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Originally published July 11, 2017
Last updated May 16, 2025
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Cholesterol isn’t entirely harmful, despite what you may have heard. In fact, this waxy substance that circulates in your blood can actually improve your health when maintained at the right levels. Understanding the difference between “good” and “bad” cholesterol is key to managing the health of your heart and blood vessels, your cardiovascular system.
“When people think about their cholesterol numbers and they just focus on the total number, that’s really hard for us to interpret,” explains Parveen Garg, MD, a cardiologist with the USC Cardiac and Vascular Institute, part of Keck Medicine of USC.
Understanding the different types of cholesterol helps you understand how each type affects your health. Some protect against heart attacks and strokes, while others increase these risks. What matters most is achieving the right balance for your individual health situation.
Your diet contributes about 25% of your cholesterol, while your body naturally produces the remaining 75%. Several factors influence that natural production. For one, your cholesterol naturally increases as you age. Your race or ethnicity, genes and family history also play a significant role. Gender affects cholesterol levels, particularly in women after menopause, when changes in estrogen levels can raise bad cholesterol and lower good cholesterol. Other health conditions, including diabetes, obesity and smoking, also impact your cholesterol levels. These factors, along with high blood pressure, increase your risk of cardiovascular problems like heart attack and stroke.
There are two main types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL is often called “good” cholesterol, while LDL is known as “bad” cholesterol. Dr. Garg describes this distinction through their different roles in your body.
HDL is called “good” cholesterol because it helps remove LDL from your blood circulation. The more HDL you have, the better this process works. However, Dr. Garg emphasizes two important points: while HDL can help remove circulating bad cholesterol, it cannot remove plaques that have already formed in your arteries. Having high HDL doesn’t mean you can ignore high LDL levels either. “Having really high good cholesterol doesn’t mean you don’t have to worry about your bad cholesterol,” he points out. “If your bad cholesterol is high, it’s still a problem.”
LDL, known as “bad” cholesterol, can cause problems when levels are too high. When bad cholesterol circulates in our bloodstream, it contributes to heart attacks and strokes by forming blockages in our arteries, he says.
Triglycerides make up the third component of cholesterol and act as unused calories that are stored as fat in the blood. Eating more calories than you burn can cause triglycerides to build up in the bloodstream, increasing your risk for heart attacks.
More than one-third of Americans have high LDL cholesterol. It’s important to work with your physician to understand your own cholesterol levels.
“When looking at cholesterol numbers, we don’t just focus on the total number,” Dr. Garg says. “We need to look at the individual components — HDL, LDL and triglycerides — to get a complete picture.”
Healthy cholesterol levels — measured in milligrams (mg) per deciliter (dL) of blood) — are typically:
Unlike body temperature or high blood pressure, there is no simple threshold that separates good from bad cholesterol. Dr. Garg stresses that what’s considered high cholesterol for one person might be acceptable for another. Your doctor will consider your overall health, including factors like age, family history and other conditions that might affect your cardiovascular health. This personalized approach helps determine the best way to manage your cholesterol levels.
Managing cholesterol is a holistic or whole-person approach that ultimately improves one’s overall health. To lower cholesterol with diet, Dr. Garg recommends focusing on foods and cooking methods:
Foods to limit (high in saturated fat):
Foods to add to your diet that can help lower cholesterol:
How you cook matters, too. “Deep-frying anything increases its saturated fat content,” he warns. Instead of frying, try healthier cooking methods like baking, grilling or steaming. Choose heart-healthy oils for cooking. Select lean cuts of meat and trim excess fat. These simple changes in cooking methods can help manage your cholesterol levels.
Exercise also plays a crucial role in managing your cholesterol. “We recommend at least 150 minutes of moderate-intensity aerobic activity per week,” he says. This includes activities that lead to faster breathing, increased heart rate (but not racing or pounding), a feeling of warmth and even light sweating. Good activities are dancing, swimming, bicycling or team activities like basketball or soccer. Walking at a purposeful pace — about three to four miles per hour or completing a mile in 15 to 20 minutes — is some of the best exercise you can get.
Lifestyle choices can significantly affect your cholesterol levels beyond diet and exercise. Quitting smoking will help improve your good cholesterol levels. Dr. Garg says that both chronic stress and poor sleep can work against your cholesterol-management efforts. When you’re stressed or not sleeping well, your body produces more stress hormones that can affect cholesterol production. These conditions often lead to unhealthy eating habits and reduce your motivation to exercise. Lack of sleep and ongoing stress can also increase inflammation in your body, further impacting your cardiovascular health. Consider adopting some stress-management strategies.
While lifestyle changes help manage cholesterol, they sometimes fall short on their own. The good news is that treatment options for high cholesterol have expanded significantly over the years.
“Fifteen years ago, we mainly had statins to lower cholesterol, which were not always tolerable for patients,” Dr. Garg says. “Now we have multiple options for treating high cholesterol, even for patients who can’t take statins.”
When recommending treatment, your doctor will consider several factors, including your overall heart disease risk, other health conditions, family history and current lifestyle. This personalized approach helps ensure you receive the most effective treatment for your specific situation.
If your doctor diagnoses you with high cholesterol, Dr. Garg recommends:
Managing cholesterol is a crucial component of overall cardiovascular health. Dr. Garg emphasizes that the steps you take to improve your cholesterol can have far-reaching benefits. These extend beyond just lowering your cholesterol levels.
Specifically, managing your cholesterol can lead to lower blood pressure and promote better eating habits. It often results in increased physical fitness and reduced stress levels. Finally, it can help decrease inflammation throughout your body.
Dr. Garg recommends getting screened for cholesterol every five years starting at age 18. In your mid-40s, increase screening to every one to two years, and by age 65, check yearly. These recommendations vary according to your individual health and risk factors, so follow your doctor’s advice for your specific situation.
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