Posted On: September 5, 2025

Heart Disease Prevention: What You Need to Know About Cholesterol

When it comes to heart disease prevention, cholesterol is among the key topics to address. Cholesterol is a waxy, fat-like substance found in every cell of your body. It is essential for building hormones, vitamin D, and cell membranes. But too much of the wrong kind can quietly damage your arteries and raise your risk for heart attack or stroke.

The tricky part? You usually do not exhibit symptoms of high cholesterol, making it one of the health concerns known as “silent killers.”

How Common Is High Cholesterol in the U.S.?

Cholesterol problems are widespread. According to the American Medical Association, nearly 94 million U.S. adults (36%) have total cholesterol levels considered too high. About 7% of children and teens also struggle with unhealthy levels.

Sex differences matter as well. Men under 55 are more likely to have elevated cholesterol compared to women. After menopause, women’s risk climbs sharply, often surpassing men’s.

Why Americans Face Higher Risk

People in the United States often face more heart disease risk than those in many other countries. A big reason is lifestyle. Diets high in processed foods, red meat, sugar, and saturated fats contribute to higher cholesterol levels and weight gain. Limited physical activity is another major factor, as long work hours and sedentary routines leave many Americans without enough daily movement. Stress, which is widespread and often poorly managed, also plays a role in raising cholesterol and blood pressure.

Access to healthcare further shapes risk. While many have excellent medical care, others delay routine checkups or cholesterol screenings because of time constraints, cost, or lack of insurances. This means high cholesterol can go unnoticed for years. Smoking and higher rates of obesity compared to other developed countries also add to the burden. Together, these patterns create a landscape where heart disease prevention becomes both a medical and a cultural challenge in the U.S.

Types of Cholesterol: The Good, the Bad, and the Misunderstood

Not all cholesterol is harmful. Here is the breakdown for better understanding:

• Total cholesterol: The combined measure of LDL, HDL, and triglycerides.
• LDL (low-density lipoprotein): Known as “bad cholesterol.” High levels cause plaque buildup in arteries. Key contributors to this are foods containing saturated fats, trans fats, excess refined carbs and sugars, and processed meats.
• HDL (high-density lipoprotein): The “good cholesterol.” It helps remove excess cholesterol from your bloodstream. Key contributors to this are fatty fish, olive oil and other unsaturated fats, and fruits, veggies, and whole grains.
• Triglycerides: A  type of fat that contributes to total cholesterol levels. Your body makes them from extra calories, and they’re stored in fat cells to be burned later. 

Proteins related to cholesterol

• Lipoprotein(a): A less commonly tested particle I routinely check once on members of my practice. One in five individuals has an elevated lipoprotein(a), and these individuals require more aggressive cholesterol management. High levels are strongly linked to heart disease and are largely determined by genetics.
• Apolipoprotein B (ApoB): A protein that’s part of certain cholesterol-carrying particles in your blood. The number of ApoB particles tells you how many of these potentially harmful, plaque-forming particles are in your bloodstream. Because of that, ApoB gives a clearer picture of heart disease risk than just measuring LDL cholesterol levels alone.
• Apolipoprotein E (ApoE): This protein is related to a person’s genetic variations in the APOE gene, which plays a role in cholesterol metabolism and brain health. The APOE gene produces a protein called Apolipoprotein E, which is involved in transporting cholesterol in the body, and clearing amyloid beta plaques, a hallmark of Alzheimer’s disease.

Understanding your numbers is not just about total cholesterol; it is about the balance between these different types.

Why High Cholesterol Is Considered a Threat

Unlike high blood pressure, which can sometimes cause headaches or vision changes, high cholesterol rarely announces itself. Plaque quietly builds up inside your arteries, narrowing them over time. Often the first warning sign is a serious event such as a heart attack or stroke.

That is why regular testing is so important, especially if you have a family history of heart disease.

How High Cholesterol Damages Your Heart

When LDL cholesterol sticks to artery walls, it forms plaque. This buildup hardens and narrows arteries, reducing blood flow. Eventually, plaques can rupture, triggering clots that block circulation entirely.

How bad can the result be? It leads to increased risk of coronary artery disease, peripheral artery disease, and even sudden cardiac death.

Women, Men, and Cholesterol: Key Differences

Sex and hormones play a big role in cholesterol levels:

• Premenopausal women generally have higher HDL, or “good,” cholesterol, thanks to estrogen.
• Postmenopausal women often see HDL drop and LDL rise, increasing heart disease risk.
• Men under 55 tend to have higher rates of high cholesterol and are more likely to develop heart disease earlier.

Because of these differences, it is important for women to pay special attention as they approach menopause and for men to be proactive about their health exams.

A No-Cost Heart Disease Risk Assessment

Your heart disease risk is not determined by cholesterol alone. Other factors contribute to your true risk, even if your cholesterol looks “borderline.” As part of my proactive approach to healthcare, I offer members a complimentary cardiovascular risk assessment that evaluates:

• Cholesterol and related particles, including LDL, HDL, triglycerides, lipoprotein(a), and apolipoproteinB
• BMI
• Blood pressure
• Medical history for you and your family
• Medications
• Lifestyle factors such as smoking, diet and activity

This whole-person approach helps you understand your true heart health picture and take steps to reduce risk.

Lifestyle Strategies to Protect Your Heart

The good news is that lifestyle changes can dramatically improve cholesterol and heart health.

• Eat smart: Focus on fiber-rich foods like oats, beans, fruits, and vegetables. Limit saturated and trans fats.
• Stay active: Try to have at least 150 minutes of moderate activity each week. Walking counts.
• Maintain a healthy weight: Nothing extreme; even a modest weight loss can improve cholesterol levels.
• Avoid smoking: Tobacco lowers HDL cholesterol and damages blood vessels.
• Limit alcohol: Too much can raise triglycerides and worsen cholesterol.

And remember, consistency, not perfection, is what protects your health!

When to Seek Professional Care

You should schedule a cholesterol screening if:

• You are over 20 and have not had your levels checked in the past 4 to 6 years.
• You have a family history of high cholesterol or premature heart disease.
• You notice risk factors like high blood pressure, diabetes, or weight gain.

If your cholesterol is already high, work with your physician to set goals. In some cases, medication may be necessary in addition to lifestyle changes.

Conclusion

Cholesterol may be silent, but its impact on heart disease risk is powerful. By knowing your numbers, understanding the differences between LDL, HDL, lipoprotein(a), and apolipoproteinB, and taking charge of your lifestyle, you can protect your heart for the long run.

For women especially, paying attention during life transitions like menopause can be lifesaving. Prevention starts with awareness. Take advantage of risk assessments, check your cholesterol regularly, and make heart-healthy choices every day.