While our bodies need a certain amount of cholesterol to work properly, too much of the “bad” type can be dangerous. Over time, cholesterol and fat can collect in the inner walls of the arteries – including the ones that supply blood to the heart.

This buildup can cause a narrowing of the arteries (atherosclerosis), which is a major cause of heart and blood vessel disease. People with too much low-density lipoprotein, or LDL, cholesterol – also called the “bad” cholesterol – are more likely to have a heart attack or a stroke.

Cholesterol is a waxy, fat-like substance that travels through the blood. Fats in some foods we eat gets made into cholesterol and is also made by the liver. It serves a variety of functions. For example, it helps create the outer coating of our cells and aids the body in making vitamin D and certain hormones.

Extra dietary fats get absorbed by the body and raise bad cholesterol in the blood.

Saturated and trans fats also raise LDL-cholesterol levels in the blood and increase the chance of heart disease. Foods that are high in animal fat (full-fat milk, cheese, meat) or prepared with butter, shortening or partially hydrogenated oils and sweets (cookies and cakes) are often the main culprits.

Many people don’t know that they have high levels of harmful cholesterol. That’s because there are usually no signs or symptoms associated with an early buildup of fatty plaques in the arteries.

Plaque is made up of cholesterol, fat and other substances. It’s not until there may be a large blockage of the artery that you might notice something is wrong. For example, you may have chest pain, pain in the arms or jaw, nausea, sweating, or shortness of breath. These usually occur when the blood supply to the heart or brain is being slowed or blocked.

Unfortunately, these blockages can rupture and cause major problems, even when they are much smaller and without causing any early symptoms. That is why, for some people, the first sign of elevated cholesterol may be a heart attack or stroke.

So – even if you’re feeling fine – it’s a good idea to get your cholesterol checked. Your care team will consider your cholesterol numbers along with any other factors that make heart disease or stroke more likely to occur, such as your age, if you have diabetes or high blood pressure, of if you smoke.

High LDL and total cholesterol are generally related to either conditions passed on in families (inherited) or poor lifestyle habits that include:

• Eating unhealthy fats and simple carbohydrates
• Not exercising regularly
• Being overweight or obese

In addition, you have a greater chance of heart disease or a stroke if you have:

• High blood pressure
• Diabetes
• Family history of early heart disease
• Active smoking
• Low HDL-cholesterol levels (also called the “good” cholesterol)
• Or if you are Black or African American

It’s important to track your cholesterol and risk for related heart disease, heart attack or stroke. A simple blood test – called a lipid panel – is used to check the amount of cholesterol in your blood.

Cholesterol is measured in milligrams (mg) per deciliter (dL) of blood – mg/dL in the United States. The test provides four measures:

• Total or overall cholesterol
• LDL, or “bad,” cholesterol
• HDL, or “good,” cholesterol
• Triglycerides

Lipoprotein (a) is another test that your care team may check to better understand your risk for stroke, heart attack or other diseases. It may be considered if you have early heart disease or a strong family history of early heart disease.

It’s important to track your cholesterol over time, especially because there are often no signs and symptoms of early buildup of fat and cholesterol in the artery walls.

Talk with your health care team about how often your cholesterol should be checked and what numbers would be ideal for you.

The end goal in bringing down your LDL-cholesterol is to lower the chance of a first or future heart attack or stroke due to blockages in your arteries.

Your treatment plan to lower your cholesterol numbers will be based on your overall risk for cardiovascular disease. For example, a standard risk assessment would note whether you already have atherosclerosis or have a high chance of developing it. Treatments will also depend on:

• Your cholesterol levels
• Other conditions you may have
• Treatments tried before (if applicable)
• Personal choice

Trying to lower LDL levels often can be helped by making healthier lifestyle choices. In fact, the choices we make every day can affect our cholesterol.

Here are four things that can make a difference:

1. Revamp the way you eat by following a heart-healthy plan such as the Mediterranean or DASH diets (these are less “diets” than ways to eat healthy)
2. Exercise regularly
3. Stay at a healthy weight and lose any extra pounds
4. Don’t smoke, and stay away from secondhand smoke

Many people with elevated LDL cholesterol, particular if it is an inherited condition, also need to take medication.

You probably know that fried chicken, a doughnut or a loaded double cheeseburger are not the best foods to put in your body. Why? Because foods like these are packed with unhealthy fats and lack many of the important nutrients for heart health. The good news is that a healthy diet can also taste great!

High cholesterol can be prevented and treated. Studies show that keeping LDL cholesterol low not only can prevent someone from developing clogged or narrowed arteries in the first place (primary prevention), but doing so also helps reduce the chance of a heart attack, stroke or related death among people who already have heart disease (secondary prevention).

The opposite is true, too: Those with high levels of high-density lipoprotein (HDL) – the “good” cholesterol – tend to have cleaner arteries and a lower chance of heart attack and stroke. That’s because HDL acts like a scavenger, helping to find harmful cholesterol and remove it from your arteries.

The challenge is that there are often no signs or red flags of having too much bad cholesterol until it starts to affect your arteries. For this reason, it’s important to know your cholesterol numbers and your related risk for developing heart disease, or having a heart attack or stroke.

Keeping LDL-cholesterol levels low is an essential part of staying heart healthy. Adopting a healthy diet, getting regular exercise, keeping weight well managed and, in some cases, taking medications, can go a long way to help.

Your health care team will work with you to help prevent or treat high cholesterol and support your overall cardiovascular health. Here are some questions you may want to ask:

• What is my cholesterol?
• What’s the difference between LDL cholesterol and triglycerides?
• Should I have my lipoprotein (a), or Lpa, level checked?
• Would I benefit from genetic testing for a cholesterol disorder?
• If my LDL is high because of a genetic disorder (passed down in families), should my children have their cholesterol checked?
• Will exercise and diet alone be enough to lower my cholesterol?
• How does cholesterol relate to the risk of cardiovascular disease?
• How much exercise should I be getting? What types of activities are best for me?
• Are there foods I should avoid/eat more of?
• Do I need medication? If so, which medication and why?
• When can we expect to see a difference?
• What side effects should I watch for?
• I know statins are usually the first drug therapy, but what can you tell me about non-statin medications?
• I feel fine. Why do I need medicine to lower my cholesterol?
• What can I do to raise my “good” cholesterol?
• How often do I need to get my cholesterol level checked?
• What about my other risk factors for cardiovascular disease?