1. Genetics
A condition called familial hypercholesterolemia (FH) can make some people genetically more susceptible to high bad cholesterol. There are two types of familial hypercholesterolemia: heterozygous, in which a person inherits the abnormal gene from only one parent; and homozygous, in which the person has two copies of the abnormal gene, one from each parent. Homozygous familial hypercholesterolemia is both rarer and more dangerous.
People with familial hypercholesterolemia do not recycle LDL cholesterol effectively and end up with high levels of this type of cholesterol, making them more susceptible to atherosclerosis, which often begins at a much younger age. About 1 in 200 adults has the familial hypercholesterolemia gene mutation. If left untreated, these people are 20 times more likely to develop heart disease.
If you have a parent, sibling, or child with familial hypercholesterolemia or who has had a heart attack as a child, you should be tested for the condition. (Most people with familial hypercholesterolemia need to take cholesterol-lowering medications like statins to maintain healthy cholesterol levels.)
2. Smoking
Although smoking doesn’t directly cause high cholesterol, it is a major proven risk factor for heart disease and stroke. That risk increases if you also have high LDL cholesterol. One reason is that smoking lowers your HDL levels, reducing or eliminating HDL’s protective effects.
Quitting smoking has immediate benefits for your heart health.
3. Diet
When it comes to what you eat, the best way to lower your cholesterol is to reduce your intake of saturated and trans fats, with recommendations to limit saturated fat to less than 6 percent of your daily calories and minimize the amount of trans fats you eat. This means cutting back on red meat, tropical oils, fried foods, and whole milk, but the average American intake is about 300 milligrams (mg) per day, which you shouldn’t exceed.
Instead, choose low-fat or fat-free dairy products, fruits, vegetables, whole grains, poultry, fish, nuts, and non-tropical vegetable oils. Healthier cooking oils include canola, corn, olive, peanut, safflower, soybean, sunflower, vegetable, and specialty oils. As a general rule, eat a diet that is mostly whole, plant-based foods and low in saturated fat and animal fats.
4. Age
As we age, our metabolism changes and our livers do not remove as much LDL cholesterol as they did when we were younger. Therefore, you may be at higher risk for high cholesterol as you age. High cholesterol is most often diagnosed in the 40–59 age group.
5. Race or Ethnicity
Non-Hispanic whites are more likely to have higher total cholesterol levels than other groups. Asian Americans are more likely to have higher LDL cholesterol levels than other groups. African Americans are more likely to have higher levels of “good” HDL cholesterol than other groups.
6. Gender
Men are more likely to have higher total cholesterol levels than women. This may be because men report higher average cholesterol intakes than women.
The risk of high cholesterol in women increases after menopause. During menopause, hormones that protect against high blood cholesterol decrease, resulting in higher LDL cholesterol and lower HDL cholesterol.
