What is high cholesterol?
Cholesterol is a fatty substance your body needs to build cells and hormones. The problem arises when LDL ("bad") cholesterol is too high or HDL ("good") cholesterol is too low. Excess LDL deposits in artery walls, forming plaques that narrow arteries (atherosclerosis) — reducing blood flow to the heart and brain. High cholesterol affects 1 in 3 adults globally and is one of the leading modifiable risk factors for cardiovascular disease.
Cholesterol test results — what's optimal vs dangerous
| Marker | Optimal | Borderline | High Risk |
|---|---|---|---|
| Total Cholesterol | <180 mg/dL | 180–239 | ≥240 mg/dL |
| LDL Cholesterol | <100 mg/dL | 100–159 | ≥160 mg/dL |
| HDL (men) | >60 mg/dL | 40–60 | <40 (low = bad) |
| Triglycerides | <100 mg/dL | 100–199 | ≥200 mg/dL |
What causes high cholesterol?
Diet & Lifestyle (most common)
Saturated fats (red meat, full-fat dairy, ghee, coconut oil in excess), trans fats (fried food, packaged snacks, margarine), low physical activity, obesity, smoking (lowers HDL), and excess alcohol (raises triglycerides) all worsen cholesterol profiles.
Medical conditions that raise cholesterol
Hypothyroidism — one of the most underdiagnosed causes of high cholesterol. Always test TSH when cholesterol is high. Diabetes — raises triglycerides and lowers HDL. Chronic kidney disease — raises LDL. Familial hypercholesterolaemia (FH) — genetic condition causing very high LDL (often above 190 mg/dL) from birth, regardless of diet.
How to lower cholesterol — what actually works
- Replace saturated fats with unsaturated fats — olive oil, nuts, seeds, avocado instead of butter/ghee
- Eat more soluble fibre — oats, beans, lentils, apples, psyllium (isabgol) bind cholesterol in the gut
- Exercise 150 min/week — raises HDL most effectively
- Lose 5–10% of body weight — significantly improves all lipid values
- Quit smoking — HDL rises within weeks of quitting
- Statins — if LDL stays above target despite lifestyle changes, statins (atorvastatin, rosuvastatin) reduce LDL by 30–50% and cut heart attack risk by 25–35%
LDL targets by risk level
| Risk Category | LDL Target |
|---|---|
| Low risk (no risk factors) | <160 mg/dL |
| Moderate risk (1–2 risk factors) | <130 mg/dL |
| High risk (diabetes, hypertension) | <100 mg/dL |
| Very high risk (previous heart attack/stroke) | <70 mg/dL |
Questions to ask your doctor
- What is my 10-year cardiovascular risk — do I actually need a statin?
- Should I test my thyroid (TSH) since hypothyroidism can cause high cholesterol?
- Does anyone in my family have very high cholesterol — could this be familial?
- How long should I try lifestyle changes before starting medication?