Why High Cholesterol Isn't Always Bad, According to Cardiologists

Emily Laurence

Medical tool for hypertension

Typically, any conversation about cholesterol frames it as something to be cautious of. In most contexts, high cholesterol is seen as bad and something to be avoided. There's a good reason for this: High LDL cholesterol can lead to plaque buildup in the arteries, which increases the risk of heart disease. 

But high cholesterol isn’t always cause for alarm. Sometimes, it’s nothing to worry about at all. Confused? Here, cardiologists explain when high cholesterol is a problem and when it’s not.

Related: This Is the Worst Habit for Heart Health, According to Cardiologists

What Exactly Is Cholesterol?

Cholesterol plays an important role in the body because it’s used to build cells and make vitamins and hormones. There are two sources of cholesterol: the liver (which makes all the cholesterol the body needs) and animal-derived foods, like meat, poultry and dairy. Eating too much of these foods can cause the liver to get more cholesterol than the body needs. When this happens, too much cholesterol can circulate in the blood, which can lead to cardiovascular problems.

It’s also important to know the difference between LDL cholesterol and HDL cholesterol. LDL cholesterol is the “bad” cholesterol that can increase the risk of heart disease and stroke when levels are too high. HDL cholesterol is “good” cholesterol and high levels of it can lower the risk of heart disease and stroke. 

Interventional cardiologist and Reveal Vitality founder Dr. Christopher Davis, MD, FACC, explains that our bodies make cholesterol naturally and some people naturally produce more cholesterol than others. “They are ‘hyperproducers,’ meaning that their liver produces more cholesterol based on their genetics,” he says. An estimated 15% to 20% of the population are hyperproducers. 

Dr. Davis also explains that there are also "hyper absorbers;" people who are predisposed to absorb more of the cholesterol they eat. Hyper-absorbers are more at risk for cardiovascular disease because of this genetic predisposition.

Related: We Hear About 'Bad' Cholesterol All the Time—But Exactly How Bad Is It? Doctors Explain

“Genetics is the cause of high cholesterol in almost all patients with persistently high cholesterol levels. Diet does play some role, of course, but persistently elevated high cholesterol is between 70% and 80% genetics and between 20% and 30% diet and lifestyle, says Dr. Arash Bereliani, MD, a cardiologist, medical director of the Beverly Hills Institute for Cardiology and Preventive Medicine, and the co-founder of B100 Method.

Related: Want to Lower Your Cholesterol Naturally? These 10 Lifestyle Tweaks Could Make a Big Difference

Why High Cholesterol Isn’t Always Cause for Concern

Here’s what can be confusing about cholesterol: Sometimes high cholesterol is cause for concern and sometimes it isn’t. “Some people with high cholesterol levels never get heart disease because they are protected by other genes,” Dr. Bereliani says.

Dr. Bereliani emphasizes that high cholesterol does not equal heart disease. “Plaque buildup in the arteries is a complex process and requires other factors in addition to cholesterol. High cholesterol is only one of many factors that causes heart disease and if you do not have other factors needed to cause plaque, then you might never develop heart disease. Consequently, not everyone with high cholesterol will need to be treated with cholesterol medication,” he explains, adding that, unfortunately, some people who do not need to be on cholesterol medications are taking cholesterol medications unnecessarily and living with adverse side effects of the medications when they really don’t have to be on them in the first place.

This is why, he says, it’s important to work with a cardiologist if you have high cholesterol. A cardiologist can help pinpoint the cause through advanced testing and determine whether or not a cholesterol medication would be helpful or harmful.

“Advanced lipid testing allows us to look at the size of [cholesterol] particles and allows us to look at inflammation markers which is important because cholesterol by itself does not cause heart disease,” Dr. Davis says, explaining that this is a good way of knowing what someone’s risk really is. Scientific research shows that people with small cholesterol particles are more at risk for heart disease than people with large cholesterol particles.

If you have high cholesterol from genetics, you may need cholesterol medication or you may not. The only way to know for sure is to see a cardiologist for testing. Once you know what your cholesterol numbers are, the reasons behind why and what your inflammation markers are, you and your doctor can form a plan together so your heart stays healthy for many, many years to come.

Next up, check out this list of 25 foods that are good for your heart.

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