The Truth About Cholesterol: 12 Things You Need to Know – Eggs, Weight, Statins, and More

Why Does This Matter?

Cholesterol is one of the most important risk factors for potentially fatal cardiovascular diseases such as heart attack and stroke. High cholesterol usually causes no symptoms, so it can damage our blood vessels unnoticed for years. According to the World Health Organization, cardiovascular disease accounts for more than 30% of deaths worldwide. Learning about this subject can therefore save lives!

Hearsay circulating online, including the mistaken belief that eggs are harmful because of their cholesterol content, can add to the confusion. Some dietary trends also downplay cholesterol's effects and blame sugar alone. Scientific evidence, however, shows a much more complex picture. This article explains the facts about cholesterol in simple, accessible language.

1. What Is Cholesterol and What Does It Do?

Cholesterol is a fat-like substance naturally present in our bodies. It forms part of cell membranes and plays a role in producing certain hormones, such as estrogen and testosterone, and vitamin D. Cholesterol is therefore not entirely bad, but too much creates serious risks.

Cholesterol is divided into two main types:

• LDL (low-density lipoprotein): Known as “bad cholesterol.” Excess LDL builds up in blood vessels, creates plaques, and causes blockages.

• HDL (high-density lipoprotein): This is “good cholesterol.” It carries LDL to the liver, helping remove it from the body.

2. When Should You Have Your Cholesterol Checked?

The UK's National Health Service (NHS) recommends cholesterol testing every 5 years for people over 40. For those over 75, these checks should be annual. If you have a family history of heart disease at a young age, testing earlier is important.

3. What Does the Blood Test Show?

A cholesterol test usually measures:

• Total cholesterol
• HDL (good) cholesterol
• LDL (bad) cholesterol
• Triglycerides (another type of fat circulating in the blood)

What Are Normal Cholesterol Levels?

Total Cholesterol

• <200 mg/dL → Desirable
• 200–239 mg/dL → Borderline high
• ≥240 mg/dL → High

LDL (Bad) Cholesterol

• <100 mg/dL → Optimal
• 100–129 mg/dL → Near optimal
• 130–159 mg/dL → Borderline high
• 160–189 mg/dL → High
• ≥190 mg/dL → Very high

HDL (Good) Cholesterol

• <40 mg/dL (in men) or <50 mg/dL (in women) → Low (increased risk)
• ≥60 mg/dL → Protective level (cardioprotective)

Triglycerides

• <150 mg/dL → Normal
• 150–199 mg/dL → Borderline high
• 200–499 mg/dL → High
• ≥500 mg/dL → Very high

4. What Are Triglycerides?

Triglycerides are the type of fat in which the body stores unused calories. Excess levels increase the risk of heart disease. Risk may be hidden, especially in people with normal HDL but high triglycerides. A balanced diet and exercise are very effective at lowering triglyceride levels.

5. What Does Inherited High Cholesterol Mean?

High cholesterol does not always result from an unhealthy diet. The inherited condition familial hypercholesterolemiaaffects 1 in every 250 people. For these individuals, lowering cholesterol through diet alone is often insufficient; medication is essential.

If a first-degree relative had a heart attack at a young age (<55 for men or <65 for women), this suggests that you may also have genetic risk. You should definitely be tested.

6. What Increases Your Cardiovascular Disease Risk?

Cholesterol is one of many factors doctors use to calculate a “cardiovascular risk score.” Other risk factors include:

• Age
• Sex (risk is higher in men)
• Smoking
• Alcohol consumption
• High blood pressure
• Family history
• Overweight or obesity

Statin treatment is generally recommended if the risk score is above 10%.

7. Statins: Are They Effective at Lowering Cholesterol?

Statins reduce cholesterol synthesis in the liver and lower bad cholesterol by increasing the number of LDL receptors. They can generally reduce LDL by up to 50%. They are extremely safe, and scientific evidence shows that they prolong life in patients who have had a heart attack.

If statins are insufficient in people with very high cholesterol, newer-generation drugs such as PCSK9 inhibitors may also be used.

8. Can You Lower It Without Medication?

If your high cholesterol is not inherited, you may be able to lower it through lifestyle changes. You can discuss a 2-3-month trial without medication with your doctor. During this period, habits such as:

• Healthy eating
• Regular physical activity
• Weight management can lower LDL and raise HDL.

9. Which Foods Help Cholesterol Levels?

Cholesterol-friendly foods include:

• Oats: Their beta-glucan reduces cholesterol absorption in the intestine. A daily intake of 3g of beta-glucan (about 40g of rolled oats) is effective.
• Legumes (lentils, beans, chickpeas): Their fiber and low fat content provide a dual cholesterol-lowering effect.
• Olive oil, avocado, nuts (almonds, hazelnuts, walnuts): Rich in unsaturated fatty acids.
• Oily fish (salmon, mackerel, sardines): Contain Omega-3 fatty acids and are heart-friendly.
• Vegetables and fruit: Rich in fiber, antioxidants, and vitamins, they are cornerstones of the “portfolio diet.”

10. Which Foods Should You Avoid?

• Saturated fats: Butter, cream, red meat, and processed meats (sucuk, salami, sausages)
• Tropical oils: Coconut oil (about 85% saturated fat), palm oil
• Very sugary foods: Particularly products marketed as low-fat but containing high amounts of sugar
• Ultraprocessed foods (UPF): Packaged cakes, cookies, ready meals

11. Are Eggs and Shellfish Really Harmful?

These foods used to be criticized because they contain cholesterol. Current scientific evidence, however, shows that dietary cholesterol has a limited effect on blood levels. The main culprit is saturated fat. For most people, eggs and seafood can therefore form part of a healthy diet. People with familial hypercholesterolemia should be cautious, however.

12. Conclusion: Know Your Cholesterol, Protect Your Health

Like high blood pressure, cholesterol is a silent, insidious enemy. Regular checks, informed food choices, and healthy lifestyle habits can help keep it under control. Remember, small changes make a big difference!