Common Misconceptions about Cholesterol

Updated:Apr 26,2017
Learn the facts


How much do you know about cholesterol? Here are some common misconceptions — and the truth.

High cholesterol isn’t a concern for children.

High cholesterol can be inherited (familial hypercholesterolemia). Children who have this genetic disorder are at very high risk of heart disease. This problem is underdiagnosed and undertreated worldwide. These kids need to be identified and aggressively treated with medications.

Cholesterol testing should be considered for children and adolescents who are at higher-than-normal risk, meaning those with:
  • A parent or grandparent who had evidence of coronary atherosclerosis, peripheral vascular disease or cerebrovascular disease; who had a coronary artery procedure; or who had a heart attack or sudden cardiac death before age 55.
  • A parent who has a history of high total cholesterol levels (240 mg/dL or higher).
All children--not just those at higher risk--will benefit from a healthy diet and lifestyle. Compelling evidence shows the atherosclerotic process (buildup of plaque in arteries) begins in childhood and progresses slowly into adulthood. Later in life, it often leads to coronary heart disease, the leading cause of death in the United States. Establishing the habits of healthy eating and physical activity early in life can reduce the risk of later cardiovascular problems.

To reduce fatty deposits in children’s arteries, it’s important to discourage cigarette smoking, encourage regular aerobic exercise, identify and treat high blood pressure, avoid or reduce overweight, diagnose and treat diabetes and encourage a healthy diet. Children ages 2 and older should be encouraged to eat a diet emphasizing fruits, vegetables, fish, whole grains, low sodium and few sugar-laden foods and drinks.

You don't need a cholesterol check until you’re middle aged.

Everyone should start getting tested for cholesterol and other risk factors at age 20. These measurements help to determine risk for a heart attack or stroke. In some cases, children can have high cholesterol levels. Evidence suggests these children are at greater risk for developing heart disease as adults. Lack of regular physical activity, poor dietary habits and genetics can all affect a child's cholesterol levels. Parents and caregivers can help kids develop a heart-healthy lifestyle by serving foods low in saturated fat and trans fats; encouraging at least 60 minutes of physical activity on most (and preferably all) days; and stressing the importance of avoiding tobacco products.

Thin people don't have high cholesterol.

Overweight people are more likely to have high cholesterol, but thin people can have it too. In fact, a person with any body type can have high cholesterol. People who don’t easily gain weight are often less aware of how much saturated and trans fat they eat. Nobody can “eat anything they want” and stay heart-healthy. Have your cholesterol checked regularly regardless of your weight, physical activity and diet. Learn more about how to improve your cholesterol levels.

High cholesterol is a man's problem, not a woman’s.

Premenopausal women may have some protection from high LDL (bad) levels of cholesterol, compared to men. That’s because the female hormone estrogen is highest during the childbearing years and tends to raise HDL (good) cholesterol levels. This may help explain why premenopausal women are usually protected from developing heart disease.

But as people get older, gain weight or both, their triglyceride and cholesterol levels tend to rise. Postmenopausal women may find that, despite a heart-healthy diet and regular physical activity, their cholesterol still rises. This is why women nearing menopause should have their cholesterol levels checked and talk with their doctor about their risk factors and options.

At one time, it was thought that hormone replacement therapy (HRT) might lower a woman’s risk of heart disease and stroke. However, recent studies have shown that HRT does not reduce the risk of heart disease and stroke in postmenopausal women. That’s why the American Heart Association recommends it not be used for cardiovascular prevention.

If your doctor hasn't mentioned your cholesterol, you’re OK.

Your health is your responsibility. Starting at age 20, ask your healthcare professional to test your cholesterol, assess your risk factors and estimate your risk for a heart attack or stroke. If you’re between age 40 and 79, talk to your doctor about assessing your 10-year risk. Once you know your risk, you can take action to lower it. Your doctor may recommend diet and lifestyle changes and maybe medication, too. Follow all of your doctor's instructions, and have your cholesterol and other risk factors rechecked every four to six years. See a list of questions to ask your doctor about cholesterol.

Diet and physical activity dictate your cholesterol level.

Diet and physical activity affect overall blood cholesterol levels, but other factors also contribute. Being overweight or obese tends to increase bad cholesterol (LDL) and lower good cholesterol (HDL). Getting older also causes LDL cholesterol to rise. For some, heredity may play a role. Even so, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health. Have your cholesterol tested and work with your healthcare professionals on the plan that's best for you. Learn more about the sources of cholesterol.

If you take cholesterol meds, you don’t need to make lifestyle changes.

Drug therapy is important, but making diet and lifestyle changes are the best ways to reduce heart disease and stroke risk. To lower cholesterol, eat a heart-healthy diet and get 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week. It's also very important to take your medication exactly as your doctor has instructed so it can work most efficiently. Learn more about cholesterol medications and get tips for taking your meds.

If the Nutrition Label shows no cholesterol, a food is “heart-healthy.”

Nutrition labels on food are helpful for choosing heart-healthy foods, but you must know what to look for. Many “low-cholesterol” foods have high levels of saturated fat and/or trans fat — and both raise blood cholesterol. Even “low-fat” foods may have a surprisingly high fat content. Look for how much saturated fat, trans fat, and total calories are in a serving. Also check the serving size; it may be smaller than you expect. Ingredients are listed in descending order of use, so choose products where fats and oils appear near the end of the ingredients list. Learn more about fats.

Using margarine instead of butter will help lower cholesterol.

Butter has a high amount of saturated fat and some trans fat. That raises LDL cholesterol and contributes to atherosclerosis.

Many hard margarines have a high amount of trans fat as well as saturated fat. That’s still bad.

The healthiest choice is a liquid margarine or a soft margarine in a tub. These are made with vegetable oils and have less partially hydrogenated fat and saturated fat than solid spreads like hard stick margarine and butter. Look for margarines that say 0 g trans fat on the Nutrition Facts label.

Switching from butter to soft margarine is a good step but by itself probably won’t reduce your cholesterol to healthy levels. That’s why your doctor may recommend other diet and lifestyle changes or medication. Learn more about eating a healthy diet.


This content was last reviewed April 2017.

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