Cholesterol - Good vs. Bad

By: Alere Staff

High cholesterol is one of the main controllable risk factors for heart disease. In the United States, nearly 31 million adults have high cholesterol, or a total cholesterol level greater than 240. One of every two women, over the age of 40, has high or borderline high cholesterol levels. High cholesterol, when combined with other risk factors such as smoking, high blood pressure, diabetes and obesity can increase a person’s risk for developing heart disease.1

What is cholesterol and how are “good” and “bad” cholesterol defined? What does a high cholesterol diagnosis mean? What factors can you change? What do you do if diet and exercise are not enough? Understanding these conditions will help you to make some informed decisions regarding your health. 

What is Cholesterol? 

Cholesterol is a waxy substance that comes from two sources: it is produced by your body in the liver and from the food you consume. Your cholesterol levels are impacted by factors you can and can’t control. Some of the factors you can’t control include age, gender and family history. Diet, physical activity and weight are factors that may be controllable and can also effect cholesterol levels. 

Cholesterol is not generally bad for your body. Cholesterol is important for helping the body repair cells, digest foods, process vitamin D and develop other hormones. Cholesterol travels through the blood stream in small “packages” called lipoproteins (a combination of fat and protein particles). There are two types of cholesterol lipoproteins: LDL, or low density lipoproteins, and HDL, or high density lipoproteins.1,2,3 

LDL cholesterol is referred to as “bad” cholesterol. This type of cholesterol particle is largely responsible for buildup of plaque along artery walls. LDL cholesterol should be below 100. Levels greater than 130 are considered “high.” Elevated LDL levels are a predictor for heart disease.1,2,3 

HDL cholesterol is also called “good” cholesterol. HDL particles remove LDL particles from the blood stream and return them to the liver for processing and removal. HDL cholesterol levels should be between 40 and 59. However, elevated HDL levels (above 60) are thought to be protective; in other words, high HDL levels can contribute to a lower risk for heart disease. Low HDL levels, below 40, are considered a risk for heart disease.1,2,3 

Triglyceride levels are also measured during routine cholesterol screening. Triglycerides are fatty substances that are added to the lipoprotein “envelope” that carries cholesterol particles through the blood stream. Triglycerides are stored in your fat cells and they are used for energy by the body. An acceptable triglyceride level is less than 150. Elevated triglycerides can also contribute to vascular disease and levels above 200 may be treated with medication.1,2,3 

High Cholesterol: Diagnosis 

High cholesterol, or hypercholesterolemia, is a condition in which the total cholesterol level is greater than 240. Ideally total cholesterol levels should be below 200. Your total cholesterol is a combination of measured LDL, HDL and triglyceride levels (Total = LDL + HDL + 20% of triglycerides). There are no specific symptoms related to high cholesterol. When too much LDL cholesterol is circulating in the blood, plaque deposits can form along the artery walls. These deposits can harden and block blood flow or cause the artery to become stiff, contributing to a condition known as atherosclerosis. Sometimes pieces of plaque can break off and travel through the blood stream, blocking another artery. Sometimes a blood clot will form over an area where plaque has broken and this will reduce blood flow, this is called a thrombus. This can affect any artery in your body and lead to emergent situations like a heart attack and stroke. This can also result in chronic conditions of coronary artery disease (arteries that supply blood flow to the heart), carotid artery disease (arteries that supply blood flow to the brain), peripheral vascular disease (arteries that supply blood flow to the arms and legs) and renal artery disease (arteries that supply blood flow to the kidneys).4 

The American Heart Association recommends that all adults age 20 or older have their cholesterol and other traditional risk factors checked every four to six years. This blood test, called a lipoprotein panel or lipid test requires fasting from food or drink (water is allowed) for nine to twelve hours prior to the test. The resulting panel measures total cholesterol, LDL levels, HDL levels and triglyceride levels. These levels can help guide your physician in developing a plan of care for prevention and risk factor management for heart disease.2 

Factors You Can Change 

The goal for treatment of high cholesterol is to reduce future risk of atherosclerosis or vascular disease. There are several approaches to the treatment of high cholesterol. You should discuss your goals and treatment options with your doctor, especially if you have any other risk factors such as smoking, high blood pressure, diabetes and family history of premature heart disease. 

Changes in diet can be the first step in lowering cholesterol levels. The American Heart Association recommends limiting foods that are high in saturated or trans fats to less than 7% of your daily intake. Saturated fats are mostly from animal sources and these fats tend to be solid at room temperature. This includes meats such as lamb, beef, poultry or pork, lard, cream, butter, cheese and other full fat dairy products. Trans fats can come from natural sources or be man-made. Read the food labels of the products you buy to determine the amount of trans fats. If trans fats are not listed, look for the ingredient “partially hydrogenated oil.” It is best to avoid trans fats because they raise the bad LDL levels and lower the good HDL levels.2,4 

Healthy forms of fat are monounsaturated fat or polyunsaturated fat and it is recommended to limit your intake of fat to 25-35% of your daily diet. These can be found in nuts, seeds, soybeans, vegetable oils and fish. Including a variety of fresh fruits and vegetables in your daily diet also aids in lowering cholesterol because foods high in fiber prevent the absorption of cholesterol. Talk to your doctor about consultation with a registered dietician to help create a dietary plan that works for you.4,5 

Your treatment plan may also include an exercise program. Discuss appropriate exercise goals with your doctor. Increase in physical activity helps to raise the good HDL levels. It may also help with weight loss, blood pressure management and smoking cessation. The Mayo Clinic recommends working up to 30 to 60 minutes of exercise per day. This could include walking, biking or swimming.3 

Diet and Exercise Not Enough? 

When diet and exercise are not enough to lower your cholesterol levels to the goal set by you and your doctor, your doctor may prescribe medication. There are several types of medications for the treatment of high cholesterol and some people may need to take multiple medications to lower levels.

  • Statins: These medications work in the liver to prevent the formation of cholesterol.
  • Absorption Inhibitors: These medications prevent the absorption of cholesterol in the small intestine (from foods that you eat).
  • Resins: These medications remove cholesterol in the small intestine.
  • Injectable Medications: These medications are a relatively new treatment option that increases the liver’s absorption of bad LDL particles.
  • Fibrates, Niacin and Omega 3 Fish Oil: These medications (can be prescribed or over- the- counter) are used to reduce triglyceride levels. They may also have some effect on cholesterol levels.2,4 

Talking to Your Doctor 

Cholesterol management is a topic that most adults will discuss with their doctor at some point in time. Be prepared prior to your visit with some questions to ask and topics to cover such as:

  • When should I get my blood tested?
  • Discuss any symptoms that you may be having such as chest pains or shortness of breath. 
  • List your family history and personal history of any heart disease, high blood pressure, diabetes, smoking or smoke exposure and current medications that you take.
  • Bring a family member or friend to help you process the information you will receive.
  • Be prepared to discuss your current diet and exercise routine.
  • Write down any other questions you may have for the doctor so that you do not forget to ask them.3 

Since your cholesterol level is a known risk factor for heart disease, early detection and prevention of high cholesterol levels is the key to reducing your risk for heart attack or stroke. Modification of diet and exercise are simple ways that you can make a great impact on your future heart health. Partner with your health care team to set goals and routinely evaluate your progress. 


  1. U.S. Department of Health and Human Services. What is Cholesterol? National Heart, Lung and Blood Institute. Retrieved April 19, 2016 from the website:
  2. American Heart Association. About Cholesterol. April 21, 2014. Retrieved from the website:
  3. Mayo Clinic Staff. Preparing for Appointment. Mayo Clinic. Feb 9, 2016. Retrieved from the website:
  4. Centers for Disease Control and Prevention. High Cholesterol Facts. National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention. Mar 17, 2015. Retrieved from the website: