Cholesterol isn’t all bad. This waxy, fat-like substance produced by the liver keeps your body’s cell membranes strong, helps to produce hormones and vitamin D, and aids in the digestion process.
But a particular kind of cholesterol—low-density lipoprotein, or LDL—increases your risk for heart attack and stroke. While high-density lipoprotein, or HDL, also known as “good cholesterol,” carries excess cholesterol back to your liver to be removed, LDL builds up in the walls of your arteries, eventually leading to blockages that stop blood flow.
“A lot of people have the belief that as long as they’re under a certain threshold of LDL, they’re fine, and that’s not the case,” says UNC Health cardiologist Christopher Kelly, MD. “Lower LDL means a lower risk of stroke and heart attack, but the acceptable level depends on your overall risk profile. There is no universal ‘normal’ level.”
It’s never too early to think about your LDL—even some children have high cholesterol—so Dr. Kelly shares some steps to take.
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Maintain a healthy lifestyle.
To reduce your risk of heart attack and stroke, start with habits that will help you achieve or maintain a healthy weight. Being overweight or obese raises LDL and also increases your risk for high blood sugar and high blood pressure, two other risk factors for heart attack and stroke.
“The foundation is maintaining a healthy lifestyle, with 150 minutes of exercise per week and a diet with lots of fruits and vegetables and whole grains,” Dr. Kelly says.
Any animal-based product—meat, eggs, dairy—will have cholesterol, but that doesn’t necessarily mean that you have to avoid all of them. Instead, avoid versions that are ultraprocessed (such as hot dogs and fast food) or have a lot of sugar (certain yogurts, baked goods).
“Plant-based foods are naturally lower in cholesterol, but high cholesterol is often about what your body is producing rather than what’s in your diet,” Dr. Kelly says. “A healthy diet can help your cholesterol and has other benefits for your health, but there are other influences.”
Talk to your doctor or consider working with a dietitian on the diet that’s right for you and your cholesterol risk. It’s also important to quit smoking (or never start), minimize alcohol intake, control stress and get good quality sleep. But even people with healthy habits can have high cholesterol, which makes the next step very important.
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Talk with your doctor about risk factors and screening.
There are no symptoms of high cholesterol, which is why it’s important to see your healthcare provider regularly for screening.
According to guidelines released by the American College of Cardiology, the American Heart Association and other leading medical associations in March 2026, children should have their first cholesterol screening between the ages of 9 and 11. It should be checked again around the age of 18, and adults should be screened every five years for life.
Your doctor may recommend more frequent screenings if you have other risk factors for heart attack or stroke, such as a family history of heart disease or diabetes, or if you start taking a cholesterol-lowering medication.
Your risk factors will help your doctor determine a safe range for your LDL.
“In the general population, the target for LDL is under 100 milligrams per deciliter,” Dr. Kelly says. “That’s if your risk for heart attack or stroke is minimal. As you develop more risk, because of age or diabetes, for example, it needs to be much less than that. People at high risk need to be under 55 milligrams per deciliter.”
Your doctor has several tools to help determine your overall risk. The American Heart Association’s PREVENT calculator uses your age and metrics from your blood work to estimate your risk of heart disease within 10 years. Your doctor may recommend calcium scoring, which involves using a CT scan to look at how much plaque is in your heart; if your score is high, they may recommend more aggressive management.
The 2026 guidelines also recommend a new test for everyone of lipoprotein(a), or Lp(a).
“This is a one-time test to measure Lp(a), which is a genetically determined level of cholesterol,” Dr. Kelly says. “Right now, medications can’t change it, but there are options being studied in clinical trials. High Lp(a) puts you at higher risk of heart attack and stroke, so you may need more aggressive LDL lowering.”
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Consider a statin, not a supplement.
You may eat well, exercise, maintain a healthy weight and still need to take medication for high cholesterol.
“Taking medication for cholesterol doesn’t necessarily mean you did anything wrong,” Dr. Kelly says. “You may just be genetically disposed to have higher LDL, but with that risk, we need to target for lower and lower LDL.”
Your doctor likely will prescribe a statin if you need to lower your cholesterol levels. The most common are atorvastatin (Lipitor) and rosuvastatin (Crestor), which work by inhibiting production of cholesterol in the liver.
If you need a statin, you probably will need it for the rest of your life, but long-term use is safe and rarely causes side effects, Dr. Kelly says.
“The most common side effect is muscle cramps, which happen to fewer than 5 percent of people,” he says. “If that happens, we can try a different dose or a different statin.”
Statins are commonly diagnosed for millions of people around the world; their ubiquity has made them a target for online misinformation.
“Right now, a lot of wellness influencers and podcasters profit from saying that statins aren’t safe or effective, and that’s not true,” Dr. Kelly says. “Because so many people use statins, it’s a big market for people selling supplements. Supplements for cholesterol don’t work.”
Talk to your doctor if you have concerns.
“Statins are effective and successfully lower cholesterol by 50 percent or more,” Dr. Kelly says. “Taking this medication reduces your risk of heart attack and stroke.”
Concerned about cholesterol? Talk to your doctor or find one near you.