Cholesterol and Stroke

What is cholesterol?

Cholesterol is a waxy substance found throughout your body. Your body makes all the cholesterol it needs for important jobs, such as helping to build cells and make certain hormones. When cholesterol is too high, it can put you at a higher risk of heart disease or stroke.

Cholesterol comes from two sources. Your liver makes all the cholesterol you need. The rest of the cholesterol in your body comes from food from animals. For example, meat, poultry and dairy products all contain dietary cholesterol.

Those same foods can also be high in saturated and trans fats. These fats can increase the cholesterol in your body. For some people, this added cholesterol means they go from a normal cholesterol level to one that’s unhealthy.

Some tropical oils, such as palm oil, palm kernel oil and coconut oil, contain saturated fat that can increase bad cholesterol. These oils are often found in baked goods.

Two types of lipoproteins carry cholesterol to and from cells. One is low-density lipoprotein, or LDL. The other is high-density lipoprotein, or HDL.

LDL cholesterol

LDL cholesterol is considered the “bad” cholesterol because it contributes to fatty buildups in arteries. This narrows the arteries and increases the risk for stroke.

HDL cholesterol

HDL cholesterol is often called the “good” cholesterol because a healthy level may help protect against stroke.

HDL carries LDL (bad) cholesterol away from the arteries and back to the liver. There the LDL is broken down and passed from the body.

Triglycerides

Triglycerides are the most common type of fat in the body. They store excess energy from your diet.

A high triglyceride level combined with high LDL cholesterol or low HDL cholesterol is linked with fatty buildups within the artery walls, which increases the risk of stroke.

How can high cholesterol cause a stroke?

Too much LDL can lead to plaque in the arteries that carry blood to your brain. A plaque can narrow the artery or break open and form a blood clot. That clot can block blood flow and cause an ischemic stroke.

Know your numbers

Ask for a cholesterol (lipid) panel. You’ll get results for LDL, HDL, triglycerides and total cholesterol. Many adults need testing every 5 years if risk stays low. You may need testing more often if you have other risks.

Talk with your health care team about what these numbers mean. It’s important to know your cholesterol numbers and work with your health care team to treat your overall risk of stroke.

Other tests may be right for you. Your health care team may want these extra tests to get a more complete picture of your stroke risk.

• Lipoprotein(a) or Lp(a) – It is recommended that every adult should get tested for Lp(a) at least once in their lifetime.
• Apolipoprotein B or ApoB – If you have high triglycerides, metabolic syndrome or Type 2 diabetes, this test might be appropriate.
• Coronary artery calcium (CAC) scan – This imaging test is most useful if the decision to start a cholesterol-lowering medication is uncertain.

Ways to lower cholesterol (and stroke risk)

Healthy habits

• Eat smart: Enjoy more vegetables, fruits, whole grains, beans, nuts and fish. Limit saturated and trans fats, sodium and added sugars.
• Move more: Regular activity on most days supports healthy cholesterol and blood pressure.
• Don’t smoke or vape. Avoid secondhand smoke. Limit alcohol.
• Manage weight, sleep, blood sugar and blood pressure. These steps support overall brain and heart health.

Medications (when needed)

• Statins are the most common medications used to reduce LDL and the risk of stroke.
• After a stroke or TIA from blocked arteries, many people need a statin.
• If your LDL stays at 70 mg/dL and above (or even 55 mg/dL and above for people at very high risk) on a statin, your health care team may add another medication. Your health care team will likely want to recheck your cholesterol 4–12 weeks after medication changes, then every 6–12 months.
• Don’t stop taking your medication without talking to your health care team.

Cholesterol and recovery after stroke

If you had an ischemic stroke or TIA caused by plaque or blockages, lowering LDL will likely be a key part of your recovery plan. Most people will be prescribed a statin. If LDL is still not low enough, adding other medications such as ezetimibe or a PCSK9 inhibitor can help get LDL to goal and lower the chance of another stroke.

What is prevent, and what does it have to do with cholesterol and stroke?

Prevent, a risk estimator, is a tool your health care team may use to help estimate your chances of having a heart event or stroke in the next 10 and 30 years. This tool helps guide treatment plan decisions for you and your health care team. The risk estimate is based on health information usually collected during your yearly check-up, such as:

• Age
• Blood pressure readings
• Cholesterol test results
• Other personal details

It is important to know that Prevent is only meant to be used for people between the ages of 30 and 79 without a history of cardiovascular disease or stroke. If you are a stroke survivor, talk with your health care team about your risk for another stroke and how to best lower your risk.