Cholesterol risks are more serious than social media influencers say
A growing number of self-styled ‘health experts’ are not taking cholesterol seriously. The messaging isn’t just misleading, it’s potentially life-threatening.
Scroll through social media and you’ll likely stumble across a “health influencer” tearing into a slab of red meat while confidently claiming cardiologists have it all wrong about the risks of high cholesterol.
But as a cardiologist and a cardiac researcher in vascular biology, I can tell you this messaging isn’t just misleading, it’s potentially life-threatening.
Throughout my career I’ve seen the consequences of high cholesterol, from heart attacks and strokes to bypass surgeries and stents and more.
And yet a growing number of self-styled “health experts” are claiming high cholesterol is misunderstood and even harmless.
So why are so many people not taking cholesterol seriously?
Much of it comes from misunderstanding what cholesterol is. Cholesterol is essential – it’s made by the liver and helps build healthy cells, produce hormones, and digest fats.
But not all cholesterol behaves the same way. High levels of HDL (“good”) cholesterol protect the heart, while too much LDL (“bad”) cholesterol can cause fatty deposits to build up in the arteries. Like blood pressure or blood sugar, it’s all about balance – the right kind, in the right amount, at the right level.
What are the different types of cholesterol?
In clinical practice, cholesterol is broken down into several broad types: HDL cholesterol, LDL cholesterol, and triglycerides. Your total cholesterol level is calculated by adding your HDL cholesterol level, LDL cholesterol level and 20 per cent of your triglyceride level.
High-density lipoprotein (HDL) picks up excess cholesterol and takes it back to the liver. Having high HDL is linked to lower risk of heart disease, heart attack, and stroke.
Low-density lipoprotein (LDL) carries cholesterol particles throughout your body but when your levels are too high it builds up in the walls of your arteries, making them hard and narrow which can increase the risk of a heart attack and stroke.
Triglycerides are the most common type of fat found in the body and provide the body with energy, but high levels also increase the risk of heart disease.
There is also a lesser-known cholesterol-carrying particle called Lipoprotein (a) or Lp (a), which unlike LDL and HDL cholesterol is primarily influenced by your genetics rather than lifestyle factors such as diet and exercise.
Lp (a) is not currently part of a standard cholesterol testing in Australia but that is likely to change in the future.
Total cholesterol – HDL cholesterol, LDL cholesterol, triglycerides, and Lp (a) – are the core and commonly measured components of what is referred to as your lipid profile, which determines your cardiovascular risk.
The ideal scenario? Higher HDL; lower Lp (a), LDL and triglycerides; and total cholesterol within the normal range.
What are the harms of high LDL or total cholesterol levels?
Some advocates for diets high in saturated fats – like the carnivore and keto diets – argue high cholesterol doesn’t increase your risk of heart disease. They point to other changes seen with these diets – such as reduced inflammation, weight loss, and better blood sugar control – as benefits that supposedly offset any rise in cholesterol.
Many are also convinced that studies dating back decades are flawed and part of a conspiracy perpetuating a narrative that cholesterol is dangerous.
But the evidence tells a very different story.
A 2022 meta-analysis involving more than one million people found that those with higher total cholesterol had a 27 per cent greater risk of dying from cardiovascular disease, while those with higher LDL had a 21 per cent greater risk.
Conversely, people with higher HDL levels were 40 per cent less likely to die from cardiovascular causes.
In simple terms: when LDL and total cholesterol are too high, fatty plaques accumulate in the arteries, narrowing them and increasing the risk of heart attacks and strokes.
How do the foods we eat impact cholesterol levels?
While your liver produces most of your cholesterol, diet still plays a crucial role. It’s not so much about cholesterol-rich foods – eggs, for instance – but the types of fat you eat that plays a major role in blood cholesterol levels.
Unsaturated fats, also known as healthy fats, can help increase levels of HDL good cholesterol. These fats are found in foods such as fatty fish, nuts, olive oil, seeds and avocado.
Saturated fats, on the other hand, found in red and processed meats, butter, cheese, and many processed foods, can raise LDL cholesterol when consumed in excess.
It’s therefore important to eat these foods in moderation, no more than three red meat meals per week. Instead, aim for variety – plenty of fish, white meats such as chicken or turkey, or high-fibre plant-based proteins such as legumes.
Soluble fibre is another key player. It binds cholesterol in the gut and helps remove it from the body. That’s why diets that cut out plant foods can raise cholesterol levels over time.
Foods high in soluble fibre include certain fruits and vegetables, legumes, nuts, seeds, oats, barley, brown rice and psyllium husk.
What treatment options are available to manage high cholesterol?
Lifestyle changes and moving toward a healthier way of living are always the first “prescription” for my patients who have a lipid profile outside the healthy range. This may include high total cholesterol, high LDL cholesterol and/or high triglyceride levels.
That means adopting a healthy diet – preferably the Mediterranean diet, the gold standard for heart health – as well as regular exercise, weight loss where needed, reducing alcohol intake, quitting smoking, getting adequate sleep, and managing stress.
But for many people, whether due to genetics, other conditions, or simply the difficulty of sustaining major behaviour change, medications are essential. And one of the most important medications we have at our disposal for managing cholesterol and heart disease risk are statins.
While some people are wary of going on statins, often because of misinformation they have heard online or fear of side effects, statins have a strong safety profile, and their benefits far outweigh their risks.
A 2022 meta-analysis found that statins reduced the relative risk of heart attacks by around 33 per cent and deaths by around 8 per cent. This equates to one heart attack prevented for every 118 people taking a statin. While this absolute risk reduction may seem small, when millions of people take them, it adds up to thousands of lives saved and many more heart attacks prevented.
There are also newer alternatives on the market, drugs like evolocumab and inclisiran, which work by stopping the PCSK9 protein in the liver breaking down LDL receptors, which ensures more receptors are able to work effectively to reduce your LDL cholesterol.
These medications are given as injections, ranging in frequency from every two weeks to twice a year, and are only available on the PBS (ie, at a subsidised cost) to limited patients with specific conditions.
However, it’s expected they will eventually become more accessible to a broader range of patients and could, one day, replace statins as the go-to for cholesterol management.
The take-home message
Cholesterol is a vital part of life – but it can become deadly when out of balance.
The evidence is clear: high cholesterol remains one of the most important and modifiable risk factors for heart disease, and one of Australia’s leading causes of death.
So make sure you get your cholesterol levels regularly tested, go easy on butter and red meats, and eat as many healthy fats as you can – along with plenty of fibre.
Your heart will thank you for it.
Professor Jason Kovacic is the chief executive and director of the Victor Chang Cardiac Research Institute.
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
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