High Cholesterol Causes and Treatment

For decades, conventional wisdom has insisted on one simple truth: lower your cholesterol, protect your heart. This mantra helped popularize statin medications and led many doctors to focus almost entirely on cutting “bad” LDL cholesterol. 

On the other side, a growing chorus claims that cholesterol doesn’t matter at all. Both extremes miss the bigger picture.

In reality, heart disease is influenced by a wide range of factors—from genetics and chronic inflammation to diet, lifestyle, and the specific types of cholesterol particles coursing through your arteries. 

Some people with high LDL remain heart-healthy, while others with normal levels face unexpected cardiovascular events. Clearly, cholesterol matters, but it’s not the whole story.

In the sections that follow, we’ll cut through the myths and explore how advanced testing, imaging, and a more nuanced understanding of risk factors can help you make informed decisions. By looking beyond the headlines and digging deeper than a basic cholesterol test, you can chart a better path to long-term heart health.

Does High Cholesterol Cause Heart Disease?

The relationship between cholesterol and heart disease is more complex than most headlines suggest. While cholesterol levels do play a part, other factors—like inflammation, genetics, and lifestyle—are often equally or more important.

Myth 1: Heart disease is caused solely by high cholesterol, especially “bad” LDL.
Fact: Although LDL cholesterol can contribute to plaque formation, it’s far from the only culprit. Chronic inflammation, poor dietary patterns, sedentary habits, and metabolic issues often drive heart disease risk more than any single cholesterol number. Even within LDL, the size and density of the particles matter—smaller, denser LDL particles are more dangerous than larger, fluffier ones.

Myth 2: Lowering total cholesterol is enough to reduce your cardiovascular risk.
Fact: Lower total cholesterol doesn’t always translate to better heart health. What truly counts is addressing the root causes of elevated LDL, triglycerides, and inflammation. By improving your diet, managing stress, staying active, and identifying hidden metabolic issues, you can reduce your overall risk more effectively than by focusing on cholesterol alone.

How Do You Know If You Have the “Wrong” Type of Cholesterol?

Basic Cholesterol Tests

When your doctor orders a standard blood test, you typically receive these key numbers:

• Total Cholesterol: A sum of all cholesterol in your blood (HDL, LDL, and more).
• LDL (“Bad”) Cholesterol: The primary focus for many doctors, as high levels can contribute to plaque formation.
• HDL (“Good”) Cholesterol: Helps clear LDL from the bloodstream. Aim for levels above 60 mg/dL (1.5 mmol/L).
• Triglycerides: Another blood fat that, when elevated, can increase heart disease risk. Ideally, keep them below 40 mg/dL (1.0 mmol/L).

HDL-to-Triglyceride Ratio

Rather than looking at LDL alone, pay close attention to your HDL-to-triglyceride ratio. A high HDL combined with low triglycerides often indicates a healthier cardiovascular profile, reducing your risk of heart disease more effectively than simply lowering LDL.

Advanced Cardiovascular Testing

For a more comprehensive assessment of your heart disease risk, consider tests that go beyond the standard lipid panel. These can help pinpoint underlying issues that contribute to plaque buildup and inflammation. Key measurements include:

Finding the Best Treatment Approach

If your cholesterol levels are high—especially if you have the “wrong” type of LDL—don’t assume you automatically need a statin or supplement. Instead, consider taking these steps first:

1. Address Underlying Causes:
   • Diet: Focus on whole, minimally processed foods.
   • Exercise: Aim for regular physical activity, such as brisk walks or light strength training.
   • Stress Management: Practice techniques like meditation, yoga, or deep breathing.
   • Sleep Optimization: Ensure 7–9 hours of quality sleep each night.
2. Many people find that making these lifestyle changes can help improve their cholesterol profile without medication.
3. Consider Advanced Imaging:
   If you and your doctor are still concerned, advanced imaging tests can provide more detailed insights:
   • Calcium Score Test: Measures the amount of hardened (calcified) plaque in your arteries.
   • CT Angiogram: Shows both hard and soft plaque, offering a full picture of your arterial health.
4. These tests help determine whether you truly need statin therapy or if you can continue managing your heart health through lifestyle adjustments and other targeted treatments.

Case Study: Looking Beyond Cholesterol Levels

A 56-year-old client presented with exceptionally high cholesterol readings:

At first glance, these numbers strongly suggested an urgent need for statin therapy. In fact, her doctors were ready to prescribe statins without exploring other tests. However, the patient was already following a healthy lifestyle, and something just didn’t add up. Before starting medication, she opted for a Calcium Score test, which measures the amount of calcified plaque in the arteries. The surprising result? A score of zero—indicating no calcified plaque buildup.

This scenario underscores the importance of looking beyond basic cholesterol numbers. Had she relied solely on these values, she would have started statin treatment unnecessarily. Instead, advanced imaging and a more comprehensive evaluation of her cardiovascular risk told a very different story—highlighting that cholesterol alone doesn’t always predict heart disease.

But on the flip side I have seen clients with average levels of cholesterol but a CT angiogram shows atherosclerosis and I would recommend statin therapy along with natural treatments.

Modifiable Risk Factors for High Cholesterol

1. Insulin Resistance

• Cause: High intake of sugar and refined carbs (e.g., cereals, breads, cookies, juices).
• Effect: Elevated triglycerides and increased LDL “buses” to transport them, combined with inflammation, raises heart disease risk.
• Lifestyle Tips:
  • Reduce refined carbohydrates
  • Increase whole, nutrient-dense foods
  • Aim for a healthy waist circumference (≤40 inches/102 cm for men, ≤35 inches/88 cm for women)
  • Incorporate regular exercise to improve insulin sensitivity

2. Low Thyroid Function

• Cause: Underactive thyroid hormone production leads to higher cholesterol synthesis and reduced LDL clearance.
• Effect: Even mildly low thyroid function can push up LDL and total cholesterol.
• Lifestyle & Testing Tips:
  • Test beyond TSH (e.g., T3, T4) to get a full thyroid profile
  • Address thyroid issues first before starting statins
  • Ensure adequate iodine, selenium, and nutrient intake for thyroid health

3. Infections

• Cause: Bacterial, viral, or gum infections (e.g., H. pylori, herpes, EBV) can raise LDL levels.
• Effect: LDL may increase as the body’s natural defense against pathogens.
• Lifestyle & Testing Tips:
  • Practice good oral hygiene (treating gum disease)
  • Consider testing for gut pathogens and viruses
  • Use targeted treatments (e.g., antimicrobials, probiotics) as needed

4. Gastrointestinal (GI) Dysfunction

• Cause: Conditions like H. pylori, SIBO, parasites, or leaky gut can drive up LDL.
• Effect: Gut-derived toxins (LPS) increase inflammation, boosting LDL as a defensive response.
• Lifestyle & Testing Tips:
  • Improve gut health with probiotics, prebiotics, and addressing infections
  • Even without digestive symptoms, gut issues can contribute to high cholesterol
  • Comprehensive GI testing can guide targeted interventions

5. Environmental Toxins

• Cause: Exposure to mercury, BPA, and other toxins can promote insulin resistance and increase LDL.
• Lifestyle Tips:
  • Avoid reheating or storing food in plastic
  • Opt for glass or stainless-steel containers
  • Consider testing for heavy metal exposure if indicated

6. HPA Axis Dysfunction (Adrenal Fatigue)

• Cause: Chronic stress, poor sleep, and high cortisol levels drive insulin resistance and elevate LDL.
• Lifestyle Tips:
  • Prioritize sleep (7–9 hours per night)
  • Practice stress management (meditation, yoga, relaxation techniques)
  • Engage in regular, moderate exercise

7. Diet & Lifestyle

• Dietary Focus: It’s not dietary cholesterol that’s the main issue—it’s refined carbs and processed foods.
• Individual Differences: Those with certain genetic variations (e.g., APOE, LDLR) may need to moderate saturated fat intake.
• Lifestyle Tips:
  • Emphasize whole, nutrient-dense foods (vegetables, fruits, lean proteins, healthy fats)
  • Focus on increasing fiber and in particular soluble fiber
  • Regular exercise to improve insulin sensitivity and raise HDL
  • Avoid highly processed foods that fuel inflammation and metabolic issues

Unmodifiable Risk Factors: Genetics & Family History

Your genetic makeup plays a role in cholesterol levels and heart disease risk, but having certain genes doesn’t guarantee you’ll develop heart problems. Instead, it’s a clue that you may need to be more proactive about managing your cardiovascular health. 

Even without genetic testing, a strong family history of heart disease can suggest an inherited predisposition.

With genetic testing I prefer SelfDecode as they use polygenic testing to assess for heart disease risk, this means they don’t look at one gene in isolation but take into account 1,000’s of genes that can influence your cardiovascular risk.

Key Points:

• Family History:
  • If multiple close relatives have had heart disease, you may carry certain genetic variants that increase your risk.
  • This family-based risk, even without formal testing, can be a prompt to take preventive steps earlier and more aggressively.
• Common Genetic Variants:
  • Familial Hypercholesterolemia (FH):
    • Genes: LDLR, APOB
    • Impact: Leads to very high LDL levels and an increased risk of early heart disease.
  • APOE4 Variant:
    • Impact: Increases the risk of cardiovascular disease and Alzheimer’s.
    • Diet Implication: Limiting saturated fats and shifting to a Mediterranean-style diet can help improve cholesterol profiles.
  • PCSK9 Variants:
    • Impact: Certain mutations raise LDL by limiting its clearance from the bloodstream.
    • Treatment Note: PCSK9 inhibitors can be helpful for individuals with these variants.
  • LPA Gene (Lipoprotein(a)):
    • Impact: Elevated Lp(a) can promote plaque buildup and heighten heart disease risk.

What You Can Do:

• Consider Genetic Testing: If you have a strong family history, genetic testing (through services like SelfDecode) can shed light on specific risk factors.
• Work with a Professional: A knowledgeable healthcare practitioner can interpret results and tailor strategies—ranging from dietary tweaks to medication decisions.
• Adopt a Proactive Lifestyle: Even with a genetic predisposition, you can lower your risk by:
  • Choosing a nutrient-dense diet suited to your genetic profile
  • Exercising regularly to improve lipid and blood sugar levels
  • Managing stress and prioritizing good sleep

Genes aren’t destiny. By understanding family history and genetic risk, you can take proactive, informed steps to protect your heart health.

Supplements to Support Healthy Cholesterol Levels

Before considering supplements, remember that optimizing diet, exercise, sleep, and stress management comes first. Supplements can play a supportive role, especially if you’re genetically predisposed to high cholesterol or seeking more natural options.

Well-Researched Supplements:

1. Pantethine
   • What It Is: A derivative of Vitamin B5 and a precursor to Coenzyme A.
   • Benefits: Studies show it can significantly lower total cholesterol and LDL, as well as reduce arterial plaque. It may also help increase HDL levels.
2. Tocotrienols
   • What It Is: A form of Vitamin E distinct from common alpha-tocopherol.
   • Benefits: Certain tocotrienol supplements have been linked to improved LDL profiles and arterial health. They are often better choices than regular Vitamin E (alpha-tocopherol), which can sometimes increase heart disease risk.
   • Note: Look for “tocotrienol-rich” formulas rather than standard Vitamin E.
3. Red Yeast Rice Extract
   • What It Is: A natural source of monacolin K, which inhibits HMG-CoA reductase—the same enzyme targeted by statin drugs.
   • Benefits: Effectively lowers LDL and total cholesterol. Most people tolerate it better than statins, though a small percentage may experience mild side effects if used long-term.
   • Tip: Choose a reputable brand with added Coenzyme Q10 for extra cardiovascular support.
4. Omega-3 Essential Fatty Acids
   • What It Is: Found in oily fish (salmon, sardines) or fish oil supplements.
   • Benefits: Improves overall cardiovascular health, supports cognitive function, and can help lower triglycerides. If you don’t eat fatty fish 3–4 times a week, consider a high-quality fish oil supplement.

Additional Evidence-Based Supplements to Consider:

5. Plant Sterols and Stanols
   • What They Are: Compounds found naturally in plants that resemble cholesterol’s structure.
   • Benefits: Reduce LDL absorption in the gut, potentially lowering LDL cholesterol by 5–15%.
6. Berberine
   • What It Is: An alkaloid derived from various plants (e.g., Berberis species).
   • Benefits: Shown in studies to help improve lipid profiles and support healthy blood sugar levels, which can indirectly benefit heart health.
7. Niacin (Vitamin B3)
   • What It Is: A B-vitamin used in therapeutic doses.
   • Benefits: Can lower LDL and triglycerides while raising HDL.
   • Note: High doses may cause flushing and require medical supervision.

Combination Approaches:
Research suggests that using multiple supplements together can be more effective than a single ingredient alone. In one study, a combination of pantethine, plant sterols, green tea extract, tocotrienols, and red yeast rice extract reduced total cholesterol and LDL by about 35%—better results than many statin drugs.

Key Takeaways:

What’s the next step

If you have a family history of cardiovascular disease, high blood pressure, high cholesterol, previous heart disease or just want to find out what your cardiovascular risk is, I suggest doing the extensive cardiovascular test 

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A good place to start is to schedule a 30 minute consultation to assess your risk factors and find out the best test options for you. If you go ahead with any testing the price of the consultation will be taken off the cost of the test, effectively making the consultation free.

Frequently Asked Questions

Q: Do I need to take statins if my cholesterol is high?
A: Not necessarily. While statins can be effective for some individuals, high cholesterol alone doesn’t always mean you need medication. Advanced testing, imaging, and evaluating lifestyle factors can help determine whether statins are truly necessary—or if dietary changes, exercise, and other interventions can address the underlying issues.

Q: If my family has a history of heart disease, am I doomed to get it too?
A: No. A strong family history or certain genetic variants may raise your risk, but they do not guarantee you’ll develop heart disease. By focusing on modifiable factors—diet, exercise, stress management, and regular health screenings—you can significantly lower your risk, even if your genetic predisposition is higher.

Q: Can I rely solely on a standard cholesterol test to assess my heart disease risk?
A: A standard cholesterol test is a start, but it doesn’t tell the whole story. Advanced lipid panels, inflammation markers, and imaging tests like a calcium score or CT angiogram provide a deeper understanding of your cardiovascular health. This information can help guide a more targeted and effective prevention or treatment plan.

Q: Aren’t high-fat foods and dietary cholesterol the main causes of high cholesterol?
A: Not necessarily. While some individuals, especially those with certain genetic variants like APOE4, may need to moderate their intake of saturated fats, the biggest culprits for many people are refined carbohydrates, sugary foods, and a generally poor-quality diet. Adopting a whole-foods, balanced approach tailored to your genetic profile can often improve cholesterol levels more than simply reducing dietary fat.

Q: How often should I monitor my cholesterol and heart health markers?
A: It depends on your individual risk factors. People with family history, genetic predispositions, or existing conditions may benefit from more frequent monitoring—every 6-12 months—while those at lower risk might only need check-ups every 1-2 years.