High cholesterol, especially elevated LDL, results from a mix of inherited and modifiable factors. Genetics (including familial hypercholesterolemia) can cause persistently high LDL. Diets high in saturated and trans fats and low in fiber worsen cholesterol, while active lifestyles, weight control, and smoking cessation improve it. Other medical conditions and some medications can also change lipid levels. Regular testing, targeted lifestyle changes, and medications such as statins when necessary form the current approach to managing high cholesterol.
Why high cholesterol matters
High cholesterol - specifically high levels of low-density lipoprotein (LDL) cholesterol - raises the risk of heart disease and stroke. Multiple factors influence cholesterol levels: some you can change, others you cannot. Understanding the main causes helps you take targeted steps to lower risk.
Genetics: inherited risk
A family history of high cholesterol is one of the strongest non-modifiable risk factors. Familial hypercholesterolemia (FH) is an inherited condition that causes very high LDL from a young age and often requires medical treatment. If several close relatives have early heart disease or very high cholesterol, discuss testing with your clinician.
Diet: what raises and what lowers cholesterol
Foods high in saturated and trans fats tend to raise LDL cholesterol. Common sources include fatty cuts of meat, full-fat dairy, fried foods, and many baked goods made with hydrogenated oils. Trans fats are especially harmful and have been removed from many food supplies, but they still appear in some processed products.
Dietary cholesterol (for example, in eggs) has less impact on blood cholesterol for most people than was once thought, but overall eating patterns matter. Diets rich in soluble fiber (oats, beans, fruits), plant sterols, nuts, and fatty fish (omega-3s) can help lower LDL or improve the cholesterol profile. Replacing saturated fats with polyunsaturated and monounsaturated fats supports better lipid numbers.
Lifestyle: activity, weight, and smoking
Physical inactivity and excess weight often raise LDL and lower protective HDL cholesterol. Regular aerobic exercise, even moderate activity most days, helps improve lipid levels and cardiovascular health. Smoking lowers HDL and damages blood vessels, compounding risk; quitting improves cholesterol-related risk over time.
Other medical conditions and medications
Several health conditions affect cholesterol. Type 2 diabetes, hypothyroidism, chronic kidney disease, and certain liver disorders can raise LDL or change lipid patterns. Some medicines (for example, certain steroids or some antipsychotics) can also affect cholesterol. Managing underlying conditions and reviewing medications with your provider are important steps.
When lifestyle changes aren't enough
If lifestyle changes and treating other conditions don't bring LDL to target levels, your clinician may recommend medication. Statins are the most commonly used drugs and strongly reduce heart disease risk. Other options (ezetimibe, PCSK9 inhibitors, bile acid sequestrants) exist for people who need additional lowering or who cannot tolerate statins.
Practical takeaways
- Get your lipid panel checked regularly and discuss family history with your clinician.
- Focus on a heart-healthy eating pattern: reduce saturated/trans fats, increase fiber, and include plant-based foods and fatty fish.
- Stay active, manage weight, and stop smoking.
- Treat contributing medical conditions and follow your clinician's advice about medication when needed.