Cholesterol is a type of fat found in our blood. Our bodies need a small amount of cholesterol to build the structure of cell membranes, make certain hormones, and contribute to metabolism, such as the production of vitamin D. The catch: We don’t need too much cholesterol.

Atherosclerosis, also known as narrowing of the arteries, occurs when cholesterol accumulates and blocks blood flow. This buildup is called plaque, which can block arteries and burst, leading to the formation of a blood clot. Atherosclerosis can cause heart problems such as chest pain (angina) or a heart attack. It can also lead to brain problems, including transient ischemic attack, stroke, peripheral arterial disease in the legs or arms, and even kidney failure.

Cholesterol and triglycerides are types of lipids. They travel in our blood by attaching to proteins. Adults 20 and older should ask their healthcare team about their lipid profile and how to interpret the numbers.

Low-density lipoprotein (LDL) cholesterol: LDL is known as “bad” cholesterol. A level below 100 milligrams per deciliter (mg/dl) is optimal for healthy people in the absence of coronary heart disease. If you have heart disease, your LDL should be below 70 mg/dl, experts say. Treatment decisions to achieve appropriate levels should be based on personal risk factors.

High-density lipoprotein (HDL) cholesterol: HDL is known as “good” cholesterol. It absorbs cholesterol from the blood and brings it to the liver, which carries it out of the body. For women, it must be greater than 50 mg/dl. For men, it must be greater than 40 mg/dl.

Triglycerides: Triglycerides are a type of fat used to produce energy. High triglycerides can cause heart disease. Less than 150 mg/dl is optimal.

Total cholesterol: This is the sum of LDL and HDL cholesterol plus 20% of triglyceride levels. A total cholesterol level below 200 mg/dl is desirable.

Some overweight people may have heart disease not because their LDL levels are high, but rather because their HDL levels are low and their triglycerides are high. This relationship can cause heart disease as much or more than just high LDL cholesterol.

These lipid abnormalities are significant in young people in their thirties or forties who are overweight. Their triglyceride levels increase and their HDL decreases. They become prediabetic. Their LDL stays the same, but they’re still headed toward heart disease.

Treatment for high cholesterol depends on individual risk. The higher the risk — for example, with a person who has already had a heart attack — a higher percentage reduction is necessary. Cholesterol-lowering medications can reduce LDL by about 60 to 65 percent. Lifestyle changes can reduce LDL by 10-15%.

Several medications can help manage lipids.

The body’s ability to manage cholesterol is genetically determined. Genetic disorders that increase cholesterol levels are common. Familial hypercholesterolemia is usually caused by a genetic mutation that prevents the body from eliminating cholesterol. People with this condition are more likely to need medication to lower their cholesterol levels.

In people with genetic disorders that expose them to high cholesterol from birth, heart disease may occur at a younger age. So doctors start treating their high cholesterol with medication at a young age.

Beyond medications, lifestyle changes help manage lipids:

• Limit the consumption of meat and dairy products; they contain saturated fats, which increase LDL cholesterol.
• Eat more fish, soluble fiber, fruits and vegetables.
• Avoid diets high in carbohydrates, especially refined carbohydrates like sugar and white flour. They quickly raise blood sugar levels, thereby increasing triglycerides. Reducing refined simple carbohydrates helps reduce triglycerides and weight because you store less fat.
• Control your weight. It reduces your triglycerides and improves your HDL levels.
• Do about 150 minutes of aerobic activity per week at moderate intensity. Moderate intensity means you have to breathe through your mouth. If you breathe through your nose, it’s low intensity. Exercise prevents cholesterol accumulation, but does not change LDL concentration levels. You need to burn around 2,000 calories per week to reduce LDL concentration. However, exercise helps reduce triglyceride levels and maintain weight loss.
• Do strength training at least twice a week. It helps your cardiovascular and muscular systems. Not everything we do to prevent heart disease is necessarily related to cholesterol.

The National Heart, Lung and Blood Institute recommends that people get their first cholesterol screening between ages 9 and 11 and repeat it every five years.

For men ages 45 to 65 and women ages 55 to 65, cholesterol screening tests should occur every one to two years. Over 65? Test every year. More frequent testing may be needed for people with or at risk of coronary heart disease.

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