# Understanding and Managing High Cholesterol and Triglycerides **Prepared by:** Pedro Cheung MD **Last Updated:** May 2026 ## A Patient Guide to Hyperlipidemia and Dyslipidemia --- > **This handout is for general educational purposes.** Always follow the specific advice of your doctor or healthcare provider, as your treatment plan may differ based on your individual health needs. --- ## What Is Hyperlipidemia? Your blood carries several types of fats, collectively called **lipids**. When one or more of these fats reaches an unhealthy level, the condition is called **hyperlipidemia** — literally, "too much fat in the blood." A related term, **dyslipidemia**, is broader: it refers to any abnormal lipid level, including levels that are too high _or_ too low. The most important lipids measured in a routine blood test are: - **LDL cholesterol** ("bad" cholesterol) — the main driver of plaque buildup in your arteries - **HDL cholesterol** ("good" cholesterol) — helps remove harmful cholesterol from your bloodstream - **Triglycerides** — a form of fat stored in your fat cells and released for energy; elevated levels raise cardiovascular and other risks - **Total cholesterol** — a combined measure of all cholesterol fractions in your blood These are measured together in a blood test called a **lipid panel** or **lipid profile**. Understanding each number — and what it means for your health — is the first step toward protecting your heart, your arteries, and your overall wellbeing. --- ## How Cholesterol Works in Your Body Cholesterol is not purely dangerous — your body actually needs it. The liver produces cholesterol to build cell membranes, make hormones (including estrogen, testosterone, and cortisol), and produce bile acids for digesting food. The problem arises when certain types of cholesterol build up to unhealthy levels in your bloodstream. Because cholesterol does not dissolve in blood, it is packaged with proteins into particles called **lipoproteins** that carry it through your circulation. The type of lipoprotein matters enormously: ### LDL Cholesterol — The "Bad" Cholesterol **Low-density lipoprotein (LDL)** carries cholesterol from the liver out to the rest of the body. When LDL levels are too high, excess cholesterol deposits into the walls of arteries — a process called **atherosclerosis**. Over time, these deposits (called **plaques**) harden and narrow the arteries, restricting blood flow. If a plaque ruptures, it can trigger a blood clot that blocks an artery entirely, causing a **heart attack** or **stroke**. High LDL cholesterol is the single most important lipid-related cause of cardiovascular disease. It often produces **no symptoms** — which is why getting screened is critical. ### HDL Cholesterol — The "Good" Cholesterol **High-density lipoprotein (HDL)** works in the opposite direction: it picks up excess cholesterol from the blood and artery walls and carries it back to the liver, which processes and removes it from the body. Think of HDL as the cleanup crew of your circulatory system. Higher HDL levels are generally protective. Low HDL — especially when combined with high LDL or high triglycerides — significantly increases the risk of heart attack and stroke. ### Triglycerides — The Overlooked Fat **Triglycerides** are the body's primary stored form of energy. When you eat more calories than you immediately need, the excess is converted into triglycerides and stored in fat tissue. Triglycerides are also produced in the liver, particularly in response to excess sugar, refined carbohydrates, and alcohol. Elevated triglycerides (called **hypertriglyceridemia**) are associated with: - Increased cardiovascular risk, particularly when combined with low HDL or high LDL - **Pancreatitis** — painful and potentially life-threatening inflammation of the pancreas — when levels are severely elevated (generally above 500–1,000 mg/dL) - Insulin resistance and metabolic syndrome --- ## Understanding Your Numbers A lipid panel measures your cholesterol and triglyceride levels in milligrams per deciliter (mg/dL). Here is how to interpret your results: ### Cholesterol and Triglyceride Reference Ranges (Adults) |Lipid|Desirable|Borderline/Elevated|High / Concerning| |---|---|---|---| |**Total Cholesterol**|Below 200 mg/dL|200–239 mg/dL|240 mg/dL or higher| |**LDL ("Bad") Cholesterol**|Below 100 mg/dL|100–129 mg/dL|160 mg/dL or higher| |**HDL ("Good") Cholesterol**|60 mg/dL or higher|40–59 mg/dL (men) / 50–59 mg/dL (women)|Below 40 mg/dL (men) / below 50 mg/dL (women)| |**Triglycerides**|Below 150 mg/dL|150–499 mg/dL|500 mg/dL or higher| |**Non-HDL Cholesterol**|Below 130 mg/dL|130–159 mg/dL|160 mg/dL or higher| > **Note:** For HDL, higher is better. For LDL, lower is better — and in people with heart disease or very high risk, your doctor may set your LDL goal below 70 mg/dL or even below 55 mg/dL. Your personal targets depend on your overall health and cardiovascular risk. Always discuss your numbers with your healthcare provider in the context of your full health picture. ### Non-HDL Cholesterol — An Important Combined Measure **Non-HDL cholesterol** is simply your total cholesterol minus your HDL. It captures all the "atherogenic" (artery-clogging) particles in one number — including LDL, VLDL, and other harmful remnants. Many experts consider non-HDL cholesterol an even more reliable predictor of cardiovascular risk than LDL alone, and the most recent 2026 ACC/AHA Dyslipidemia Guidelines include it as a key treatment target. --- ## Why Your Lipid Levels Matter: The Risk to Your Heart and Beyond High cholesterol and triglycerides are often described as "silent" conditions — they damage your blood vessels quietly for years without causing any symptoms. But the consequences, when they arrive, can be severe and sudden. ### Atherosclerosis and Cardiovascular Disease Persistently elevated LDL cholesterol accelerates the buildup of fatty plaques in artery walls throughout the body. As these plaques grow, they narrow the passageway for blood. When blood flow to the heart is severely reduced, the result is **angina** (chest pain) or a **heart attack**. When a clot blocks blood flow to the brain, a **stroke** occurs. People with high LDL cholesterol have a significantly elevated risk of both heart attack and stroke compared to those with healthy levels. Heart disease and stroke are the leading causes of death in the United States. ### The Role of Low HDL Low HDL means the "cleanup crew" is understaffed. When HDL levels are low — particularly below 40 mg/dL in men or 50 mg/dL in women — the risk of cardiovascular disease rises substantially, especially when combined with elevated LDL or triglycerides. The combination of high triglycerides and low HDL is particularly dangerous and is a central feature of **metabolic syndrome**, a cluster of risk factors strongly linked to heart disease and type 2 diabetes. ### High Triglycerides: Two Separate Risks Elevated triglycerides raise cardiovascular risk through several mechanisms, including the production of small, dense LDL particles that are especially prone to causing arterial damage. But they carry a second, distinct danger: **acute pancreatitis**. When triglyceride levels climb above approximately 500 mg/dL — and particularly above 1,000 mg/dL — the risk of a sudden, severe pancreatitis attack rises sharply. Pancreatitis causes intense abdominal pain and can be life-threatening if untreated. ### Peripheral Artery Disease Atherosclerosis does not stop at the heart and brain. Plaque buildup in the arteries of the legs causes **peripheral artery disease (PAD)**, which produces leg cramping, pain with walking, poor wound healing, and in severe cases, limb loss. ### The Good News The relationship between lipid control and cardiovascular risk is one of the most thoroughly studied in all of medicine — and the evidence is overwhelming: bringing LDL down reduces the risk of heart attack and stroke proportionally. Every meaningful reduction in LDL cholesterol matters, and the benefits accumulate over time. High triglycerides and low HDL, when addressed through lifestyle and when necessary medication, also translate into real reductions in risk. --- ## What Causes Abnormal Lipid Levels? Lipid levels are shaped by a combination of genetics, lifestyle, and underlying health conditions. **Lifestyle factors** that raise LDL and triglycerides or lower HDL: - Diet high in saturated fats, trans fats, refined carbohydrates, and added sugars - Excess calorie intake and overweight/obesity - Physical inactivity - Excessive alcohol consumption (particularly raises triglycerides) - Smoking (lowers HDL) **Medical conditions** associated with abnormal lipids: - Type 2 diabetes and insulin resistance - Hypothyroidism (underactive thyroid) - Chronic kidney disease - Liver disease - Polycystic ovary syndrome (PCOS) **Medications** that can affect lipid levels include corticosteroids, certain blood pressure medications (thiazide diuretics, beta-blockers), some HIV medications, and oral estrogens. **Genetics** play a significant role. **Familial hypercholesterolemia (FH)** is an inherited condition in which LDL cholesterol is very high from birth — often above 190 mg/dL — due to a gene that prevents the liver from clearing LDL efficiently. FH affects approximately 1 in 250 people and dramatically increases the risk of premature heart disease if untreated. If you have a strong family history of early heart attacks or very high cholesterol, talk with your doctor about being tested. --- ## Your 10-Year Cardiovascular Risk: Why It Matters Not everyone with elevated lipids carries the same risk. Your doctor evaluates your lipid numbers in the context of your **overall cardiovascular risk profile** — which includes your age, blood pressure, smoking history, diabetes status, and other factors. Modern guidelines, including the 2026 ACC/AHA Dyslipidemia Guideline, now use updated risk calculators called the **PREVENT-ASCVD equations** to estimate your 10-year risk of a heart attack or stroke. This risk estimate is essential because it helps guide treatment decisions: - People at **lower risk** may reach their goals through lifestyle changes alone - People at **intermediate or high risk** benefit from both lifestyle changes and cholesterol-lowering medication - People who already have **known heart disease or stroke** (secondary prevention) are at the highest risk and typically require more aggressive lipid management — with LDL targets below 55–70 mg/dL Ask your doctor what your estimated cardiovascular risk is and what your personal LDL and non-HDL cholesterol targets should be. --- ## Lifestyle Changes: The Foundation of Lipid Management Lifestyle changes are the cornerstone of managing hyperlipidemia — recommended by every major medical guideline as the essential first step for everyone, regardless of whether medication is also needed. For many people, meaningful improvements in lipid levels are achievable through lifestyle alone. For those on medication, lifestyle changes make the medication work better. --- ### 1. Eat a Heart-Healthy Diet Diet is the single most powerful lifestyle tool for improving lipid levels. The right dietary changes can lower LDL cholesterol by 10–35% — comparable to the effect of low-to-moderate statin doses. #### Reduce Saturated and Trans Fats Saturated fat — found primarily in red meat, full-fat dairy, butter, tropical oils (coconut oil, palm oil), and processed foods — raises LDL cholesterol more than almost any other dietary factor. Replacing saturated fats with unsaturated fats (olive oil, avocado, nuts, fatty fish) has been shown in high-quality clinical trials to reduce cardiovascular disease risk by approximately 30%. **Trans fats**, found in partially hydrogenated oils and many packaged baked goods, are even more harmful — they raise LDL and lower HDL simultaneously. Avoid them entirely. **Practical targets:** - Limit saturated fat to less than 6% of total daily calories - Eliminate trans fats completely - Replace butter with olive oil for cooking and spreads #### Increase Soluble Fiber Soluble fiber — a type of fiber that forms a gel-like substance in the intestine — directly blocks the absorption of cholesterol from food and bile acids. This forces the liver to pull LDL out of the blood to make more bile, which lowers blood LDL levels. Aim for **10–25 grams of soluble fiber per day**. **Best sources of soluble fiber:** - Oats and oatmeal (one of the most effective foods for LDL reduction) - Beans and lentils (among the best foods for overall lipid health) - Psyllium husk - Barley - Apples, pears, citrus fruits - Brussels sprouts, broccoli, sweet potatoes #### Add Plant Sterols and Stanols **Plant sterols and stanols** are natural compounds in vegetable oils, nuts, seeds, and fortified foods (certain margarines, orange juices, and yogurt drinks). They work similarly to soluble fiber — blocking cholesterol absorption in the gut. Consuming 2 grams per day can lower LDL cholesterol by 5–10%. #### Choose the Right Carbohydrates (Especially for Triglycerides) Refined carbohydrates and added sugars — white bread, white rice, pasta, pastries, sweetened beverages, fruit juices, candy — are the primary dietary drivers of elevated triglycerides. They signal the liver to produce more VLDL (the lipoprotein that carries triglycerides into the bloodstream) and suppress the enzymes that clear triglycerides. For people with high triglycerides: - Eliminate sugary drinks entirely — soda, juice, energy drinks, sweetened teas - Limit added sugar dramatically - Replace refined grains with high-fiber whole grains - Limit alcohol (see below) — even modest amounts can significantly raise triglycerides #### Evidence-Based Eating Patterns Several overall dietary patterns have strong clinical evidence for improving lipid profiles: **Mediterranean Eating Pattern** Rich in vegetables, fruits, legumes, whole grains, olive oil, nuts, and fish — with limited red meat and processed foods. Clinical trials and the most recent ACC/AHA guidelines consistently support the Mediterranean pattern for lowering LDL, reducing triglycerides, raising HDL, and most importantly, reducing the actual rate of heart attacks and strokes. **Portfolio Diet (Strongest LDL-Lowering Effect)** A plant-based pattern specifically designed to lower LDL, combining four proven components: soy protein and legumes, nuts and seeds, viscous (soluble) fiber, and plant sterols. Clinical studies show the Portfolio Diet can reduce LDL by up to 35% — an effect comparable to a low-dose statin. **Plant-Forward Diets (Vegetarian, Vegan, DASH)** Diets that emphasize vegetables, legumes, whole grains, fruits, and nuts consistently lower LDL compared to typical Western diets. Meta-analyses show vegetarian diets lower LDL by an average of 13 mg/dL in clinical trials. The DASH diet (Dietary Approaches to Stop Hypertension) lowers LDL by approximately 11 mg/dL on average. **Practical Food Tips** ✅ Use olive oil as your primary cooking fat ✅ Eat oats, beans, or lentils daily ✅ Fill half your plate with non-starchy vegetables at every meal ✅ Snack on a small handful of unsalted nuts (walnuts, almonds, pistachios) ✅ Choose fatty fish (salmon, mackerel, sardines, trout) at least twice a week — omega-3 fatty acids in fish lower triglycerides ✅ Replace refined grains with whole grains (oats, barley, quinoa, whole wheat) ✅ Read labels: avoid "partially hydrogenated oils" (trans fats) and limit "saturated fat" **Foods to Limit or Avoid** ❌ Saturated fats: butter, lard, fatty red meat, full-fat cheese, coconut oil ❌ Trans fats: partially hydrogenated oils, commercial baked goods, fried fast food ❌ Sugary beverages: soda, juice, energy drinks, sweet tea, sports drinks ❌ Refined grains: white bread, white rice, most crackers, pastries, doughnuts ❌ Alcohol: raises triglycerides; those with very high triglycerides should avoid it entirely ❌ Processed and ultra-processed snack foods --- ### 2. Get Regular Physical Activity Exercise is one of the most effective tools for improving your full lipid profile — particularly for raising HDL cholesterol and lowering triglycerides. **What exercise does for your lipids:** - **Lowers LDL:** Through weight loss and by increasing the liver's ability to clear LDL from the blood - **Raises HDL:** Aerobic exercise is one of the most reliable ways to increase HDL; the more consistently you exercise, the greater the benefit - **Lowers triglycerides:** Regular aerobic activity can reduce triglyceride levels by up to 30%, one of the most powerful non-pharmacologic effects on triglycerides available **Goal:** Aim for at least **150 minutes of moderate-intensity aerobic activity per week** (or 75 minutes of vigorous-intensity), plus **2–3 sessions of strength/resistance training per week** — consistent with the American Heart Association's recommendations. #### Best Types of Exercise for Lipid Health **Aerobic/Cardio Exercise:** - Brisk walking — the most accessible starting point - Swimming and water aerobics - Cycling (outdoor or stationary) - Jogging or running - Dancing - Rowing **Resistance/Strength Training:** - Weightlifting, resistance bands, bodyweight exercises (squats, push-ups, lunges) - Builds muscle, which improves insulin sensitivity and helps lower triglycerides - Especially beneficial when combined with aerobic exercise **Breaking Up Prolonged Sitting:** Even in active people, long stretches of sitting raise triglyceride levels and reduce HDL. Aim to stand or walk briefly every 30 minutes during extended periods of sitting. A short walk after meals is particularly effective for clearing triglycerides from the blood. #### Getting Started Safely - Start with 10–15 minute walks and build gradually - Aim for consistency over intensity — regular moderate exercise beats occasional vigorous sessions - Talk to your doctor before starting a new vigorous exercise program, especially if you have known heart disease or other health conditions --- ### 3. Achieve and Maintain a Healthy Weight Excess body fat — especially **abdominal (central) fat** — drives insulin resistance, increases the liver's production of VLDL and triglycerides, and lowers HDL cholesterol. Losing weight is among the most effective strategies for improving all lipid values simultaneously. **Impact of weight loss on lipids:** - Even **5–10% weight loss** can meaningfully lower LDL, significantly reduce triglycerides (by approximately 20%), and raise HDL - **Losing 10% or more** of body weight often produces substantial improvement across the entire lipid panel - A 5–10% weight reduction can reduce triglycerides by roughly 20% on its own **Waist circumference** is an important indicator of metabolically harmful abdominal fat: - For men: aim for a waist circumference less than **40 inches** - For women: aim for less than **35 inches** **Practical approach:** - Combine dietary changes (especially reducing refined carbs, sugary drinks, and saturated fats) with regular physical activity - Focus on sustainable changes rather than crash diets - Track your food intake — awareness often leads to meaningful improvement - Work with a registered dietitian nutritionist (RDN) for personalized guidance; the 2026 ACC/AHA guideline specifically recommends referral to an RDN for people with elevated triglycerides --- ### 4. Limit Alcohol Alcohol has a strong and direct effect on triglyceride levels. The liver converts alcohol into triglycerides, and even moderate drinking can meaningfully raise fasting triglyceride levels. For people with elevated triglycerides: - **Mild-to-moderate hypertriglyceridemia:** Limit alcohol consumption significantly - **Severe hypertriglyceridemia (500 mg/dL or higher):** Avoid alcohol entirely — it can trigger acute pancreatitis Alcohol also contributes excess calories, promotes weight gain, and disrupts liver metabolism — all of which worsen the overall lipid profile. **If you choose to drink:** - **Men:** No more than 2 standard drinks per day - **Women:** No more than 1 standard drink per day A standard drink = 12 oz regular beer (5% alcohol), 5 oz wine, or 1.5 oz spirits. --- ### 5. Quit Smoking Smoking directly lowers HDL cholesterol — sometimes dramatically — while worsening the quality of LDL particles, making them more likely to trigger arterial damage. Smoking also damages blood vessel walls, making them more susceptible to plaque accumulation and rupture. Quitting smoking is one of the most impactful single steps you can take for cardiovascular health. After quitting, HDL levels begin to recover within weeks to months. **Evidence-based cessation tools:** - Nicotine replacement therapy (patches, gum, lozenges, inhalers) - Prescription medications: varenicline (Chantix) or bupropion - Behavioral counseling: the California Smokers' Helpline: **1-800-NO-BUTTS** - Combination of medication + counseling produces the best quit rates --- ### 6. Reduce Refined Carbohydrates and Added Sugar This deserves its own emphasis because it is the lifestyle change most specific to **triglyceride control**. Sugar and refined starch — not dietary fat alone — are the primary driver of elevated triglycerides in most people. The liver converts excess sugar (particularly fructose) and simple carbohydrates into triglycerides far more readily than it converts dietary fat. **Key actions:** - Eliminate sugar-sweetened beverages completely — they are the single greatest dietary source of triglyceride-raising sugar - Limit fruit juice (even "100% juice" spikes triglycerides) - Avoid foods with high-fructose corn syrup - Replace white bread, white rice, and refined pasta with whole grain alternatives - Be cautious with even "natural" sweeteners — honey, maple syrup, and agave spike triglycerides similarly to table sugar --- ### 7. Manage Stress Chronic stress raises cortisol and adrenaline — hormones that signal the liver to release triglycerides and glucose into the bloodstream. Stress also indirectly worsens lipid levels by promoting overeating, increasing alcohol use, and reducing exercise and sleep. **Effective strategies:** - Regular physical activity — one of the most powerful natural stress regulators - Mindfulness meditation and deep breathing exercises - Adequate sleep (see below) - Social connection with supportive friends and family - Professional counseling or therapy for chronic anxiety or depression --- ### 8. Prioritize Quality Sleep Poor sleep impairs the liver's regulation of lipid metabolism and promotes insulin resistance, both of which worsen lipid levels. **Obstructive sleep apnea (OSA)** — a condition in which breathing stops and starts repeatedly during sleep — is associated with lower HDL levels, higher triglycerides, and increased cardiovascular risk. If you snore loudly, wake up gasping, feel exhausted despite adequate sleep, or have been told you stop breathing at night, ask your doctor about a sleep study. Treatment of sleep apnea can improve lipid levels and substantially reduce cardiovascular risk. **Sleep goals:** - Aim for **7–9 hours** of quality sleep per night - Maintain a consistent sleep and wake schedule, including weekends - Keep your bedroom cool, dark, and quiet - Avoid screens for 30–60 minutes before bed - Limit caffeine after noon --- ## Combined Impact of Lifestyle Changes on Lipid Levels The estimated effects below are based on clinical research. Individual responses vary: |Lifestyle Strategy|Effect on LDL|Effect on Triglycerides|Effect on HDL| |---|---|---|---| |Mediterranean diet|↓ 5–15%|↓ 10–20%|↑ Modest| |Portfolio diet (high-fiber, plant-based)|↓ **Up to 35%**|↓ Moderate|↑ Modest| |Eliminating refined carbs and sugar|Modest|↓ **20–50%**|↑ Modest| |Regular aerobic exercise|↓ Modest–Moderate|↓ **Up to 30%**|↑ **5–10%**| |Weight loss (5–10%)|↓ 5–10%|↓ **~20%**|↑ Modest| |Quitting smoking|Modest|Modest|↑ **Significant**| |Eliminating alcohol (high TG)|Minimal|↓ **Substantial**|Varies| |Increasing soluble fiber|↓ **5–15%**|↓ Modest|Minimal| Combining multiple strategies multiplies the effect. A comprehensive lifestyle overhaul — improved diet, regular exercise, weight loss, and smoking cessation — can reduce LDL by 20–35% and triglycerides by 40–50% or more, while meaningfully raising HDL. For many people, this is enough to achieve treatment goals without medication. For others, lifestyle changes remain essential even when medication is prescribed. --- ## When Medication Is Needed Lifestyle changes are the foundation — but they are not always sufficient on their own, particularly if lipid levels are significantly elevated, cardiovascular risk is high, or genetic factors limit how much lifestyle can achieve. Needing medication is not a personal failure; it reflects the biology of the condition. The 2026 ACC/AHA Dyslipidemia Guideline recommends a brief overview of key medication classes: **Statins** (e.g., atorvastatin/Lipitor, rosuvastatin/Crestor, simvastatin) The most widely prescribed and most evidence-backed lipid-lowering medications. Statins reduce LDL cholesterol by 30–55% and have been directly proven to lower the risk of heart attack and stroke. They are recommended as the first medication for most people who need pharmacologic treatment. **Ezetimibe** (Zetia) Works by reducing the amount of cholesterol absorbed from food in the intestine. Often added to a statin when the statin alone does not achieve the LDL goal. Lowers LDL by an additional 15–20%. **Bempedoic Acid** (Nexletol) A newer oral agent that blocks cholesterol production in the liver; useful for people who cannot tolerate statins. **PCSK9 Inhibitors** (alirocumab/Praluent, evolocumab/Repatha, inclisiran/Leqvio) Powerful injectable medications that cause the liver to remove much more LDL from the blood. Can lower LDL by 50–60% on top of statin therapy. Reserved for high-risk patients or those with familial hypercholesterolemia who cannot reach LDL goals with other medications. **Fibrates** (fenofibrate, gemfibrozil) Primarily lower triglycerides (by 30–50%) and modestly raise HDL. Used mainly in people with very elevated triglycerides. **Prescription Omega-3 Fatty Acids** (icosapent ethyl/Vascepa, omega-3 acid ethyl esters/Lovaza) High-dose prescription formulations (not over-the-counter fish oil supplements) that substantially lower very high triglycerides. Icosapent ethyl (Vascepa) has also been shown to reduce cardiovascular events in high-risk patients with elevated triglycerides on statin therapy. > ⚠️ **Note:** Over-the-counter fish oil supplements and most dietary supplements have _not_ been shown to reliably lower LDL or meaningfully reduce cardiovascular risk. The 2026 ACC/AHA guideline does not recommend dietary supplements as a substitute for proven lipid-lowering therapies. Always take medications as prescribed, and never stop them without consulting your doctor. --- ## Routine Healthcare: Your Lipid Management Checklist |How Often|What to Do| |---|---| |**Every visit**|Blood pressure, weight check, review of lifestyle habits| |**Every 4–12 weeks**|Lipid panel — when starting/adjusting medications, until stable| |**Every 3–12 months**|Lipid panel once goals are achieved and stable| |**At least once in a lifetime**|Lipoprotein(a) [Lp(a)] test — a genetic lipid risk factor that doesn't change with lifestyle or most medications| |**Once a year**|Review medications, assess diet and exercise habits, discuss cardiovascular risk| |**As recommended**|Coronary artery calcium (CAC) scoring — may help clarify whether medication is needed in intermediate-risk individuals| **When to start screening:** - Adults should have a baseline lipid panel by age 20 - Screening every 5 years thereafter if levels are normal - More frequently if levels are elevated, you have risk factors, or you are on treatment - Children with a family history of early heart disease or very high cholesterol should be screened earlier --- ## Key Takeaways ✅ **Hyperlipidemia and dyslipidemia** refer to unhealthy levels of LDL, HDL, triglycerides, or a combination — they are common and often silent ✅ **High LDL cholesterol** is the primary driver of arterial plaque and the leading lipid-related cause of heart attack and stroke ✅ **Low HDL** and **high triglycerides** independently raise cardiovascular risk — especially when they occur together ✅ **Very high triglycerides** (above 500 mg/dL) carry a serious risk of acute pancreatitis — a painful, potentially life-threatening emergency ✅ **Diet is the most powerful lifestyle tool:** reduce saturated fats and refined carbohydrates; increase fiber, fish, nuts, and olive oil ✅ **Regular aerobic exercise** is one of the most effective ways to raise HDL and lower triglycerides ✅ **Losing 5–10% of body weight** can improve all three lipid values — LDL, HDL, and triglycerides ✅ **Alcohol and sugar are the primary dietary drivers of high triglycerides** — limiting both is essential ✅ **Quitting smoking** meaningfully raises HDL and reduces cardiovascular risk ✅ **Medication** (especially statins) is appropriate when lifestyle changes alone are insufficient — and works best alongside, not instead of, lifestyle improvements ✅ **Know your 10-year cardiovascular risk** — your LDL target depends on your overall risk profile, not just your cholesterol number ✅ You are not alone: your healthcare team, registered dietitians, and lifestyle medicine specialists are here to help --- ## Questions for Your Doctor - What are my LDL, HDL, triglyceride, and non-HDL cholesterol levels — and what should my personal targets be? - What is my estimated 10-year cardiovascular risk (ASCVD risk)? - Should I have my lipoprotein(a) [Lp(a)] tested? - Based on my risk level, do I need medication in addition to lifestyle changes? - Is a statin right for me? What dose and which type? - Is my triglyceride level high enough to worry about pancreatitis risk? - Should I see a registered dietitian nutritionist (RDN) for personalized dietary guidance? - Should I be evaluated for sleep apnea? - Is there a family history concern — could I have familial hypercholesterolemia? - How often should I recheck my lipid panel, and when will we reassess my treatment plan? --- _Prepared by your healthcare team. For questions or concerns about your cholesterol, triglycerides, or overall cardiovascular health, please contact our office._ --- **Sources and Further Reading:** - 2026 ACC/AHA Guideline on the Management of Dyslipidemia — American College of Cardiology / American Heart Association: [www.acc.org](https://www.acc.org/About-ACC/Press-Releases/2026/03/13/18/01/ACCAHA-Issue-Updated-Guideline-for-Managing-Lipids-Cholesterol) - American Heart Association — Cholesterol: [www.heart.org/cholesterol](https://www.heart.org/en/health-topics/cholesterol) - Centers for Disease Control and Prevention — Cholesterol: [www.cdc.gov/cholesterol](https://www.cdc.gov/cholesterol) - National Heart, Lung, and Blood Institute — Blood Cholesterol: [www.nhlbi.nih.gov/health/blood-cholesterol](https://www.nhlbi.nih.gov/health/blood-cholesterol) - NHLBI — Therapeutic Lifestyle Changes (TLC) Program: [www.nhlbi.nih.gov/health/TLC](https://www.nhlbi.nih.gov/health/TLC-Therapeutic-Lifestyle-Changes-Lower-Cholesterol) - Mayo Clinic — High Cholesterol: [www.mayoclinic.org](https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/cholesterol-medications/art-20050958) - International Atherosclerosis Society — Triglycerides Revisited Consensus Statement (2024): [www.athero.org](https://athero.org/wp-content/uploads/2024/07/IAS_Triglycerides-Revisited-Consensus_Aug2024.pdf) - American College of Cardiology — Dietary Approaches for Elevated LDL-C (2025): [www.acc.org/latest-in-cardiology](https://acc.org/Latest-in-Cardiology/Articles/2025/07/01/01/Prioritizing-Health-Dietary-Approaches-For-Elevated-LDL-C)