High Cholesterol Graphic

High Cholesterol (Hyperlipidemia)

cardiogram High Cholesterol, Medical Conditions

High cholesterol is a common, but serious, issue. It arises when there’s an excess amount of a waxy substance called cholesterol in the blood. Around 38% of the U.S. adult population have high cholesterol1. And the development of it can lead to heart disease and stroke. But there are ways to both prevent and lower cholesterol! Before we get there, let’s start with the basics: 

Artist rendering of a blood vein with high levels of cholesterol
What is Cholesterol? 
Cholesterol is a substance that’s both made by the body and found in certain foods. It’s part of a structure called a lipoprotein which is made up of varying amounts of both lipids (a type of fat) and protein. All types of cholesterol have a waxy consistency, but not all are created equal. Some cholesterol is used by the body for vital functions such as hormone and cell production, and to aid in the digestion of food. On the other hand, some cholesterol can build up in the arteries and wreak havoc on your heart and overall health. 
What Are the Different Types of Cholesterol? 

While many folks have heard about “good” and “bad” cholesterol, there are actually three types. Here’s the breakdown:  

  • High-Density Lipoprotein Cholesterol (HDL-C) - Considered the “good” type of cholesterol. This is because it helps move LDL-C (see below) to the liver, which removes it from the circulation and the body. HDL-C is also thought to play a role in removing LDL-C from arterial plaque. 
  • Low-Density Lipoprotein Cholesterol (LDL-C) - Known as “bad” cholesterol. This is due to its tendency to accumulate on arterial linings and form plaque. 
  • Very-Low Density Lipoprotein Cholesterol (VLDL-C) - Made by the liver and contains high amounts of triglycerides which are carried out to the body’s tissues.  
Artist rendering of a blood vein with high levels of cholesterol

Are Triglycerides a Type of Cholesterol? 

When healthcare professionals talk about cholesterol, the mention of triglycerides are sure to follow. Triglycerides are actually not a type of cholesterol, but rather a common type of fat. Like cholesterol, triglycerides are both produced by the body and found in certain foods. And they can also contribute to the formation of plaque in arteries. Elevated triglycerides are considered an independent risk factor for heart disease, which is why they’re checked along with cholesterol levels as part of a lipid panel. 
Cholesterol levels in adults chart
What Are Recommended Cholesterol Levels? 

Interestingly, the recommended levels of cholesterol for adults over the age of 20 differ only slightly for men versus women. Total cholesterol is the combination of HDL-C, LDL-C and a type of VLDL cholesterol. Here are some key numbers: 

  • Both men and women should strive to keep their total cholesterol level between 125 and 200 mg/dL (2) 
  • LDL cholesterol for both groups should be less than 100 mg/dL 
  • HDL for men should be at least 40 mg/dL and 50 mg/dL or higher for women 
  • Triglyceride levels should be under 150 mg/dL 

To be safe, adults should have their cholesterol levels checked when they reach age 20 and then every four to six years thereafter3. People who are treated for elevated cholesterol, or who have certain risk factors, may need to be monitored more closely and have their levels checked more frequently.  

GIF of artist rendering of cholesterol in blood stream
How is High Cholesterol Harmful?

When cholesterol levels are too high, it can lead to atherosclerosis (a disease of the artery walls due to high levels of cholesterol). Atherosclerosis begins with an injury to the artery wall which results in an immune-system reaction, including inflammation. When the innermost layer of the arterial wall (tunica intima) is damaged, blood components can invade the middle layer. A plaque then forms at the injury site (the area between the innermost layer and the middle layer of the artery wall) and LDL-C, the main component of total cholesterol, embeds itself inside the artery wall4.  

Over time, this leads to a narrowing of the artery walls which decreases the ability for oxygen delivery to the tissues throughout the body. Atherosclerosis can lead to coronary artery disease (CAD), peripheral artery disease (PAD), and chronic kidney disease (CKD) as the smaller arteries in the body become obstructed and less flexible from plaque deposits. 

A blood clot can also form if portions of plaque break off. When this rogue plaque then travels through the circulatory system, it can cause a complete blockage of blood flow, potentially causing a stroke or myocardial infarction. 

What Are Risk Factors for High Cholesterol? 
Most chronic diseases, including cardiovascular disease (CVD), involve complex interactions between many genetic and lifestyle factors. Cholesterol levels, like heart disease itself, can be affected by modifiable and non-modifiable risks. 
Non-Modifiable Risk Factors for High Cholesterol 

A non-modifiable risk is a risk factor you have no control over. Examples of risk factors we have no control over include heredity, race or ethnicity, age, and sex2. For example, some people are more likely to have high cholesterol because their parents have it and they have inherited this tendency. Cholesterol levels also naturally rise with age, and women generally have lower cholesterol levels than men prior to menopause (after which, women’s LDL-C levels tend to increase).  

When considering risk based on race and ethnicity, Hispanic men in the U.S. have significantly higher levels of LDL-C compared with their white, Black, and Asian counterparts5. Cultural factors and genetics both may contribute to racial and ethnic differences in risk levels. Unfortunately, differences in health due to the accessibility and affordability of preventative care play a role as well. Certain health conditions, such as familial hypercholesterolemia and type 2 diabetes also increase the risk for having increased cholesterol levels6. 

Modifiable Risk Factors for High Cholesterol 

Modifiable risk factors are those that can be changed in order to decrease risk. These include weight, frequency of exercise, type of diet, and tobacco use2. For instance, consuming certain foods and being overweight can increase blood cholesterol levels. Smoking decreases the “good” cholesterol (HDL-C) and constricts blood vessels that may already be partially obstructed by plaque deposits, increasing risk of stroke. While quitting smoking can help to increase HDL-C levels, physical activity has also been shown to increase HDL-C and can contribute to weight loss. Other modifiable risk factors include insulin resistance and blood sugar levels as well as psychological stress7.If LDL levels are above 190 mg/dL, medication can help to decrease this number8. 

picture of healthy foods laying on white table
Can I Lower My Cholesterol? 

Yes! Now, are you surprised that we will recommend healthy eating to do so? A typical American’s diet is high in calories, highly-processed foods, simple carbohydrates, and sodium. Simultaneously, many Americans are not regularly consuming vegetables or whole fruits, and the majority of food choices are low in fiber. To help reduce cholesterol, you we ideally want to do the opposite. Not only will this lower your cholesterol numbers, but it can also help to decrease blood pressure, weight, and overall cardiovascular risk.  

What Action Steps Should I Take to Lower Cholesterol? 

Believe it or not, cholesterol from the foods we eat is not the biggest culprit in increasing cholesterol levels in the blood. There are limited long-term, clinically-controlled research studies to use as a basis for optimal dietary cholesterol intake. And interestingly, observational studies that look back at what research participants ate in the past usually don’t show an association between dietary cholesterol and cardiovascular risk or mortality9. Because of this, foods high in dietary cholesterol such as eggs, shellfish, and organ meats are no longer restricted in diet guidelines that aim to reduce cardiovascular disease.   

So, rather than focusing on not intaking too much cholesterol to lower your numbers, you should instead focus on:10  

  • Increasing fiber through plant foods, including vegetables, whole grains, nuts, legumes, and whole fruits (at least 3-5 servings of veggies and 2-4 servings of whole fruits daily). 
  • Limiting sugary foods and beverages 
  • Limiting highly-processed foods (also called ultra-processed foods) 
  • Choosing foods containing monounsaturated and polyunsaturated fats most often 
  • Including at least two servings of fish per week 

You can also look into both the DASH diet (Dietary Approaches to Stop Hypertension) and the Mediterranean diet. They both include beneficial foods to help those with elevated cholesterol and increased risk of heart disease lower these risks10. Specifically, they include vegetables and whole fruits, whole grains, and proteins such as fish, seafood, and legumes. Limited amounts of animal products such as red meat, poultry, dairy, and eggs are consumed. In the Mediterranean diet, the main fat used is olive oil. Foods are not highly processed. And small amounts of alcohol are consumed in the form of wine with meals. The DASH diet additionally includes a specific focus on reducing sodium intake in the diet. 


Another way to improve cholesterol levels is through regular exercise. It’s been shown as an effective way of increasing HDL cholesterol, which then helps to offset LDL cholesterol11. Those who have been sedentary for a while are recommended to consistently (at least three times a week) engage in moderate-intensity aerobic exercise. For those who are used to regular exercising, high-intensity exercise works just as well, though it hasn’t been shown to be any more effective in improving cholesterol than moderate-intensity11. Exercises would be helpful include: 

  • Walking 
  • Running 
  • Swimming 
  • Cycling 
Using Cardiogram for High Cholesterol 
Cardiogram can also be a useful tool when it comes to lowering your cholesterol levels. Try these features on the Cardiogram app to help lower your LDL: 

Enroll in a habit

You can choose one of our popular daily exercise routines. On each habit, we will show you its’ clinical benefits and studies to back them up. Just be sure you've spoken with a doctor before engaging in vigorous activity if you regularly experience discomfort.


By keeping track of how you’re feeling throughout the day, you can get a better idea of how your new habits are benefiting you. Journaling about your water and food intake can also give you better insights into your diet and which healthy foods leave you feeling your best.

Exercise in your optimal zone

By  creating workouts, you're able to see how long you were in each different  heart rate zone during your workout. This way, you can make sure you’re exercising in the correct intensity level. 

Join our facebook community

If you have questions or concerns, it's important that you first seek help and advice from your doctor. However, ourCardiogram Communityon Facebook is another great resource, filled with other members who share similar experiences and enjoy helping others in the community. Our FB moderator also has a healthcare background and is ready with clinical knowledge to answer any questions you may have about your data. 


Cardiogram app shown on phone and smart watch


Cardiogram app shown on phone and smart watch

  1. https://www.cdc.gov/cholesterol/index.htm 
  2. MedlinePlus. (2017). Cholesterol levels: What you need to know. U.S National Library of Medicine. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html  
  3. American Heart Association. (2019a). How to get your cholesterol tested. https://www.heart.org/en/health-topics/cholesterol/how-to-get-your-cholesterol-tested 
  4. National Heart, Lung, and Blood Institute. (NHLBI). Atherosclerosis. U.S. Department of Health and Human Services. From https://www.nhlbi.nih.gov/health-topics/atherosclerosis 
  5. American Heart Association (2019b). Ethnicity a ‘risk-enhancing’ factor under new cholesterol guidelines. https://www.heart.org/en/news/2019/01/11/ethnicity-a-risk-enhancing-factor-under-new-cholesterol-guidelines  
  6. Centers for Disease Control and Prevention. (2020). Knowing your risk for high cholesterol. https://www.cdc.gov/cholesterol/risk_factors.htm 
  7. Dar, T., Radfar, A., Abohashem, S., Pitman, R. K., Tawakol, A., & Osborne, M. T. (2019). Psychosocial stress and cardiovascular disease. Current Treatment Options in Cardiovascular Medicine, 21(5), 23. doi: 10.1007/s11936-019-0724-5  
  8. American Heart Association (n.d.). My cholesterol guide. Retrieved from https://www.heart.org/-/media/files/health-topics/cholesterol/cccc_my-cholesterol-guide.pdf?la=en 
  9. Collins, K. (2015). The debate about dietary cholesterol: Should nutrition recommendations set a limit? https://www.acc.org/latest-in-cardiology/articles/2015/08/19/12/57/the-debate-about-dietary-cholesterol 
  10. Franz, M.J., Boucher, J.L., & Pereira, R.F. (2017). Pocket Guide to Lipid Disorders, Hypertension, Diabetes, and Weight Management, 2nd Ed. Academy of Nutrition & Dietetics.  
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906547/