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What is cholesterol — and why do I need to keep it in check?

Answers to your questions

Doctors often refer to heart disease as "the invisible killer." That's because the risk factors — like high blood pressure or high cholesterol — for heart disease often don't show any obvious symptoms until it's too late. Getting your cholesterol checked regularly (every four to six years if you don't have a personal or family history of high cholesterol, more frequently if you do) is an important part of staying in control of your health.

To check your cholesterol, your doctor will likely order a lipid panel (through a simple blood draw) as part of your annual preventive exam or other well-being checkup. This test reveals four numbers: total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. Now that you have these numbers, you might be wondering: what do they mean? How do they affect my health? How can I make sure my numbers are in the healthy range?

We sat down with Dr. Michael McCormick, medical director at Wellmark Blue Cross and Blue Shield, to get answers to your most burning questions about cholesterol.

Q: Okay, first of all — what is cholesterol?

A: Cholesterol is a fatty substance found in your blood. There are two main types: HDL — the "good" cholesterol — and LDL — the "bad" cholesterol. Typically, HDL and LDL are inverse of each other, meaning one is high when the other is low. Think of HDL as empty boxcars. They carry the bad cholesterol to the liver, which is where it's metabolized. So, the more "boxcars" you have, the better.

Q: What causes high cholesterol?

A: Among other factors, diet and exercise can impact your cholesterol levels. Exercising regularly — getting 150 minutes a week of moderately intense activity — will help you maintain an ideal weight and achieve a good balance of good vs. bad cholesterol. Being at a healthy weight also helps with your triglycerides and blood sugar, which further reduces your risk of heart disease. When it comes to eating, the fresher the food the better. Greasy, fried food often tastes good, but from a nutritional standpoint it's not healthy for your heart. Aim to eat things you can prepare yourself instead of grabbing at a drive-through window. And, stay away from empty calories like fruit juices, colas, and sugary espresso drinks.

Q: What will happen if you have high cholesterol?

A: High cholesterol, like high blood pressure, high blood sugar, and a high body mass index (BMI), is a risk factor for heart disease. If you have LDL higher than 100 mg/dL, HDL lower than 50 mg/dL, and/or total cholesterol higher than 200 mg/dL, your cholesterol levels are high. This increases your risk for build-up of plaque in your arteries, which can lead to a heart attack or stroke.

Triglycerides, the other number you'll see on your lipid panel, are another fatty substance in your blood. If your body can’t process glucose or sugar effectively, this level will go up. If your triglycerides are higher than 150 mg/dL, it can be hard on your pancreas and potentially lead to prediabetes.

Q: If I eat something with a lot of cholesterol, will that make my numbers go up?

A: Not necessarily. When you're reading nutritional labels, you don't want to pay attention to the amount of cholesterol as much as the type of fat. When you're consuming fat, you want to get unsaturated fats like polyunsaturated and monounsaturated fat — found in avocados, olives, peanut butter, fatty fish like salmon and mackerel, and nuts and seeds. Fats you want to avoid in high amounts are saturated fat External Site, often found in animal products like meat and dairy, and trans fat, often found in processed foods like cookies, cakes, crackers, margarine, and microwavable popcorn.

Q: How do I lower my cholesterol?

A: Sometimes, high cholesterol can be lowered naturally. Eating a diet rich in fiber and lower in fat can increase your HDL cholesterol and lower your LDL cholesterol. However, some people follow the proper diet, exercise, and do everything they need to be doing but still have high cholesterol — and high LDL in particular. One of the reasons for this is you can inherit high cholesterol. So, if one or more of your family members has high cholesterol, your risk for having it increases.

If you have consistently high cholesterol levels, your doctor will likely recommend medication. Generally, you'll be prescribed a statin, which is a type of medication that works in the liver to lower cholesterol, particularly LDL cholesterol. No matter what you hear, high cholesterol is not something that can be cured. However, it's manageable with a healthy lifestyle and medication, if needed.

Maintaining healthy cholesterol levels is just one of the things you should do to keep your heart healthy. For more information on how to make sure your heart is in tip-top shape, check out our other heart-health articles: