Learn about cholesterol and how it plays an important role in cardiovascular events, such as heart attack and stroke.


High cholesterol is a silent killer that needs to be addressed. Everyone needs some cholesterol to maintain good health. High cholesterol is a critical risk factor with an important role in the occurrence of cardiovascular events, such as heart attack and stroke.

Cholesterol, a waxy substance, is found in the blood. Your cholesterol level is determined both by what your body makes and by the foods that you eat.

What are good cholesterol, bad cholesterol and triglycerides? 

Low-density lipoprotein cholesterol (LDL-C), also called “bad” cholesterol, can combine with fat and other substances to build up in the inner walls of arteries when in excess. These arteries carry the blood away from the heart to the rest of the body. The hard, thick substance that builds up is called “plaque”. The condition in which plaque builds up in the arteries is called “Atherosclerosis”. Atherosclerosis can cause problems in 2 ways: 

  • Plaque can accumulate and reduce blood flow to parts of the body. 
  • Plaque can rupture or break open, causing a blood clot at this site or block blood supply to tissues beyond the clot, causing a stroke or heart attack. 

High-density lipoprotein cholesterol (HDL-C), known as “good” cholesterol removes “bad” cholesterol from the arteries and delivers it to the liver for elimination from the body. It is called “good” cholesterol since it lowers the risk of heart attacks, strokes and other health problems.

Triglycerides are a type of fats made by the body and come from food that is eaten. They also build up in the arteries and can cause plaque.

Know your cholesterol numbers

Checking your cholesterol levels and knowing your numbers is important to manage and lower your cholesterol level with lifestyle intervention and/or medication, if needed.

Type Goal to aim for
Total Cholesterol  Below 200 mg/dL 
LDL Cholesterol  Below 130 mg/dL or much lower if at risk of heart attack or stroke 
HDL Cholesterol  Above 60 mg/dL 
Non-HDL Cholesterol      
(Total cholesterol minus your HDL cholesterol) 
Below 160 mg/dL or much lower if at risk of heart attack or stroke 
Triglycerides  Below 150 mg/dL 

What factors contribute to harmful cholesterol and triglyceride levels? 

How can I reduce my risk of heart attack and stroke if I have high cholesterol? 

A heart-healthy lifestyle is necessary whether you are trying to prevent high cholesterol in the first place, or you have high cholesterol and are trying to reduce the risk of a cardiovascular event.

Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet are proven to reduce the risk of cardiovascular events. A heart-healthy diet consists of eating a larger quantity of vegetables and fruits, controlling your portion size, selecting whole grains, choosing low-fat proteins, and limiting unhealthy fats and salt.

High cholesterol is just one of many factors that can increase the risk of cardiovascular events. Other risk factors are cigarette smoking, high blood pressure, diabetes, older age, and a family history of heart disease.

Quitting smoking, drinking alcohol in moderation, exercising for 30 minutes or more most days of the week, maintaining a healthy weight, and managing stress are all important to mitigate your risk. If you have a family member (parent, sister or brother) who now has or has had a heart disease, talk to your doctor and stay on top of all your medical appointments.

While there are medications to lower cholesterol, not everyone with high cholesterol needs medication. They are generally prescribed for people:

  • who had a prior heart attack or stroke 
  • with a known heart disease or condition 
  • with Diabetes 
  • with Peripheral Artery disease (narrowing or blockage of arteries in the leg due to atherosclerosis) 
  • who have had an Abdominal Aortic Aneurysm (enlargement of the major blood vessel in the body, called the Aorta) 

Take away message 

High cholesterol is one of the major contributors to cardiovascular events that decrease life expectancy and impact quality of life. In general, people are not aware that they have high cholesterol due to a lack of evident symptoms. A blood test is required to indicate you have high cholesterol. The American Heart Association recommends that all adults aged 20 or older have their cholesterol and other traditional risk factors checked every 4-6 years, even if the risk is low.

Stay on top of your health. Aim to mitigate your risk of heart disease, stroke and other health conditions associated with high cholesterol and atherosclerosis. Prevention makes a world of difference.