Cholesterol travels in the blood via “bad” LDL (low-density lipoprotein) and “good” HDL (high-density lipoprotein). Excess LDL cholesterol can form plaque on blood vessels, narrowing them and making it hard for blood to reach organs like the heart.

Blood cholesterol, a waxy, fat-like substance, is made by your liver. Cholesterol is essential for full-body health. It’s needed for actions such as hormone creation and digesting fatty foods.

While our bodies make all the cholesterol we need, dietary cholesterol is found in most animal foods: meat, poultry, eggs, seafood, and dairy products.

Cholesterol is carried through the blood on two types of proteins called lipoproteins. These lipoproteins include LDL (low-density lipoprotein), which is sometimes referred to as “bad” cholesterol, and HDL (high-density lipoprotein), or what is typically referred to as “good” cholesterol.

The science over “good” and “bad” cholesterol has shifted quite a bit recently, so how can you be sure that you’re not putting your health in danger? Read on for everything you need to know about LDL — backed by the most recent science.

If cholesterol is essential for overall health, why would one type be bad?

In simple terms, if there is too much LDL cholesterol running through your blood vessels, it can, over time, start to build up on the sides of those blood vessels. This buildup is typically referred to as “plaque.”

Plaque buildup in your blood vessels can eventually cause those vessels to become narrower. The more narrow your blood vessels are, the harder it is for blood to reach your heart and other organs.

When blood flow becomes very blocked, it can cause chest pain (angina) and even a heart attack.

HDL cholesterol, on the other hand, returns cholesterol to the liver so it can be flushed from the body.

What should your LDL level be?

In general, most adults want to keep their LDL cholesterol levels in a certain range. Because a lot of other personal factors play into these numbers, it’s important to have a healthcare professional check your levels to help them create specific recommendations for you to go by.

LDL Cholesterol LevelCategory
Less than 100mg/dLRecommended
100-129mg/dLSlightly above recommended
130-159 mg/dLBorderline high
160-189 mg/dLHigh
190 mg/dL and aboveVery high

If you have high LDL (bad) cholesterol, you may not even know it, because there are typically no symptoms associated with this issue. This is why routine blood work is so important.

If you have extremely high LDL levels, you may notice little bumps on your skin called xanthomas or gray-white rings around the corneas of your eye called corneal arcus.

High LDL complications

Besides heart attack, there are other serious complications of not treating “bad” cholesterol.

Certain individuals may need medication or surgery due to complications of long-term high cholesterol.

The best way to find out if you have too much LDL cholesterol is having your doctor order a blood test that checks your levels. Your doctor will also request and review your family history, as high cholesterol can sometimes be hereditary.

The test your doctor will likely order is called a lipid panel. This panel shows your LDL, HDL, and other types of non-HDL cholesterol that can raise your risk of complications.

You will be diagnosed with “high cholesterol” if your non-HDL cholesterol level is higher than what your doctor thinks is ideal for you. Your doctor will also review your lab tests to see if your HDL, the healthy cholesterol, is too low.

There may be follow-up tests and visits if your doctor is concerned that you may need medication or further intervention.

According to the Centers for Disease Control and Prevention (CDC), between 2015 and 2016, more than 12 percent of adults ages 20 and older had total cholesterol levels higher than 240 mg/dL, which is quite high. About 7 percent of U.S. children and adolescents ages 6 to 19 were also found to have high cholesterol.

While it’s known that individuals living with high cholesterol are at an elevated risk of developing heart disease, new research suggests that individuals living with moderately high cholesterol for a long time, who also have higher blood pressure, may have the same risk of heart disease as those who have high cholesterol for only a short period of time.

Everyone should get their cholesterol checked, starting at age 20 and then every 4 to 6 years after that if their risk remains low.

After age 40, your doctor may want to check your levels more often. Typically, people assigned male at birth who are ages 45 to 65, along with people assigned female at birth who are ages 55 to 65, should have their cholesterol checked every 1 to 2 years.

Everyone’s risk for high cholesterol goes up with age. This is because the older we get, the harder it becomes for our bodies to filter out cholesterol.

A family history of high cholesterol can also increase risk.

While it’s impossible to control aging and family history, there are some behaviors that increase the risk of developing high cholesterol that can be changed

Individuals living with obesity and type 2 diabetes are more at risk for an increase in bad cholesterol and a dip in good cholesterol.

It’s important to work with your doctor, who can provide support and resources, to help you adhere to their recommendations on how to lower your risk. Recommendations may include losing excess weight and focusing on finding what works best for you in managing your diabetes.

Other behaviors that may put you at a higher risk include:

  • smoking, which can damage blood vessels and may lower good cholesterol
  • eating a diet high in saturated and trans fat, which includes foods like fatty meats and dairy-based desserts
  • not getting enough physical movement throughout the week (2 hours and 30 minutes of moderate-intensity exercise per week is recommended)
  • drinking an excess of alcohol

The composition of LDL cholesterol: Why it matters

While it was traditionally thought that high LDL cholesterol as a whole was “bad” and a predictor of heart disease complications, new research, including a 2019 study from Ohio University, suggests that the real predictor of complications may be a particular subclass of LDL.

LDL is comprised of three subclasses of low-density lipoproteins, A, B, and I. According to researchers, one subclass — subclass B — was found to be the most damaging and a much better predictor of potential heart attacks than the total measurement of LDL.

While this type of research is new and evolving, if you are concerned about your LDL numbers and the possibility of complications, talk with your doctor.

If you’ve been diagnosed with high LDL, the good news is that there are ways to lower it to a healthier range.

If your doctor is concerned about your LDL levels, they may prescribe medication, such as:

  • Statins. Statins are the most commonly prescribed medication for high cholesterol. They have been shown to lower the risk of heart attack and stroke in individuals with high LDL
  • Ezetimibe. These medications are sometimes prescribed if statins are not effective.
  • Bile acid sequestrants. These medications are prescribed if an individual cannot take statins, or if their cholesterol levels need to be lowered more than statins alone can do.
  • PCSK9 inhibitors. PCSK9 inhibitors are injected into the skin every couple of weeks and are prescribed when someone is at an unusually high risk for complications
  • Lomitapide and Mipomersen. These drugs are typically prescribed for individuals who have a family history of high cholesterol.

Each drug has its own side effects, so it’s important to talk with your doctor about why they’re prescribing a specific medication and what the possible side effects might be.

Your doctor will also likely recommend specific lifestyle changes regardless of whether you’re prescribed medication.

If your lipid test shows high or borderline-high LDL levels, your doctor will most likely recommend some lifestyle changes that can make a positive impact on your cholesterol as a whole based on your specific situation.

Increase physical activity

Regular physical activity can help lower both your cholesterol and blood pressure levels, and may even help you lose excess weight (if that’s something your doctor has advised or it’s simply a personal goal). Moderate exercise, which can be anything from brisk walking to riding a bike, for a few hours a week is helpful.

Eat a heart-healthy diet

Focusing on the things you can eat on a heart-healthy diet, instead of focusing on things you should not eat, can make this lifestyle change seem less daunting. When you’re eating for heart health and to lower cholesterol, it’s a great idea to focus on:

  • lean meats
  • seafood
  • fat-free or low fat milk, cheese, and yogurt
  • whole grains
  • fruits and vegetables

Eating foods that are naturally high in fiber, like oatmeal and beans, as well as unsaturated fats, like olive oil, avocados, and nuts, are also good choices when you’re eating for heart health.

Talking with a dietician is a great way to make sure your new diet includes all the essential nutrients and vitamins you need to stay healthy and energized.

Limit alcohol

Drinking too much alcohol can raise triglycerides. When you combine elevated triglycerides with high LDL cholesterol levels, it can increase your risk for heart attack and stroke. Limiting your alcohol intake, or cutting it out entirely, can help your body recover.

Quit smoking

Smoking is difficult on your body in a number of ways, including aiding LDLs in creating narrower blood vessels. If you smoke, consider quitting. Talk with your doctor about cessation programs and other supportive resources that can help you begin the process of quitting smoking.

Getting your cholesterol levels checked, especially if you have a family history of high cholesterol, is an essential part of staying informed about your health. If you’re younger than age 40, you may only need to get it checked every few years, but your doctor will help you decide what’s best.

If you see high LDL levels on your lipid test, remember you’re not alone. Over 93 million U.S. adults ages 20 and older have what would be considered high cholesterol. And there are many ways to treat elevated “bad” cholesterol levels, from medication to lifestyle changes.

Taking a proactive approach to lowering your cholesterol is also a positive step toward increasing your overall health — so it’s a win-win situation.