterol absorption inhibitors
  • combination cholesterol absorption inhibitor and statin
  • fibrates
  • niacin
  • combination statin and niacin
  • PCSK9 inhibitors

With medication and a healthy lifestyle, most people can achieve cholesterol control.

In addition to statins or other cholesterol-lowering medications, you may be able to improve your lipid profile with some of the following lifestyle changes:

  • Eat a diet low in cholesterol and saturated fats, such as one that includes very little red meat, fatty meats, and whole-fat dairy. Try to eat more whole grains, nuts, fiber, and fresh fruits and vegetables. A heart-healthy diet is also low in sugar and salt. Work with a dietitian if you need help developing this type of diet.
  • Exercise most, if not all, days of the week. The American Heart Association recommends at least 150 minutes of moderate-intensity exercise, such as brisk walking, every week. More physical activity is associated with lower LDL levels and higher HDL levels.
  • Follow your doctor’s recommendations for regular blood work and pay attention to your lipid levels. These can change significantly from one year to another. Adopting a heart-healthy diet with regular physical activity, limiting alcohol, not smoking, and taking your medications as prescribed can help improve your cholesterol and triglycerides and lower your risk of heart disease.