Good vs. Bad Cholesterol: What’s the Difference?

"When you visit your primary care physician, your cholesterol is checked as part of your routine blood work,” said Esra Bayram-Fidan, MD, Catholic Health Family Medicine Physician. “Your PCP will help you understand what your numbers mean and what the key differences are between your ‘good’ and ‘bad’ cholesterol."

Dr. Bayram-Fidan emphasized the importance of knowing your cholesterol numbers because if they get to an unhealthy level, you may be at an increased risk of health problems such as heart attack and stroke.

What is the difference between good and bad cholesterol?

Cholesterol is a waxy, fat-like substance found in all the cells in your body. It helps the body build cells and make vitamins and hormones. Cholesterol comes from two sources: the liver and the foods you eat.

Full-fat dairy products, meat and poultry contain dietary cholesterol. However, these foods can also be high in saturated and trans fats. This can increase the amount of cholesterol in your body.

There are two types of cholesterol: LDL or low-density lipoprotein (“bad” cholesterol) and HDL or high-density lipoprotein (“good” cholesterol). Lipoproteins are a combination of fat (lipid) and protein. They carry cholesterol to and from cells. Too much LDL or insufficient HDL increases the risk of buildup in the artery walls. Cholesterol can also combine with other substances to form plaque.

A normal total cholesterol level is below 200 mg/dL. In the normal range:

• HDL is 60 mg/dL or higher
• LDL is below 100 mg/dL

You have high cholesterol (hyperlipidemia) if your total cholesterol level is 240 mg/dL or higher. In this range:

• HDL is under 40 mg/dL (men) or under 50 mg/dL (women)
• LDL is 160 mg/dL or higher

Triglycerides are the most common type of fat in the body. They store unused calories and provide your body with energy. Although triglycerides are not a type of cholesterol, a physician can check them with a cholesterol test. A high triglyceride level combined with high LDL or low HDL levels can increase the risk of heart attack and stroke.

How do I maintain good cholesterol?

“Healthy lifestyle habits are essential to maintaining good cholesterol,” said Dr. Bayram-Fidan.

Eating heart-healthy foods like omega-3 fatty acids can help keep your LDL at bay. Omega-3 fatty acids can help lower blood pressure and decrease your risk of heart attack and stroke. You can get them from fatty fish, like salmon and mackerel, as well as flaxseed and chia seeds.

Talk with your physician to make sure you are getting enough physical activity and maintaining a healthy weight, which can improve your cholesterol. Smoking also impacts your cholesterol. Exercising and quitting smoking can improve your HDL levels.

What factors make someone at risk for bad cholesterol?

There are several risk factors for “bad” or high cholesterol:

• Drinking too much alcohol
• Eating a diet high in saturated and trans fats
• Gaining too much weight
• Not getting enough physical activity
• Smoking (damages the blood vessels and makes them more likely to collect fatty deposits)

Some medications can raise your LDL or lower your HDL levels. Your cholesterol levels tend to rise as you get older. Men have a greater risk of high total cholesterol between the ages of 20 and 39. Women have a higher risk after menopause when there are lower levels of hormones to protect against high blood cholesterol.

The risk of high cholesterol can impact specific races and ethnicities within the U.S. differently. Statistics show that South Asians tend to have lower HDL levels and a higher risk of developing heart disease. Hispanic men have the highest levels of LDL, followed by white women. African Americans have a higher risk of dying from heart disease despite having lower total cholesterol.

How is bad cholesterol treated?

“Maintaining a healthy diet and staying physically active can help keep your cholesterol under control,” said Dr. Bayram-Fidan. “Medication can also help if lifestyle changes are not enough to manage your LDL or HDL levels.”

Your physician may recommend statins if you cannot get your cholesterol into a normal range with diet changes and physical activity. Statins block an enzyme the liver needs to make cholesterol. Since your body will always produce cholesterol, it may return to a high level if you stop taking a statin. So, you may need to take a statin for the rest of your life.

What are the risks of high cholesterol?

High cholesterol has no symptoms; you can have it for years without noticing. Atherosclerosis is when cholesterol and other substances build up in the artery walls. This can cause complications such as chest pain, heart attack and stroke.

Hyperlipidemia can also lead to coronary artery disease, which is the most common form of heart disease in the U.S. Other conditions high cholesterol can cause include carotid artery disease and peripheral artery disease.

How often should I get my cholesterol checked?

“How often you will need a blood test to check your HDL and LDL levels depends on several factors,” said Dr. Bayram-Fidan.

She noted that most healthy adults should check their cholesterol every four to six years. People with diabetes, heart disease or a family history of hyperlipidemia should talk to their PCP about checking it more often.

Most children should get their cholesterol checked at least once between the ages of 9 and 12. However, if your child has diabetes or obesity, they need more frequent screenings. Adolescents should get their cholesterol checked between the ages of 17 and 21.

“Keeping up with your annual exam and routine bloodwork will help address any concerns about your cholesterol levels before further health complications occur,” said Dr. Bayram-Fidan.