There’s nothing more perplexing when it comes to heart health than cholesterol. On the one hand, some cholesterol is beneficial. On the other, high levels have been linked with heart disease. But at least we know that “HDL” cholesterol is good and “LDL” is bad, right? Nope, stop right there! Be prepared to question everything you think you know about cholesterol based on 2022 research. We break down data from dozens of 2022 studies, so be sure to read the whole post.
Disclaimer: This post is for informational purposes only and is not meant to provide medical advice. Please talk to your doctor about your health concerns and consult them before taking any supplements or making changes to your regime.
How Does Cholesterol Work?
Cholesterol is a fat-like substance and a vital nutrient. Your body needs cholesterol to make hormones, vitamins, cells, and digestive juices (Craig et al., 2022).
If you’re just learning about cholesterol, read this post first:
Cholesterol travels through your blood assembled into spherical lipoproteins. HDL and LDL cholesterol are types of lipoproteins.
LDL transports cholesterol from your liver to your tissues. HDL picks up cholesterol from your peripheral tissues and sends it back to your liver (Elshourbagy et al., 2013).
About a third of your total cholesterol comes from diet and the rest is made in your body—mainly in your liver. Animal foods contain cholesterol in varying amounts, while plants only contain phytosterols (Kapourchali et al., 2016).
Cholesterol helps your body make vitamins and hormones. Most of it is made it your liver and the rest comes from food.
Cholesterol & Your Health
The impacts of cholesterol on your health will depend on:
- The type of cholesterol and its levels
- Your age, sex, and race
- Your genetics
- Your overall health and lifestyle
- Other individual factors
What Raises Cholesterol?
The following factors may raise cholesterol levels (NHS):
- Unhealthy lifestyle
- Diet high in processed foods
- Being overweight
- Older age
- Certain medications and supplements
- Other health conditions
What is Considered Dangerously High Cholesterol?
- > 240 mg/dL for total cholesterol, and
- > 190 mg/dL for LDL cholesterol
Go to this post to see the chart with normal ranges for all lipids.
Is Some Cholesterol Good for You?
Health effects of HDL
HDL is usually considered the “good” type of cholesterol. HDL can pick up extra cholesterol in your tissues and transport it back to your liver. It’s also anti-inflammatory and may protect your blood vessels (Elshourbagy et al., 2013).
Slightly higher HDL levels have been linked with lower rates of heart disease. Similarly, low HDL seems to be a risk factor for atherosclerosis or hardening of the arteries (Elshourbagy et al., 2013).
Health effects of LDL
LDL is typically seen as the “bad” type of cholesterol. Over decades of research, scientists kept seeing a link between high LDL levels and heart attacks and atherosclerosis. It seemed like LDL was fueling free radical damage and inflammation in the body, causing various heart disease complications (Mattiuzzi et al., 2020).
Despite the roles that HDL and LDL are said to have, therapies aimed at raising HDL cholesterol failed to live up to their expectations (Kingwell et al., 2014).
Similarly, medications that target to aggressively lower LDL failed to reduce the burden and death toll from heart disease (DuBroff & de Lorgeril, 2015).
What did scientists get wrong?
HDL cholesterol is said to be “good” and LDL cholesterol is viewed as “bad,” but this doesn’t always hold true.
What are the new findings about cholesterol?
New data put into question everything we thought we knew about cholesterol.
For years, scientists have been observing inconsistencies in the cholesterol theory.
This theory says that high cholesterol intake is bad for heart health and that everyone should aim to get their cholesterol down as low as possible.
Scientists now argue that this theory is based on flawed reasoning—we need to look at cholesterol through a different lens! (DuBroff & de Lorgeril, 2015)
No good evidence for causation
First off, findings that suggest increased heart disease risk were based on associations. There was no evidence of causation (DuBroff & de Lorgeril, 2015).
For example, just because people with high cholesterol are more likely to have heart disease doesn’t mean that high cholesterol caused their heart problems.
Low LDL and total cholesterol just as dangerous
Even when looking at associations, studies show that low LDL and low total cholesterol levels are just as (if not more) dangerous as high levels in the general population (Yi et al., 2019; Johannesen et al., 2020).
The truth about cholesterol 2022
The new truth about cholesterol is emerging from 2022 research.
In one study, both very low and very high LDL levels were associated with increased risks of dying from heart disease. Very low LDL levels were also linked with a greater chance of dying from stroke or any cause (Rong et al., 2022).
The authors warn that we must rethink the optimal range of LDL cholesterol.
HDL: “the good gone bad”
Even the protective role of “good” HDL cholesterol is under question.
People with very high levels seem to have a greater risk of mortality—suggesting that very high HDL is “the good gone bad” (Khan & Fonarow, 2022).
In a 2022 study, very high HDL cholesterol levels were linked with an increased risk of dying from any cause or from heart disease among men (but not among women) (Liu et al., 2022).
Another study voiced the same findings among both sexes in a high-risk cohort with heart disease (Liu et al., 2022).
Experts may need to determine an upper cutoff for normal HDL levels.
Both very high HDL levels and very low LDL levels have been associated with a greater risk of dying from any cause.
Race plays in
The first studies on cholesterol and heart disease only included White adults.
A 2022 US study of over 30k people revealed that low HDL cholesterol levels were linked with a higher risk of heart attacks in White but not in Black adults. Yet, higher HDL levels didn’t protect either group from cardiovascular disease (Zakai et al., 2022).
More research among different ethnicities is needed.
The eggs & cholesterol dilemma
Egg yolks pack cholesterol along with many key nutrients (including choline and vitamins K2, D, and B12) (DiBella et al., 2020).
Several 2022 studies found that diets high in eggs may increase cholesterol and reduce lifespan, while others found no association (Mofrad et al., 2022; Zhao et al., 2022; Mousavi et al., 2022; Pan et al., 2022).
A 2022 analysis claims that the conflicting findings come from differences in cholesterol absorption from one person to another. Some people absorb high amounts of cholesterol from food and will not do well on a diet high in eggs and other animal foods. Others absorb tiny amounts of cholesterol and won’t experience adverse effects on a high-cholesterol diet (Schade et al., 2022).
If you’re not sure which group you belong to, experts agree that one egg per day is still a safe choice for most people.
Learn how your body absorbs and uses cholesterol in this post.
Benefits of statins modest and uncertain
A 2022 meta-analysis revealed that statins reduce the risk of heart attacks, stroke, and dying from any cause “modestly” and “uncertainly” (Byrne at el., 2022).
Statins reduced the absolute risk by 0.4-1.3%—an effect that wasn’t linked to clinically meaningful outcomes (Byrne at el., 2022).
The authors urge clinicians to discuss these findings when making informed decisions with individual patients.
The Bottom Line: Is Cholesterol Good or Bad?
It’s easy to think of cholesterol as either good or bad. Yet, new research reveals a much more nuanced truth: the health effects of cholesterol depend on factors like age, race, sex, diet, and genetics.
Even very high “good” HDL cholesterol can be harmful. Lowering “bad” LDL cholesterol with drugs won’t be beneficial for everyone. Meanwhile, eating eggs will raise cholesterol in some people and not in others.
The bottom line is that we need an individualized approach and updated guidelines on optimal HDL, LDL, and total cholesterol levels.
If you’re unsure how to interpret your levels or how to start improving your health today, consult your healthcare provider.
And if you found useful information in this post, please share!
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Ana Aleksic, MSc Pharm
Ana is an integrative pharmacist and scientist with many years of medical writing, clinical research, and health advising experience. She loves communicating science and empowering people to achieve their optimal health. Ana has edited 800+ and written 150+ posts, some of which reached over 1 million people. Her specialties are natural remedies, women’s health, and mental health. She is also a birth doula and a strong advocate of bridging scientific knowledge with holistic medicine.