Common Misconceptions about Cholesterol

What is Cholesterol?

Learn the facts about cholesterol

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

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 very high risk of heart disease. This problem is underdiagnosed and undertreated worldwide. Once identified, children with this condition may require aggressive treatment with medications.

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

  • A parent or grandparent who had evidence of coronary atherosclerosis, peripheral vascular disease or cerebrovascular disease.
  • A parent or grandparent who had a coronary artery procedure.
  • A parent or grandparent 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).

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

Compelling evidence shows that the atherosclerotic process (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 two and older should be encouraged to eat a diet that emphasizes fruits, vegetables, fish, whole grains and low sodium, with few sugar-laden foods and drinks.

Misconception: You don’t need a cholesterol check until middle age

The American Heart Association recommends that all adults 20 and older have their cholesterol (and other risk factors) checked every four to six years. Work with your doctor 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. 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.

Misconception: Only men need to worry about cholesterol

Both men and women tend to see higher triglyceride and cholesterol levels as they get older. Weight gain also contributes to higher levels.

But it is true that 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.

On the other hand, postmenopausal women may find that, despite a heart-healthy diet and regular physical activity, their cholesterol still rises. For this reason, women nearing menopause should have their cholesterol levels checked and talk with their doctor 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 recent studies have shown that HRT does not reduce the risk of heart disease and stroke in postmenopausal women. The American Heart Association does not endorse HRT as a means for lowering cardiovascular risks.

Misconception: You should wait for your doctor to mention cholesterol

Your health is your responsibility.

Starting at age 20, ask your doctor to test your cholesterol, assess your risk factors and estimate your risk for a heart attack or stroke. 

Once you know your risk, you can take action to lower it. Your doctor may recommend diet and lifestyle changes – and possibly medication as well. Follow all of your doctor’s instructions and have your cholesterol and other risk factors rechecked every four to six years.

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 other factors inform your levels as well.

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 even play a role.

That said, 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

Medications can help control cholesterol levels, but making diet and lifestyle changes is the best way to reduce heart disease and stroke risk. To lower your cholesterol, eat a heart-healthy diet and get 40 minutes of moderate- to vigorous-intensity aerobic exercise, three to four times a week.

It’s also very important to take your medication exactly as your doctor has instructed.

Learn more about cholesterol medications.

Misconception: If the Nutrition Facts label shows no cholesterol, a 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.

Many foods marketed as “low-cholesterol” have high levels of saturated or trans fats, both of which raise blood cholesterol. Even foods billed as “low-fat” may have a surprisingly high fat content.

Look for how much saturated fat, trans fat and total calories are in a serving. (Even check the serving size itself, which 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.

Misconception: Using margarine instead of butter will help lower cholesterol

It’s true: Butter has a high amount of saturated fat and some trans fat. That raises LDL (bad) cholesterol and contributes to atherosclerosis. But 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. They 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 it’s one that, by itself, probably won’t reduce your cholesterol to healthy levels.

Learn more about eating a heart-healthy diet.

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