Reviewed by Robert Ehrman, MD

Cholesterol is a waxy substance that is vital for all normal body functions. It’s found in every cell in our bodies. When there’s too much, there is a greater risk of hardening of the arteries: the main cause of a heart attack. Normal total cholesterol is less than 200 (mg/dL). A normal triglyceride level (another type of blood fat) is less than 150 mg/dL. Currently, the American Heart Association recommends that people who don’t have diabetes keep their bad (LDL) cholesterol levels below 130 mg/dL. If you have diabetes—especially type 2—you need to be extra careful about your LDL. Your recommended LDL is 100 mg/dL or less. In some cases, such as if you have diabetes and heart disease, 70 mg/dL or less is best.

Good (HDL) cholesterol removes cholesterol from blood vessels and brings it back to the liver to be excreted from the body. Bad (LDL) cholesterol is laid down on blood vessel walls. The goal is to have your HDL as high as possible and your LDL as low as possible.

If your blood cholesterol is above where it should be, you’re more likely to have heart-related health problems. In diabetes, high cholesterol is especially bad for your heart.

From a lifestyle point of view, healthy eating and physical activity are very important. In terms of healthy eating, cut back on saturated fats, such as meat, cheese, fried foods, whole milk and sweets. There are plenty of foods that taste good and are healthier for you, such as fruits, vegetables, chicken and fish. Prepare these foods in healthier ways such as steaming, broiling or baking. Certain foods, like monounsaturated fats (canola or olive oil) and fruits and vegetables, tend to be the best at raising HDL. But, it’s easier to lower your bad cholesterol than to raise your good cholesterol. We’re not really sure why, but that’s how it works.

Cholesterol-lowering medicines can either lower the bad or raise the good cholesterol. Medicines that fall into the category of statins work by lowering LDL and triglycerides.

There are no specific symptoms of high cholesterol. However, there are symptoms of heart attack and stroke. This usually means there are problems with your cholesterol. These symptoms include chest pain, shortness of breath and lack of energy, among others.

Cholesterol is an equal opportunity killer. It affects men and women. People who are over 40 tend to benefit more from paying attention to their cholesterol levels because they are more likely to have dangerous buildups of plaque in the blood vessels.

Some studies suggest you probably want to continue taking medication for the long term because the data shows a lower risk of heart attack and stroke. Also, even if you’ve never had a heart attack, healthy eating and physical activity can lower your numbers enough. It depends on the person.

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