Debunking five myths about cholesterol
9/28/2023 by Allison Ducharme-Smith, M.D.
High cholesterol is very common. In fact, more than one in 10 people in the United States will have high cholesterol. However, many don't even know they have high cholesterol or much about this condition. Here are five common myths about cholesterol and the truth behind each of them.
Myth 1: All types of cholesterol are the same.
Truth 1: Cholesterol comes from two sources: dietary cholesterol (found in the food we eat) and blood cholesterol (naturally occurring, waxy, fat-like substance in our bodies). Blood cholesterol comes in two main types, low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
- LDL is considered the "bad cholesterol" and can contribute to plaque build-up in our arteries.
- HDL is considered the "good cholesterol" because it helps rid our bodies of extra cholesterol.
When your clinician orders a lipid panel/profile, it measure four things:
- Total cholesterol. Best is less than 200 mg/dL; above this level is considered high.
- HDL (good). Best is 60 mg/dL or more.
- LDL (bad). Best is 100 mg/dL or less. If you have an LDL level over 199, you may be at risk for a syndrome called familial hypercholesterolemia, and it's important to talk with your healthcare clinician.
- Triglycerides (also bad). Best is 150 mg/dL or less.
Myth 2: Young and thin people don't have to worry about their cholesterol.
Truth 2: While being older and/or overweight can contribute to high cholesterol, the truth is there are many different risk factors for high cholesterol. Even people who are young and thin should pay attention to their cholesterol levels. Risk factors include:
- Family history. Some forms of high cholesterol can be inherited. With familial hypercholesterolemia, people have greatly elevated cholesterol and are at a very high risk of heart attack. They may need their levels checked more often.
- Diabetes. Diabetes can lower good cholesterol and worsen bad cholesterol.
- Lack of physical activity or physical exercise. A sedentary lifestyle has been shown to affect your cholesterol, even if you're not overweight or obese.
- Older age. As we age, our cholesterol levels go up, especially in women.
Myth 3: How much you diet and exercise dictates what your cholesterol level will be.
Truth 3: Diet and physical activity does affect your cholesterol level, but they're not the only factors. Family history can be very important. If family members have high cholesterol or heart attacks before age 60, you need to have your lipid levels checked and managed.
Myth 4: My lipid panel was high, so now my doctor will make me start a statin.
Truth 4: The next step after your clinician orders a lipid panel is to assess your risk for heart attack and stroke. This assessment will help determine the best management strategy for you. Patients at high risk might need to start with medication AND lifestyle modifications, while patients at lower risk might start by modifying their lifestyle. Some of the lifestyle recommendations include:
- Getting active. Small steps can lead to big progress. We recommend getting about 150 minutes of moderate-level physical activity each week.
- Eat healthy fats. Poly- or monounsaturated fats are best — including nut oils, olive oil and avocados. Try to avoid saturated or trans fats — such as butter, margarine, cheese and red meat. These all increase bad cholesterol.
- Stop smoking. Smoking can increase your risk of heart disease and stroke, so it's very important to quit. Your care team has many resources to help you.
For those who cannot tolerate a statin medication, there are other medications that can lower cholesterol, and it's worth a discussion with your clinician about what is the best option for you.
Myth 5: Everyone who takes a statin experiences muscle pain.
Truth 5: Many patients are concerned about starting a statin due to fear that it might cause muscle pain or cramping. The truth is only about 2%-10% of patients experience muscle-related side effects, which range from muscle pain/aching to cramping. Of patients who had these side effects with one statin, 90% were able to tolerate an alternative statin medication with continued use.
If you're experiencing muscle symptoms while taking a statin, please talk with your clinician. Depending on the symptoms, they might suggest a "drug holiday" to see if the symptoms resolve, switching the statin or changing the dose. These medications are incredibly important for lowering your risk for heart disease and stroke, so it's necessary to evaluate and address your side effects.
Allison Ducharme-Smith, M.D., is an internal medicine physician in the Division of Community Internal Medicine, Geriatrics and Palliative Care and practices at Mayo Family Clinic Northeast in Rochester. She is also the Medical Director of the Good Samaritan Free Health Clinic. Her interests include preventive medicine, women's health, chronic disease management and medical education.