Cholesterol for Beginners
What is cholesterol?
Cholesterol is a waxy substance naturally found throughout the body. Our bodies need cholesterol in order to make cells, vitamins, and hormones. However, too much cholesterol can cause serious health issues.
The two main types of cholesterol include low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is known as the “bad” kind of cholesterol, while HDL is known as the “good” kind of cholesterol. Both types of cholesterol travel throughout your bloodstream. When there is too much LDL in the bloodstream, the LDL can combine with other substances and create plaque build up on the walls of your arteries. This plaque growth is known as atherosclerosis, which increases your risk for heart attacks, strokes, and other diseases. Conversely, HDL is considered good because it removes excess cholesterol from the bloodstream, reducing the risk of atherosclerosis. For these reasons, we want to keep our LDL level low and our HDL level high in order to help prevent heart disease.
Diet, exercise, and other factors such as smoking and genetics can impact your cholesterol levels. Getting your cholesterol levels checked regularly is important. Talk with your doctor about how often you should do this. If it is determined that your cholesterol levels are too high, your doctor may recommend lifestyle changes, such as diet and exercise. They may also recommend cholesterol-lowering medications.
The liver produces enough cholesterol for the body to function, but we get additional LDL (bad) cholesterol from the foods that we eat. Limiting your intake of saturated fats and trans fats is the best way to reduce your LDL. There are also some foods that you can eat to help reduce your cholesterol levels. In addition to diet, regular exercise is another effective way to reduce bad cholesterol.
| Foods that may INCREASE LDL cholesterol Limit your intake of these foods | Foods that may DECREASE LDL cholesterol Incorporate more of these foods into your diet |
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While diet and exercise may be enough for some people, others may need to take medications to help reduce their cholesterol levels. There are many drug classes that work to lower cholesterol. The most common of these medications are known as “statins.” Some patients may just need one medication to control their cholesterol levels, while others may need to take multiple medications.
Cholesterol-Lowering Medications:
| Drug Class | Examples | How They Work |
| HMG-CoA reductase inhibitors | atorvastatin, rosuvastatin, simvastatin, pravastatin | Prevents cholesterol production in the liver |
| Cholesterol absorption inhibitors | ezetimibe | Prevents cholesterol from being absorbed in the small intestine |
| PCSK9 inhibitors | alirocumab (Praluent®), evolocumab (Repatha®) | Monoclonal antibody that increases the number of LDL receptors available to eliminate circulating LDL |
| Bile acid sequestrants | cholestyramine, colestipol, colesevelam | Binds to bile acids in the intestine, resulting in the conversion of cholesterol to bile acids and increased cholesterol elimination |
| Fibrates | fenofibrate, gemfibrozil | Increases the breakdown of fats and elimination of triglycerides |
| Omega-3 fatty acids | omega-3 ethyl ester (Lovaza®), icosapent ethyl (Vascepa®) | Prevents the formation of triglycerides and increases triglyceride elimination |
| Niacin | niacin ER, niacin CR, niacin IR | Prevents the formation of triglycerides and increases triglyceride elimination |
Considerations in the older population
For some older patients, cholesterol management may no longer be a priority. Shared decision making between the patient, doctor, and caregiver should be used to determine how cholesterol is managed. For some older adults, medications may be continued to help lower cholesterol and the risks of heart attacks, strokes, etc. For other older adults, cholesterol-lowering medications may be stopped due to the risks of the medication outweighing the benefits. For example, these medications may cause problematic side effects that reduce patients’ quality of life. Diet and exercise recommendations must also be modified for some older adults. It is important to consider the patient’s mobility level and any dietary issues, such as trouble swallowing.
How low can we go?
Extremely low cholesterol is considered to be LDL < 20 mg/dL. Based on the most recent studies, there are no known risks of achieving an extremely low cholesterol level. In fact, it may help to further prevent heart disease. However, achieving this low of a cholesterol level may not be necessary for many people.
What are the goal cholesterol levels?
Your goal is based on various risk factors, so these goals differ from person to person.
When determining your personal goals, it is always best to speak with your doctor. The table below summarizes the general goals for most adults.
| Goal Value | |
| LDL | Most patients: < 100 mg/dL High risk patients: < 70 mg/dL |
| HDL | Men: > 40 mg/dL Women: > 50 mg/dL |
| Triglycerides | < 150 mg/dL |
| Total cholesterol | 125-200 mg/dL |
Written by: Jasmine Hunt, PharmD candidate 2025
References:
- https://www.heart.org/en/health-topics/cholesterol/about-cholesterol
- https://www.cdc.gov/cholesterol/about/index.html
- https://my.clevelandclinic.org/health/articles/23922-what-is-cholesterol
- https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
- https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean
- https://my.clevelandclinic.org/health/articles/16867-cholesterol–nutrition-tlc
- https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186
- https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications
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