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Good vs Bad Cholesterol: How to Keep Your Heart Healthy
- Dr Joseph Nightingale
- 3 days ago
- 6 min read
Cholesterol is widely regarded as bad for you. Most people, if told they have ‘high cholesterol,’ would worry about it, looking up healthy foods for heart health. High cholesterol can be bad for you, but it depends on the type of cholesterol.
Cholesterol isn’t all bad. There are two main types: ‘good’ HDL cholesterol and ‘bad’ LDL cholesterol. One of them helps prevent heart disease, the other increases the risk.
Understanding this difference is crucial to eating the right foods, minimising damage to your blood vessels, and lowering your risk of a heart attack.
In this article we'll explore:
Understanding the Difference Between HDL and LDL
Cholesterol is a fatty substance carried through the blood inside particles called lipoproteins. It isn’t inherently bad. Our bodies use it to make certain hormones and vitamin D and to support cell membranes.
Not all cholesterol is the same. There are two main types:
LDL cholesterol: Often called “bad” cholesterol because high levels can contribute to fatty deposits building up inside your arteries, increasing your risk of heart disease and stroke.
HDL cholesterol: Often called “good” cholesterol because it helps carry excess cholesterol away from your arteries and back to the liver, where it can be broken down and removed.
HDL doesn’t eliminate all LDL on its own. Only a fraction of blood cholesterol is carried by HDL, but it can play a beneficial role.
What Causes High Cholesterol
When a doctor talks about ‘high cholesterol,’ they may mean that your total cholesterol, non-HDL cholesterol, or LDL cholesterol is too high. LDL makes up most non-HDL cholesterol and is one of the main levels we want to reduce.
Known as hypercholesterolaemia, it’s caused by:
A diet high in saturated and trans fats
Being overweight or obese
Lack of physical activity
Smoking
Excessive alcohol consumption
Genetics, including familial hypercholesterolaemia
Getting older and menopause
Diabetes, an underactive thyroid, kidney disease, or liver disease
Certain medicines, including steroids, some diuretics, and immunosuppressants
Not all cases of high cholesterol levels are within a person's control. Some people genetically have higher levels than others. But in most cases, lifestyle factors play a central role. For example, a 2021 study revealed that lower levels of physical activity increased LDL levels.
The Health Risks of High LDL Cholesterol
Persistently high LDL cholesterol is a significant risk factor for heart disease. LDL cholesterol can build up in the walls of your arteries, contributing to the formation of plaques. Gradually, these plaques cause the arteries to become narrower and stiffer, restricting the flow of blood and oxygen around your body.
Plaques in the coronary arteries can cause chest pain known as angina. The pain occurs because the heart muscle doesn’t receive enough oxygen-rich blood.
A plaque can eventually rupture, triggering the formation of a blood clot. If the clot blocks an artery supplying the heart, it can cause a heart attack (myocardial infarction). If it blocks blood flow to the brain, it can cause an ischaemic stroke.
Atherosclerosis can develop in arteries throughout the body. Other potential consequences include:
Peripheral arterial disease: Reduced blood flow to the legs can cause pain when walking, numbness, slow-healing wounds, and, in severe cases, tissue damage.
Transient ischaemic attacks: Sometimes called “mini-strokes,” these occur when the blood supply to part of the brain is temporarily interrupted.
Renal artery disease: Narrowing of the arteries supplying the kidneys can contribute to high blood pressure and kidney damage.
Mesenteric ischaemia: Reduced blood flow to the intestines can cause abdominal pain, particularly after eating, and may damage the bowel.
Reducing LDL cholesterol levels can reduce your risk of these complications. One meta-analysis of 170,000 participants taking statins found that each 1 mmol/L reduction in LDL cholesterol reduces the relative risk of a major vascular event (heart attacks, strokes, etc.) by around 22%. Any reduction can be beneficial.
How to Check Your Cholesterol Levels
Checking your cholesterol levels is as simple as a blood test. Your doctor can request a blood test, looking at your results to determine if you need medication or lifestyle changes.
But you don’t have to see your GP to get tested.
Health Klinix offers quick, reliable cholesterol testing. Just book the appointment online or over the phone, visit our clinic, and receive your results by email. We will also send a copy to your doctor if you wish, so they can manage your care. If necessary, we can offer further testing or lifestyle advice.
How to Increase Good (HDL) and Lower Bad (LDL) Cholesterol
High cholesterol can often be improved without medication. Lifestyle changes can minimise the contributing risk factors and lower your cholesterol naturally, although some people will still need treatment.
Some effective ways to lower LDL cholesterol include:
Replace saturated fats with unsaturated fats
Eat more soluble fibre, including oats, beans, lentils, fruit, and vegetables
Maintain a healthy weight
Stop smoking
Limit alcohol
Take cholesterol-lowering medication if prescribed
Most advice focuses on reducing bad cholesterol. However, a few sensible changes can also help raise your good cholesterol levels. Some of these overlap.
Try these changes:
Get regular aerobic exercise
Lose excess weight, particularly around the waist
Stop smoking
Choose unsaturated fats, such as olive oil, nuts, seeds, and oily fish
Reduce refined carbohydrates and heavily processed foods
Keep conditions such as diabetes well controlled
Cholesterol Lowering Foods to Eat
Eating a healthy, balanced diet is one of the best approaches to lowering cholesterol levels. A few specific foods can have a stronger overall effect, especially soluble fibre, unsaturated fats, and plant sterols.
Grains like oats and barley can reduce LDL cholesterol levels. Barley, in particular, reduced LDL levels by an average of 0.25 mmol/L after around four weeks in a review of 14 clinical trials.
Beans, lentils, chickpeas, and peas are also rich in soluble fibre. A review of 26 trials found that eating roughly one serving, or 130 g, each day reduced LDL cholesterol by an average of 0.17 mmol/L.
Nuts are another sensible addition. They contain fibre and unsaturated fats, giving you a natural alternative to foods high in saturated fats. A pooled analysis of 25 trials found that eating an average of 67 g of nuts daily - roughly 16-17 whole shelled walnuts - reduces LDL cholesterol by 7.4%.
You don’t have to include all of these factors in a single day. But adding these foods alongside other broader dietary changes can help lower your LDL cholesterol levels further.
Medications to Manage Cholesterol Levels
If your cholesterol level does not go down after changing your diet and lifestyle, you might need medication. Even if your levels decrease, if you’re still at high risk of a heart attack or stroke, your doctor may recommend cholesterol-lowering medications.
Statins
Statins are the most common medicine to lower cholesterol levels. You will take one tablet per day, usually for life. All statins end in the suffix -statin, so they’re easy to identify. For example, atorvastatin, pravastatin, simvastatin.
Statins are generally well-tolerated; however, some people can experience headaches, dizziness, muscle pain, sleep problems, or digestive difficulties. In rare cases, people may experience extreme muscle pain. It’s crucial to seek immediate medical attention if this happens.
Other Medicines
If statins do not lower your cholesterol enough, or you cannot take them, your doctor may recommend another treatment. Options include:
Other tablets: Ezetimibe may be taken alone or added to a statin. Bempedoic acid may be combined with ezetimibe in certain people who cannot take statins.
Injectable treatments: Specialist options include alirocumab, evolocumab, and inclisiran.
Keeping Your Heart Healthy
High cholesterol levels often occur long before you notice any symptoms. The earlier you can bring levels down, the lower the risk to your health. You might not notice any immediate changes in your daily life. But it can mean you stay healthier, fitter, and more active for longer. That starts with a simple cholesterol test.
Health Klinix offers an affordable, private option to get tested quickly. Once you know your level, you can then change your lifestyle, add in exercise, or eat a more balanced diet, and get rechecked several months later to monitor your progress.
Book your cholesterol test today and take control of your health.
References
Perrone, M.A. et al. (2021). The Effects of Reduced Physical Activity on the Lipid Profile in Patients with High Cardiovascular Risk During COVID-19 Lockdown. International Journal of Environmental Research and Public Health, 18(16), 8858.
Cholesterol Treatment Trialists’ Collaboration (2010). Efficacy and Safety of More Intensive Lowering of LDL Cholesterol: A Meta-Analysis of Data from 170,000 Participants in 26 Randomised Trials. The Lancet, 376(9753), 1670–1681.
Ho, H.V.T. et al. (2016). A Systematic Review and Meta-Analysis of Randomised Controlled Trials of the Effect of Barley β-Glucan on LDL-C, Non-HDL-C and ApoB. European Journal of Clinical Nutrition, 70(11), 1239–1245.
Ha, V. et al. (2014). Effect of Dietary Pulse Intake on Established Therapeutic Lipid Targets for Cardiovascular Risk Reduction. CMAJ, 186(8), E252–E262.
Sabaté, J., Oda, K. and Ros, E. (2010). Nut Consumption and Blood Lipid Levels: A Pooled Analysis of 25 Intervention Trials. Archives of Internal Medicine, 170(9), 821–827.
NHS (2026). Medicines for High Cholesterol. Last reviewed 13 March 2026.
Written by:
Dr Joseph Nightingale, MBBS, MSc
Approved by:
Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
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