High cholesterol is one of those health problems that really sneaks up on you. Often called a “silent” condition, it doesn’t have any direct symptoms but quietly damages arteries over time.
It’s exactly why more than 40% of US adults with high LDL cholesterol don’t know they have it, according to a 2023 study published in JAMA Cardiology. This means that there are a whole lot of people out there who are at an increased risk of having a heart attack, stroke, or getting heart disease, and they don’t even know it.
“Heart disease doesn’t suddenly appear when someone turns 60. It’s a process that develops over decades,” says Dr. Jason Hoff, MD, a structural interventional cardiologist and assistant professor at Loma Linda University Health. He explains that every year that LDL cholesterol stays elevated, a little more plaque can build up in the arteries.
Earlier this year, the American College of Cardiology and the American Heart Association released updated guidelines for managing cholesterol, primarily focusing on earlier intervention. “The biggest shift in these guidelines is recognizing that if we can identify people at higher risk earlier, we have a chance to prevent that damage instead of trying to fix it later after a heart attack or stroke. That’s why we’re screening people earlier and being more proactive about treatment in those with significant risk factors, like a strong family history or very high cholesterol,” Dr. Hoff says.
Whether you’re 19 or 90, your cholesterol levels are something you can control. We talked to cardiologists about how to do exactly that.
What is LDL cholesterol?
Cholesterol is typically referenced generally and almost always negatively, but it’s actually a bit more nuanced. Dr. Ethan Korngold, MD, an interventional cardiologist who works with the health company Abbott, explains that cholesterol, which is a waxy fat-like substance found in the body, is essential to build cells and produce vitamins and hormones. “However, too much cholesterol can cause problems because it narrows the arteries, blocking blood flow, which increases the risk of heart disease,” he says.
Cholesterol is transported through the blood by lipoproteins, including two types of lipoproteins: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). HDL (often referred to as “good” cholesterol) transports cholesterol to the liver, where it’s then broken down and excreted. LDL transports cholesterol to cells, and as Dr. Korngold explained, too much of it can lead to plaque buildup in the arteries. That’s why LDL cholesterol is often referred to as “bad” cholesterol.
What causes LDL cholesterol?
Even if you’re relatively young and generally in good health, preventing high LDL cholesterol is still important. Hoff says that cholesterol plaque buildup is something that can happen over time without you even realizing it.
“It’s not something you can feel. It can eventually lead to a heart attack or stroke, and the process often starts decades before symptoms appear, even as early as your 20s and 30s,” he says.
Walk with a Doc CEO and cardiologist Dr. David Sabgir, MD, says being proactive about your heart health is key to staying healthy. “Even if you feel great, cholesterol can climb quietly, especially if you have a family history of heart disease,” says Dr. Sabgir. “High LDL cholesterol builds up over time and raises the risk for heart attack and stroke. The fix is simple. If we know our numbers and stay ahead of them, we can make a huge difference in our health.”
How do you know if you have high cholesterol?
Since you can’t feel LDL cholesterol slowly creeping up, how do you know if yours is too high? All three cardiologists say that it requires a blood test from your doctor and it’s something Dr. Korngold recommends everyone 20 and older have regularly checked. The American Heart Association says that optimal LDL cholesterol is at or below 100 mg/dL.
