Cholesterol is a key building block of animal cell membranes, and because of that, every animal cell produces it. Despite its bad reputation, cholesterol is actually necessary for life.
However, when there’s too much of it in the blood, it can raise the risk of heart disease. Along with fat, calcium, and other substances, cholesterol builds up as plaque in artery walls. Over time, this narrows blood vessels and can lead to serious problems like strokes and heart attacks.
According to the CDC, about 12% of U.S. adults aged 20 or older had high cholesterol between 2015 and 2016. The WHO estimates that high cholesterol contributes to 2.6 million deaths worldwide each year.
With numbers like these, it’s no wonder there’s so much confusion about cholesterol. To help clear things up, Medical News Today spoke with three experts:
- Dr. Edo Paz, cardiologist and VP of Medical at K Health
- Dr. Robert Greenfield, board-certified cardiologist and lipidologist at MemorialCare Heart & Vascular Institute
- Dr. Alexandra Lajoie, noninvasive cardiologist at Providence Saint John’s Health Center
1. All cholesterol is bad
As mentioned earlier, cholesterol is crucial for cell membranes, hormone production, vitamin D synthesis, and bile acid creation. So while high levels are risky, we couldn’t survive without it.
Dr. Greenfield put it this way: “Cholesterol itself isn’t bad—it’s just mishandled in our modern lifestyle. Our bodies weren’t designed for food abundance, so excess cholesterol gets stored where it shouldn’t, like in our blood vessels.”
How cholesterol travels in the body also matters. It’s carried by lipoproteins (fat-protein combos), mainly in two ways:
- LDL (“bad” cholesterol) – Takes cholesterol from the liver to cells. Too much in the bloodstream raises heart disease risk.
- HDL (“good” cholesterol) – Brings cholesterol back to the liver to be removed, lowering risk.
2. I’m a healthy weight, so I can’t have high cholesterol
“Oh yes, you can!” says Dr. Greenfield. “Cholesterol depends on diet and genetics. Some people inherit a condition (familial hypercholesterolemia) that affects cholesterol processing, regardless of weight.”
Dr. Paz agrees: “Even at a healthy weight, cholesterol can be high due to diet, exercise habits, smoking, or alcohol.”
Dr. Lajoie adds that weight and cholesterol don’t always match—some overweight people have normal cholesterol, while some healthy-weight people don’t. “Genetics, thyroid function, medications, sleep, and age also play roles,” she explains.
3. I’d have symptoms if I had high cholesterol
“Most people won’t feel anything,” says Dr. Paz. “That’s why regular blood tests are important. Symptoms only appear late, when arteries are already damaged.”
Dr. Greenfield notes that high cholesterol silently builds plaque until it causes serious issues like heart attacks or strokes.
4. Eating cholesterol raises my cholesterol levels
It’s more complicated than that. “Dietary cholesterol doesn’t always directly increase levels,” says Dr. Lajoie. “Sugar and simple carbs can raise cholesterol even if you avoid cholesterol-rich foods. Exercise also helps manage it.”
Dr. Greenfield explains: “Foods like red meat, cheese, and eggs contain saturated fat and cholesterol, which raise LDL. Since cholesterol comes from animal products, these foods can increase artery-clogging deposits.”
5. Everyone should aim for the same cholesterol targets
“Not true!” says Dr. Paz. “Targets depend on your heart disease risk, age, blood pressure, and medical history.”
Dr. Greenfield adds: *”For healthy people, LDL should be under 100 mg/dl. But if you’ve had heart issues or diabetes, it should be under 70 mg/dl or lower.”*
6. Only men need to worry about cholesterol
“False,” says Dr. Paz. “Women actually have slightly higher rates of high cholesterol.”
Dr. Greenfield explains: “After menopause, women lose estrogen’s protective effects and face the same heart risks as men. In fact, more women die from heart disease than breast cancer.”
7. There’s nothing I can do about my cholesterol
“Not true!” says Dr. Paz. “Medications, diet, exercise, avoiding smoking, and limiting alcohol all help.”
Dr. Greenfield adds: *”Statins are safe and effective. Newer PCSK-9 injectables can lower cholesterol even further with minimal side effects.”*
8. If I take statins, I can eat whatever I want
“Wishful thinking,” says Dr. Greenfield. “Statins lower LDL, but overeating leads to weight gain and metabolic problems. You still need to eat responsibly.”
9. I’m under 40, so I don’t need cholesterol checks
Dr. Paz says screening should start as early as age 20, especially with family history. Dr. Greenfield adds: “The longer high cholesterol goes unchecked, the higher your future heart risk. Kids with severe genetic cholesterol issues may need testing by age 2.”