Cholesterol 101| Columbia University Irving Medical Center

Patients are understandably confused about cholesterol, but here’s what you need to know.

Cholesterol produces some hormones and builds vital structures in your body. But too much — called high cholesterol — can build up in your arteries and lead to heart attack, stroke, and other cardiovascular diseases.

That’s why it’s important to get tested and know your cholesterol levels; they show how much cholesterol is circulating in your blood.

We asked Sonia Tolani, MD, an expert in cardiovascular disease and cholesterol management, to explain the good and bad about cholesterol and how to achieve healthy levels. For starters, she says, “Know your cholesterol levels and keep them under control.” You are in control. Maintaining normal cholesterol levels significantly reduces the risk of heart attack and stroke.”

What is Cholesterol?

Cholesterol is a substance that circulates in your blood. Your liver produces most of the cholesterol in your body. Other cholesterol enters your body through food.

The two main types of cholesterol:

  1. LDL (Low Density Lipoprotein)
    • This is the bad one; your target number depends on your risk of heart disease. Most people should aim for an LDL below 100, but those with diabetes or cardiovascular disease should aim for lower, below 70.
  2. HDL (high-density lipoprotein)
    • This is the good one. For women, a good level is above 60; for men it is above 40.

Too much LDL or too little HDL increases health risk.


Where does cholesterol come from?

Your liver and cells in your body produce about 80% of the cholesterol in your blood. Food provides the other 20%. Foods high in trans and saturated fats contribute to bad cholesterol (not high cholesterol foods, as was once thought). Bad means bad for your health.

When you consume more cholesterol, your liver reduces cholesterol production and removes the excess. But some people’s livers don’t do this well because of their genes.

Trans and saturated fats

Trans fats are mostly artificial (made by adding hydrogen to vegetable oil to make it firmer), but some occur naturally in animal products. The Food and Drug Administration banned trans fats in the United States in 2018, with the last allowed manufacturing date being January 1, 2021. But some packaged foods may still contain trans fat because of how it’s processed.

Processed and packaged foods include:

  • Cookies
  • Cookies
  • Crackers
  • Glaze
  • Microwave popcorn
  • Cake bases
  • Pizza
  • Vegetable shortening and oil

Look at the nutrition facts panel on packaged food to see how much trans fat it contains.

In addition to increasing the risk of heart disease and stroke, consuming trans fats increases the risk of type 2 diabetes. The American Heart Association recommends that most people reduce or eliminate consumption of trans fats.

Saturated fats occur naturally in many foods, such as animal and tropical oils, including:

  • Beef
  • Butter, cheese, cream
  • Coconut
  • Lamb
  • Fat
  • Pork
  • Poultry, especially with skin
  • palm oil

Research shows that not all saturated fats are bad to eat. The American Heart Association recommends that most people limit daily consumption of saturated fats to 13 grams per day.


Know your numbers

How much cholesterol do you have?

The amount of cholesterol you have depends on genetics, diet, age, activity, assigned gender at birth, and other factors.

Where, when and how do I get a cholesterol test?

According to the Centers for Disease Control and Prevention:

  • Healthy adults should have their cholesterol checked every four to six years.
  • Children should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.
  • People with a family history of heart disease should have their cholesterol checked more often.

Ask your doctor about the lipid panel blood test.


Keep cholesterol levels under control (low!)

  • Eat a diet low in saturated fat, such as the Mediterranean-style diet.
  • Get regular exercise (30 minutes of moderate exercise five days a week or 75 minutes of vigorous exercise a week).
  • Maintain a healthy weight.

In addition, due to genetic factors, some people require medication to control their cholesterol. Talk to your doctor about your known risk factors.


High cholesterol is one of the main risk factors for cardiovascular disease that you can control with a healthy diet and/or medication. The first step is knowing your cholesterol numbers.

Cholesterol 101| Columbia University Irving Medical Center

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