10 Risk Factors for High Cholesterol and How to Lower It

Cholesterol is a fatty substance found in the blood. The body uses it to make hormones, like testosterone and estrogen.

It is even essential for metabolism and for normal functioning of the membranes that surround cells. However, all types of cholesterol are not good for your health.

LDL or low-density lipoprotein is considered the ‘bad’ cholesterol, while HDL or high-density lipoprotein is the ‘good’ cholesterol.

A small amount of LDL is not bad for you, but an excess can cause a buildup of plaque (thick, hard deposits) in the inner walls of your arteries. This increases your risk of heart disease, attacks, or strokes.

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According to the Centers for Disease Control and Prevention (CDC), more than one-third of adults in America have raised levels of LDL cholesterol. As per the CDC, the following blood cholesterol levels are considered healthy.

Total cholesterol: less than 200 mg/dL (milligrams per deciliter of blood)

LDL cholesterol: less than 100 mg/dL

HDL cholesterol: 40 mg/dL or higher

Triglycerides: less than 150 mg/dL

As high cholesterol has no symptoms, many people are not even aware that they have it. This is why it is recommended that adults get their cholesterol levels checked every few years. People who are at a higher risk of unhealthy cholesterol levels should get checked more frequently.

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Here are the top 10 risk factors for high cholesterol.

1. Increasing Age

Your risk of high cholesterol increases as you get older. Men age 45 or older and women age 55 or older are at increased risk of high cholesterol and heart disease.

The American Heart Association recommends all adults, beginning at age 20, have their cholesterol levels checked every 4 to 6 years.

2. Women who are Postmenopausal

Anyone can have high cholesterol; however, women after menopause are at a higher risk. It is due to their increasing age as well as the hormonal changes associated with menopause. Menopause even increases the risk of heart disease among women.

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A 2009 study published in the Journal of the American College of Cardiology states that LDL cholesterol increases rapidly after menopause.

3. Genetics and Family History

Genetics and hereditary factors can also increase your risk of having high cholesterol levels. If you have a close family member who has cholesterol problems or heart disease, be alert, and get your cholesterol levels checked more often to be on the safe side.

4. Unhealthy Diet

A poor diet can also raise total and LDL cholesterol levels. Eating an excess amount of saturated fat, found in animal products, and trans fats, found in some commercially baked cookies, biscuits, pastries, and crackers, can raise your cholesterol levels.

A healthy diet that includes fresh vegetables, fruits, whole grains, fish, lean meat, and low-fat or fat-free dairy products is something that everyone should adopt.

5. Obesity

Being obese can increase your LDL cholesterol level and lower your HDL level. In fact, a body mass index (BMI) of 30 or above puts you at risk of high cholesterol.

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In addition, obesity can lead to heart disease, high blood pressure, diabetes, arthritis, chronic kidney disease, nonalcoholic fatty liver disease and many other conditions.

Try to maintain a healthy weight to reduce your risk of high cholesterol as well as heart disease.

6. Large Waist Circumference

Men with a waist circumference of at least 40 inches and women with a waist circumference of at least 35 inches are at a higher risk of developing unhealthy LDL levels.

A 2001 study published in the American Journal of Clinical Nutrition found that large waist circumference was associated significantly with low HDL-cholesterol concentrations and high fasting triacylglycerol, insulin and glucose concentrations.

7. Smoking

The harmful toxins and chemicals in cigarette smoke damage the walls of your blood vessels. This leads to the accumulation of fatty deposits in the arteries.

In fact, excess smoking also lowers your level of HDL good cholesterol. A 2013 study published in the Journal of Cellular Biochemistry highlights the effect of cigarette smoke and lower HDL cholesterol levels. This increases the risk of cardiovascular disease in smokers.

8. Diabetes

People suffering from diabetes often have higher LDL and lower HDL cholesterol because high blood sugar damages the lining of the arteries.

In fact, borderline LDL cholesterol elevation is common in diabetic patients and is associated with substantial cardiovascular risk

People with diabetes should have their cholesterol tested yearly.

9. Lack of Exercise

Regular exercise plays a key role in maintaining your heart health. It also helps maintain a healthy weight and reduce LDL cholesterol and triglyceride levels.

On the other hand, living a sedentary lifestyle and not getting enough exercise puts you at a higher risk of having a high LDL level.

Exercise for about 30 minutes most days of the week and increase your daily physical activity, such as short walks and other activities that keep your body moving.

10. Heavy Drinking

One to two drinks per day can help keep your cholesterol level in check. However, excess alcohol will have the opposite impact. It may raise triglycerides due to the high sugar and calorie content of alcoholic drinks.

Furthermore, it can cause high blood pressure, heart failure and strokes.

A 2001 study published in Alcoholism, Clinical and Experimental Research points out the connection between excess alcohol intake and increased risk of LDL cholesterol in middle-aged Japanese men.

If you drink, keep the amount in moderation.

Ways to lower your bad cholesterol

If you have any of these risk factors or already have high cholesterol, you need to take steps to lower your LDL and raise your HDL cholesterol. You just have to make some simple lifestyle changes.

However, if your cholesterol level is too high, you may need to take medication prescribed by your doctor to get your cholesterol back on track.

Here are the top 10 ways to lower your bad cholesterol level.

1. Say No to Trans Fat

When it comes to trans fats, simply avoid them as they can raise your LDL cholesterol while lowering your HDL level.

A 2010 study published in PLoS One highlights the negative effect of animal and industrial trans fatty acids on HDL and LDL levels. Furthermore, these unhealthy fats increase your risk of developing heart disease and strokes.

Avoid margarine, commercial baked goods, crackers, chips and other processed snacks as they often contain these unhealthy fats.

Also, you must avoid or limit your intake of saturated fats and dietary cholesterol, found in egg yolks, red meat, shrimp, lobster, high-fat cheeses, full-fat dairy products, butter and organ meats.

Eat more polyunsaturated and monounsaturated fats, which you can find in olive, canola, and safflower oils; salmon, tuna, trout and mackerel; seeds and nuts; avocados; and soybeans.

2. Opt for Plant-Based Protein

If you are at a high risk of having high cholesterol and cardiovascular disease, opt for protein-rich plant foods instead of animal protein.

Plant-based protein sources are rich in nutrients and phytochemicals that help lower total cholesterol, LDL cholesterol, blood sugar and insulin levels. It even reduces the risk of several cancers.

A 2005 study published in the Annals of Internal Medicine journal emphasizes avoiding saturated fat and cholesterol and including nutrient-dense plant-based foods.

Some good sources of plant-based protein are legumes, lentils, peas, pinto beans, red beans, white beans, soybeans, nuts and seeds.

3. Eat Nuts as Healthy Snacks

Be it a mid-morning or mid-afternoon snack, nuts like walnuts, almonds, peanuts, hazelnuts, pistachios and pecans are the best option if you wish to keep your cholesterol level within the normal range. Nuts are rich in plant sterols, fiber and omega-3 fatty acids that help lower cholesterol and triglyceride levels.

A 2011 study published in The Nutrition Reviews suggests that almonds have a consistent LDL-cholesterol lowering effect in healthy individuals as well as those with high cholesterol and diabetes.

Another 2015 study published in the Journal of American Heart Association notes that daily consumption of almonds may even prevent the onset of cardio-metabolic disease.

However, to enjoy these benefits of almonds and other nuts, choose raw or dry-roasted, unsalted varieties.

4. Include Garlic in Your Diet

Chewing 2 or 3 raw garlic cloves daily on an empty stomach or adding them to salad dressings, soups and sandwiches can help keep your cholesterol levels normal.

In addition, garlic helps prevent blood clots, improves blood circulation, reduces blood pressure and protects against heart disease.

A 2006 study published in the Journal of Nutrition notes that regular garlic intake can lower triglyceride, blood glucose and cholesterol levels. Garlic extract can also help reduce high blood pressure and high cholesterol.

Try to eat raw garlic daily. If you opt to take a supplement, always consult your doctor first.

5. Eat Oatmeal for Breakfast

Eating a bowl of oatmeal is one of the easiest ways to keep your cholesterol levels in check. Its soluble fiber reduces the absorption of cholesterol into your bloodstream and, in turn, lowers LDL. It also keeps you feeling full longer and prevents mindless eating.

A 2011 study published in the Nutrition Reviews highlights the cholesterol-lowering effects of oat β-glucan, a soluble dietary fiber found in the endosperm cell walls of oats.

On average, oat consumption is associated with 5 and 7 percent reductions in total and LDL cholesterol levels, respectively.

Enjoy at least 1 cup of cooked oatmeal daily for breakfast. Top it with nuts, seeds or berries for added health benefits.

6. Switch to Green Tea

Instead of coffee, start drinking green tea to effectively lower your LDL level.

A 2011 study published in the American Journal of Clinical Nutrition notes that regular intake of green tea beverages or extracts can result in significant reductions in serum total cholesterol and LDL-cholesterol concentrations. However, it has no effect on HDL cholesterol.

Green tea contains catechins, which are antioxidants that help lower LDL levels and inhibit the abnormal formation of blood clots. As a bonus, green tea can prevent plaque buildup and reduce the risk of having a heart attack or stroke.

You can drink up to 4 cups of green tea (hot or iced) a day.

7. Eat an Avocado Daily

Avocados are a rich source of oleic acid, a healthy monounsaturated fat that helps increase HDL and lower LDL. They are also rich in fiber and beta-sitosterol that can effectively control cholesterol levels. As a bonus, the monounsaturated fat content lowers the risk of heart disease and stroke.

A 2015 study published in The Journal of American Heart Association suggests that eating 1 avocado per day as part of a moderate‐fat and cholesterol‐lowering diet may lower LDL and non-high density lipoprotein levels.

Eat an avocado daily or add a few slices of avocado to your salad to enjoy maximum health benefits. Along with avocados, you can include strawberries, plums, blueberries, and oranges in your diet to reduce your cholesterol level.

8. Use Corn Oil

You should limit the use of regular cooking oil and replace it with corn oil to reduce your LDL level significantly. Corn oil has a unique combination of healthy fatty acids and plant sterols, which help lower cholesterol. It also reduces the risk of cardiovascular disease, heart attacks and strokes.

A 2015 study published in the Journal of Clinical Lipidology says that corn oil reduces cholesterol significantly more than extra-virgin olive oil with favorable changes in both total and LDL cholesterol.

Add moderate amounts of corn oil to your diet. Olive, sunflower and coconut oil are also healthy options, however not as effective as corn oil.

9. Use Spices Generously

Using spices in your cooking is another easy way to achieve healthy cholesterol levels. Spices like cinnamon, cayenne pepper, turmeric, black pepper and coriander not only add flavor but also improve cholesterol and heart health.

A 2008 study published in the Journal of Environmental Biology points out the cholesterol-lowering property of coriander seeds due to its hypolipidemic action on the metabolism of lipids.

A 2003 study published in Diabetes Care shows that daily intake of 1 to 6 grams of cinnamon powder daily reduces serum glucose, triglyceride, LDL and total cholesterol in people with Type 2 diabetes.

Add cinnamon powder to your oatmeal or smoothie, add black pepper or cayenne pepper to your soup or salad, or try coriander seed tea to improve your cholesterol levels.

10. Fill Up on Fiber-Rich Foods

Eat more foods rich in soluble fiber to reduce your cholesterol level. Soluble fiber prevents your body from absorbing cholesterol.

It also keeps you feeling full longer, thus preventing you from reaching for unhealthy snacks. This also helps with weight loss.

A 1999 study published in the American Journal of Clinical Nutrition highlights cholesterol-lowering effects of dietary fiber. Fiber can reduce total as well as LDL cholesterol.

Another 2000 study published in the American Society for Clinical Nutrition notes that long-term use of a standard dose of psyllium (5.1 g twice daily) resulted in 5 percent lower serum total-cholesterol concentrations and 7 percent lower LDL-cholesterol concentrations. Psyllium, also known as isabgol, is a good source of dietary fiber.

Some excellent sources of soluble fiber are beans, oats, barley, peas, apples, oranges, pears, sweet potatoes, carrots, Brussels sprouts, beets, okra, and eggplant. Remember, when eating fiber-rich foods, drink plenty of water to prevent gastrointestinal discomfort.

Expert Answers (Q&A)

Answered by Dr. Purvi Parwani (Cardiologist)

Do eggs increase cholesterol levels?

Chicken eggs are high in cholesterol. Studies have shown an association between egg consumption and higher cholesterol level. It’s important to know that most of the cholesterol is contained in the egg yolk. To decrease the amount of cholesterol consumed through eggs, one can replace the whole egg with egg whites.

It’s also important to pay attention to the cooking method. For example, poached eggs are a healthier alternative to the traditional fried egg recipes.

Can apple cider vinegar help lower your cholesterol levels?

There are some animal studies to indicate that apple cider vinegar can reduce the cholesterol level. The human data is limited to one study with a mere association of apple cider vinegar to low cholesterol level in women who indicated higher intake than usual.

It’s important to remember that apple cider vinegar is a weak acid and has been associated with side effects like tooth enamel erosion, throat burn, skin burn, and digestive problems.

Can a lack of sleep affect your cholesterol levels?

While there are few studies looking at examining the link between sleep and high cholesterol, it is important to understand that, generally, sleep deprivation indicates poor lifestyle habits or disease status.

In some of these studies, though, there was an association of lack of sleep with a higher level of bad cholesterol (LDL) or lower level of good cholesterol (HDL). The subjects of the studies were found to have stressful jobs, sedentary lifestyles, unhealthy diet choices, and a risk of metabolic syndrome- all of which are associated with high cholesterol level.

Sleep deprivation also tends to change our appetite and stress hormone levels. The physiological changes due to this imbalance can lead to high cholesterol and in turn, higher incidence of heart disease.

What foods can help increase the levels of good cholesterol (HDL)?

My favorite question! Consumption of olive oil, avocado, soy products including tofu, fatty fish, nuts, flaxseed, legumes like chickpea, lentils, soybean, black bean, whole grain, quitting smoking, daily exercise, decreasing LDL and triglyceride level will improve your HDL.

Can stress affect your cholesterol levels?

Again, as I had mentioned for sleep deprivation, studies indicate a link between stress and high cholesterol level. However, most individuals with high stress usually have poor lifestyle habits, unhealthy dietary choices, as well as a lack of exercise.

In addition, long-term stress can increase the level of stress hormones like cortisol in the body, which, in turn, affects metabolism and increases cholesterol.

Why are men more prone to high levels of cholesterol than women?

Cardiovascular disease is the most common cause of death in US women as well as men. Overall, a higher proportion of women have elevated cholesterol level than men. Women before the menopause tend to have lower bad cholesterol and higher good cholesterol compared to men due to the protective effect of estrogen.

After menopause, once the estrogen effect goes away, women actually have double the chance of having a higher cholesterol level when compared to men of the same age.

Please provide an insight on how to maintain optimum cholesterol levels for the benefit of our readers.

I recommend daily laughter with family at the dinner table! Nature walks every weekend with family and friends are also beneficial. The following dietary and lifestyle changes can go a long way in healthy cholesterol management:

Stop smoking
Exercise daily
Eat a plant-based diet which includes whole fruits and green leafy vegetables, increase the intake of whole-grain, legumes
Consume olive oil and nuts in moderation every day
Limit your portion sizes
Eat red meat only once or twice a month
Drink alcohol only in moderation
Remember to stop eating once you are 80% full

About Dr. Purvi Parwani: She is a cardiologist and assistant professor of medicine at Loma Linda University. Her clinical interest involves cardiovascular disease prevention and diagnosis.

She believes that cardiovascular health starts with physical and mental well-being and focuses on lifestyle modification, exercise, diet, and yoga for her patients.