Common Misconceptions about Cholesterol

Video: What is Cholesterol?

Learn the facts about cholesterol

How much do you know about cholesterol? Here are some common misconceptions – and reality.

Misconception: Cholesterol isn’t a concern for children.

High cholesterol can be inherited. This is referred to as familial hypercholesterolemia.

Children who have this genetic disorder are at high risk of heart disease. This problem is underdiagnosed and undertreated worldwide. Once identified, children with this condition may require aggressive treatment with lifestyle changes and medications.

Cholesterol testing could be considered for children and adolescents with elevated risk. That includes children or adolescents with:

  • Family history of early cardiovascular disease (less than 55 years for men and less than 65 years for women)
  • Family history of total cholesterol of 240 mg/dL or above
  • Obesity or other metabolic risk factors

Regardless of their risk, all children benefit from a healthy diet and lifestyle. Establishing healthy eating and physical activity habits early can reduce the risk of cardiovascular problems over time.

Evidence shows that the buildup of plaque in arteries begins in childhood and progresses slowly into adulthood. Later in life, this often leads to coronary heart disease, the leading cause of death in the United States.

To reduce your child’s risk, it’s important to:

  • Discourage cigarette smoking.
  • Encourage regular aerobic exercise.
  • Identify and treat high blood pressure.
  • Help your child maintain a healthy weight.
  • Diagnose and treat diabetes.
  • Encourage a healthy diet.

Children age 2 and older should eat a diet that emphasizes fruits, vegetables, fish, whole grains and limits sodium and sugar-sweetened foods and drinks.

Misconception: You don’t need your cholesterol checked until middle age.

The American Heart Association recommends all adults 20 and older have their cholesterol (and other risk factors) checked every four to six years as long as risk remains low. Work with your health care professional to determine your risk for cardiovascular disease and stroke.

Misconception: Thin people don’t have high cholesterol.

Overweight people are more likely to have high cholesterol, but thin people can be affected as well.

Have your cholesterol checked regularly regardless of your weight, physical activity and diet.

Learn more about how to improve your cholesterol levels.

Misconception: Only men need to worry about cholesterol.

Both men and women tend to see higher triglyceride and cholesterol levels as they get older. Although atherosclerosis typically occurs later in women than men, cardiovascular disease remains the leading cause of death in women. Overweight and obesity also contributes to higher levels.

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 it tends to raise HDL (good) cholesterol levels. This may help explain why premenopausal women are usually protected from developing heart disease.

But cholesterol levels can still rise in postmenopausal women, despite a heart-healthy diet and regular physical activity. Women nearing menopause should have their cholesterol levels checked and talk with their health care professional about their risk factors and treatment options.

At one time, it was thought that hormone replacement therapy might lower a woman’s risk of heart disease and stroke. But studies have shown that HRT doesn't reduce the risk of heart disease and stroke in women. The AHA doesn't endorse HRT as a means to lower cardiovascular risks.

Health care professionals should consider women-specific conditions, such as premature menopause (less than age 40) and pregnancy-associated conditions, when discussing their cholesterol levels and potential treatment options.

Misconception: You should wait for your health care professional to mention cholesterol.

You need to take charge of your health. Starting at age 20, ask your health care professional to test your cholesterol, assess your factors and estimate your risk for a heart attack or stroke. 

If you’re between 20 and 39, health care professionals can assess your lifetime risk. If you’re between 40 and 75, they will assess your 10-year risk. 

Once you know your risk, you can take action to lower it. Your health care professional may recommend diet and lifestyle changes and possibly medication. Follow all instructions and have your cholesterol and other risk factors checked every four to six years as long as your risk remains low.

Questions to ask your doctor about cholesterol (PDF).

Misconception: Diet and physical activity dictate your cholesterol level.

Diet and physical activity do affect overall blood cholesterol levels, but so do other factors.

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.

So, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health.

Understand the sources of cholesterol.

Misconception: With medications, no lifestyle changes are needed.

Lipid lowering medications can help control cholesterol levels, but making diet and lifestyle changes are recommended to reduce heart disease and stroke risk. As part of the regimen to lower cholesterol, eat a heart-healthy diet and get at least 150 minutes of moderate- to vigorous-intensity aerobic exercise a week.

It’s also important to take medication exactly as your health care professional has instructed.

Learn more about cholesterol medications.

Misconception: If the Nutrition Facts label shows no cholesterol, the food is “heart healthy.”

A food’s Nutrition Facts label can be helpful for choosing heart-healthy foods, if you know what to look for.

Look for how much saturated fat, trans fat and total calories are in a serving. (Check the serving size too. It may be smaller than you expect.) Ingredients are listed in descending order of use, so choose products where fats and oils are near the end of the ingredients list.

Learn more about fats.

Misconception: Using margarine instead of butter will help lower cholesterol.

Butter is high in saturated fat and has some trans fat – raising LDL (bad) cholesterol and contributing to atherosclerosis. But many hard margarines also have a high amount of saturated and trans fat.

The healthiest choice is a liquid or soft tub margarine. These are made with vegetable oils. They have less partially hydrogenated fat and saturated fat than solid spreads, such as 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, it probably won’t reduce your cholesterol to healthy levels.

Learn more about eating a heart-healthy diet.