Cholesterol & Heart Health

The following factors increase your likelihood of having unhealthy cholesterol levels. Some you can change, and others you can’t:

Age, sex and family history

• Age: Normal age-related changes in the body may increase LDL or “bad” cholesterol. High LDL levels are most commonly diagnosed in 40- to 59-year-olds. Younger people, including children and teens, can have high LDL but it’s less common.
• Genetics: A family history of high cholesterol may mean your body has more difficulty removing or breaking down LDL or “bad” cholesterol because of changes in genes. Be sure to tell your healthcare provider of any family history.
• Sex: Men typically have higher cholesterol until women reach menopause, after which their risk increases. Being pregnant may also alter your cholesterol.
• Race: Your race or ethnicity may affect your risk of having unhealthy cholesterol levels. Overall, white people are more likely than other groups to have high levels of total cholesterol.
  • Asian Americans, including those of Indian, Filipino, Japanese and Vietnamese descent, are more likely to have high levels of LDL or “bad” cholesterol than other groups.
  • Hispanic Americans are more likely than others to have lower levels of HDL or “good” cholesterol.
  • African Americans are more likely to have high HDL levels. However, they are more likely to have other risk factors, such as high blood pressure, obesity or diabetes, which may overcome the benefits of higher HDL levels. 

Lifestyle choices: 

Your lifestyle, including diet, smoking, stress, alcohol consumption and physical activity levels, affect cholesterol levels. Lifestyle choices can can raise LDL and lower HDL.

• Diet
• Smoking
• Alcohol use
• Stress
• Physical inactivity 

Medical conditions & medications that negatively affect cholesterol levels

Certain medical conditions may raise your LDL and lower your HDL levels. These include: 

• Diabetes
• Chronic kidney disease
• HIV infection
• Hypothyroidism
• Lupus
• Multiple myeloma
• Obesity
• Polycystic ovary syndrome
• Sleep apnea
• Medications: Some medications may also impact cholesterol, raising LDL or lowering HDL. 

There are usually no symptoms of high cholesterol. Many people don’t know they have it until their healthcare provider does a routine blood test to check. When and how often you should get this test depends on your age, risk factors and family history. It is recommended to have cholesterol testing as part of routine cardiovascular risk assessment. 

These tests measure total cholesterol, LDL, HDL and triglycerides. Screening frequency varies by age, risk factors and family history:

• Children: Testing is recommended if there is a family history of high cholesterol or other risk factors.
  • Ages 2 to 8 years: Cholesterol testing is recommended if:
    • A family history of early cardiovascular disease or high cholesterol.
    • Other risk factors such as obesity, diabetes or hypertension.
    • A repeat cholesterol test is recommended at 12 to 16 years.
  • Ages 9 to 11 years: All children should undergo cholesterol testing.
  • Ages 17 to 20 years: A repeat cholesterol test is recommended.
• Adults: Testing every 4-6 years is standard for adults over the age of 20, with more frequent testing for those with known cardiovascular risks.
  • Severe Hypercholesterolemia (LDL ≥ 190 mg/dL): Patients should undergo more aggressive cholesterol management and testing, possibly more frequently, as part of high-intensity statin therapy.
  • Diabetes: Adults with diabetes, particularly those between 40 to 75 years old, should have their cholesterol checked regularly, with a focus on maintaining lower LDL levels.
  • Ages 65 and older may benefit from annual testing. 

You may need to get your cholesterol checked more often if you have heart disease, diabetes or a family history of high cholesterol. If you have unhealthy, actively treated or borderline cholesterol levels, you may need to have it tested more often. Talk with your doctor to find out how often is best for you.

Cholesterol Testing

Many screening sites measure only total cholesterol. It is very important to look at all types of cholesterol in your blood and not just your total cholesterol number. So, follow up with a healthcare provider for a blood test called a complete lipid profile. You may need to fast for 9 to 12 hours before getting this test done.

A lipid profile tells you the levels of each type of fat in your blood, including:

• Total cholesterol
• HDL “good” cholesterol
• LDL “bad” cholesterol
• Triglycerides

Understanding Cholesterol Numbers

Talk with your healthcare provider about what all your lipid numbers should be for you. Your numbers may depend on your age, race, blood pressure, weight, family history and more. However, here are some general guidelines: