Good and Bad Cholesterol and Heart Disease

Health Information

What is cholesterol?

Disclaimer: The information provided here is intended for general health care information purposes or educational purposes only, and should not be considered complete or used as a substitute for consultation or advice from a physician and/or healthcare provider. It should not be used to diagnose and treat any diseases. Individuals are encouraged to contact their own private physician or healthcare provider regarding continuation or changes in their symptoms. If you have a serious health problem or should you have any questions about the information found on this site, please call or consult your physician or healthcare provider before taking any action.


Cholesterol is a waxy material found in all parts of your body. It helps to make your cells, some hormones, and vitamin D. Cholesterol comes from two sources: your body and the foods you eat. Your liver makes all the cholesterol your body needs.

Why should I worry about cholesterol?

Too much cholesterol in your body means that you have more chance of getting heart disease than a person who has a healthy cholesterol level. Here's what happens. Over time, if you have too much cholesterol in your body, it can build up on the walls of the arteries that carry blood to your heart. This means that less blood and oxygen are getting to your heart. This can cause chest pain and heart attacks.

I've heard people talk about good and bad cholesterol. What do they mean?

Good cholesterol (HDL) takes the bad cholesterol out of your blood and keeps it from building up in your arteries. Bad cholesterol (LDL) makes cholesterol build up on the walls of your arteries and increases your chances of getting heart disease.

My doctor uses numbers to tell me about my cholesterol. Can you help me understand what these numbers mean?

The numbers tell you how much cholesterol you have in your blood.

Your total cholesterol level should be less than 200. This is healthy.

The higher your level of total cholesterol (240 or above), the more chance you have of getting heart disease.

Your good cholesterol level (HDL) should be 35 or higher. Doctors say a level of 60 can help protect you from heart disease.

Your bad cholesterol level should be less than 130.

Talk with your doctor to see if you need to make changes in the way you live or the foods you eat to have healthy cholesterol levels.

What makes my cholesterol levels go up?

Eating foods such as meats, whole milk dairy products, egg yolks, and some fish can make your cholesterol levels go up. Being overweight can make your bad cholesterol go up and your good cholesterol go down. Also, after women go through menopause (the change of life), their bad cholesterol levels tend to go up.

What can I do to lower my cholesterol levels?

Here are ways to lower your cholesterol levels. Taking these steps can help lower your chance of getting heart disease.

Eat foods with less fat, saturated fat, and cholesterol.

Take off the skin and fat from meat, poultry, and fish.

Broil, bake, roast, or poach instead of frying foods.

Eat lots of fruits and vegetables everyday.

Eat lots of cereals, breads, rice, and pasta made from whole grains, such as whole wheat bread or spaghetti.

Eat less sausage, bacon, salami, bologna, other fatty sandwich meats, whole milk, cheese, butter, and oil.

Drink skim or low-fat milk.

Use skim or low-fat milk, cheese, and yogurt in cooking.

Use liquid or soft margarine or vegetable oils.

Eat more egg whites and less egg yolks.

Read food labels to learn how much fat is in the food you eat. Also look for the amount of saturated fat and cholesterol in food.

Ask your doctor or dietitian about which foods will help lower your cholesterol levels.

Get lots of exercise everyday. Talk to your doctor about what are the safest and best ways for you to exercise. Some examples of good ways to exercise include walking, yard work, housework, dancing, aerobic dance, running, swimming, jumping rope, and bicycling.

Lose weight if you are overweight.

Stop smoking.

Take your high blood cholesterol medication (take only as prescribed by your doctor).

Cholesterol Quiz

CHECK YOUR CHOLESTEROL AND HEART DISEASE I.Q.

Prepared by the National Heart, Lung, and Blood Institute

Are you cholesterol smart? Test your knowledge about high blood cholesterol with the following questions. Circle each true or false.

T F 1. High blood cholesterol is one of the risk factors for heart

disease that you can do something about.

T F 2. To lower your blood cholesterol level you must stop eating meat altogether.

T F 3. Any blood cholesterol level below 240 mg/dL is desirable for adults.

T F 4. Fish oil supplements are recommended to lower blood cholesterol.

T F 5. To lower your blood cholesterol level you should eat less saturated fat, total fat, and cholesterol, and lose weight if you are overweight.

T F 6. Saturated fats raise your blood cholesterol level more than anything else in your diet.

T F 7. All vegetable oils help lower blood cholesterol levels.

T F 8. Lowering blood cholesterol levels can help people who have already had a heart attack.

T F 9. All children need to have their blood cholesterol levels checked.

T F 10. Women don't need to worry about high blood cholesterol and heart disease.

T F 11. Reading food labels can help you eat the heart healthy way.

Answers to the Cholesterol and Heart Disease I.Q. Quiz

1. True. High blood cholesterol is one of the risk factors for heart disease that a person can do something about. High blood pressure, cigarette smoking, diabetes, overweight, and physical inactivity are the others.

2. False. Although some red meat is high in saturated fat and cholesterol, which can raise your blood cholesterol, you do not need to stop eating it or any other single food. Red meat is an important source of protein, iron, and other vitamins and minerals.

You should, however, cut back on the amount of saturated fat and cholesterol that you eat. One way to do this is by choosing lean cuts of meat with the fat trimmed. Another way is to watch your portion sizes and eat no more than 6 ounces of meat a day. Six ounces is about the size of two decks of playing cards.

3. False. A total blood cholesterol level of under 200 mg/dL is desirable and usually puts you at a lower risk for heart disease. A blood cholesterol level of 240 mg/dL is high and increases your risk of heart disease. If your cholesterol level is high, your doctor will want to check your level of LDL-cholesterol ("bad" cholesterol). A HIGH level of LDL-cholesterol increases your risk of heart disease, as does a LOW level of HDL-cholesterol ("good" cholesterol). An HDL-cholesterol level below 35 mg/dL is considered a risk factor for heart disease. A total cholesterol level of 200 239 mg/dL is considered borderline-high and usually increases your risk for heart disease. All adults 20 years of age or older should have their blood cholesterol level checked at least once every 5 years.

4. False. Fish oils are a source of omega-3 fatty acids, which are a type of polyunsaturated fat. Fish oil supplements generally do not reduce blood cholesterol levels. Also, the effect of the long-term use of fish oil supplements is not known. However, fish is a good food choice because it is low in saturated fat.

5. True. Eating less fat, especially saturated fat, and cholesterol can lower your blood cholesterol level. Generally your blood cholesterol level should begin to drop a few weeks after you start on a cholesterol-lowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more.

6. True. Saturated fats raise your blood cholesterol level more than anything else. So, the best way to reduce your cholesterol level is to cut back on the amount of saturated fats that you eat. These fats are found in largest amounts in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils--coconut, palm, and palm kernel oils.

7. False. Most vegetable oils--canola, corn, olive, safflower, soybean, and sunflower oils--contain mostly monounsaturated and polyunsaturated fats, which help lower blood cholesterol when used in place of saturated fats. However, a few vegetable oils-- coconut, palm, and palm kernel oils--contain more saturated fat than unsaturated fat. A special kind of fat, called "trans fat," is formed when vegetable oil is hardened to become margarine or shortening, through a process called "hydrogenation." The harder the margarine or shortening, the more likely it is to contain more trans fat. Choose margarine containing liquid vegetable oil as the first ingredient. Just be sure to limit the total amount of any fats or oils, since even those that are unsaturated are rich sources of calories.

8. True. People who have had one heart attack are at much higher risk for a second attack. Reducing blood cholesterol levels can greatly slow down (and, in some people, even reverse) the buildup of cholesterol and fat in the wall of the coronary arteries and significantly reduce the chances of a second heart attack. If you have had a heart attack or have coronary disease, your LDL level should be around 100 mg/dL which is even lower than the recommended level of less than 130 mg/dL for the general population.

9. False. Children from "high risk" families, in which a parent has high blood cholesterol (240 mg/dL or above) or in which a parent or grandparent has had heart disease at an early age (at 55 years or younger), should have their cholesterol levels tested. If a child from such a family has a cholesterol level that is high, it should be lowered under medical supervision, primarily with diet, to reduce the risk of developing heart disease as an adult. For most children, who are not from high-risk families, the best way to reduce the risk of adult heart disease is to follow a low saturated fat, low cholesterol-eating pattern. All children over the age of 2 years and all adults should adopt a heart healthy eating pattern as a principal way of reducing coronary heart disease.

10. False. Blood cholesterol levels in both men and women begin to go up around age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a women's LDL-cholesterol level goes up--and so her risk for heart disease increases. For both men and women, heart disease is the number one cause of death.

11. True. Food labels have been changed. Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products. Also, look for the list of ingredients. Here, the ingredient in the greatest amount is first and the ingredient in the least amount is last. So to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first, or that list many fat and oil ingredients.

Where to go for help

  • Ask Your Health Professionals
  • In addition to your doctor, other health professionals can help you control your blood cholesterol levels. These persons include:
  • Registered dietitians (R.D.) or qualified nutritionists, who can explain food plans and show you how to make changes in what you eat. They can give you advice on shopping for and preparing foods, and eating out. They also can help you set goals for changing the way you eat, so you can successfully lower your high blood cholesterol without making big changes all at once in you eating habits or in your lifestyle.
  • To find a Registered Dietitian contact: The National Center for Nutrition and Dietetics' Consumer Nutrition Hotline 1-800-366-1655, your local hospital or health department, or your doctor.
  • The nurse in you doctor's office, who also may be able to answer questions about hour high blood cholesterol or your diet.
  • Lipid specialists, who are doctors with an expertise in treating high blood cholesterol and similar conditions. In special cases, you may be referred to lipid specialist if the treatment your doctor is prescribing does not successfully lower you blood cholesterol levels.

Your doctor, who can answer questions about the medicines you are taking. Be sure to tell your doctor about everything you are taking and if you feel different after you take any of them.

Pharmacists, who are aware of the best ways to take medicines to lessen side effects and of the latest research on drugs.

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