What are the biggest contributors to high cholesterol?

October 28, 2025 •

4 min read

According to the CDC, nearly 94 million U.S. adults aged 20 or older have high total cholesterol. This widespread condition, a major risk factor for heart disease, often has no symptoms, making it a silent threat. Taking control of your cardiovascular wellness begins with understanding what are the biggest contributors to high cholesterol, which encompass dietary choices, lifestyle habits, and genetics.

Quick Summary

An unhealthy diet high in saturated and trans fats, a sedentary lifestyle, genetics, and certain medical conditions are major contributors to high cholesterol, a key risk factor for heart disease and stroke.

Key Points

Dietary Fats: Consuming diets high in saturated and trans fats from sources like red meat and processed foods is a major cause of high LDL, or 'bad', cholesterol.
Lack of Exercise: A sedentary lifestyle contributes to lower levels of 'good' HDL cholesterol and higher levels of 'bad' LDL cholesterol.
Genetics: Familial hypercholesterolemia (FH) is an inherited condition that causes extremely high cholesterol levels from birth, requiring medication in addition to lifestyle changes.
Medical Conditions: Underlying health issues such as diabetes, obesity, hypothyroidism, and chronic kidney disease are linked to higher cholesterol levels.
Lifestyle Habits: Smoking, excessive alcohol consumption, and chronic stress are significant risk factors that negatively impact cholesterol and overall heart health.
Age and Gender: The risk of high cholesterol increases with age, and hormonal changes, particularly after menopause, can influence a woman's cholesterol levels.

Understanding Cholesterol: Good vs. Bad

Cholesterol is a waxy, fat-like substance that is essential for building healthy cells and producing hormones and vitamin D. Your liver produces all the cholesterol your body needs, but you also consume it through animal-based foods. Problems arise when there is an excess of cholesterol in the blood, particularly the "bad" low-density lipoprotein (LDL) cholesterol. Excess LDL can lead to the formation of plaque in your arteries, a condition known as atherosclerosis, which narrows the blood vessels and increases the risk of a heart attack or stroke. Conversely, high-density lipoprotein (HDL) or "good" cholesterol helps transport excess cholesterol from the arteries back to the liver for removal. The balance between these two types is critical for heart health. Various factors, both controllable and uncontrollable, can tip this balance and contribute to high cholesterol.

Dietary Choices: A Primary Driver

For most people, the most common and manageable cause of high cholesterol is an unhealthy diet. Consuming certain fats in excess can raise harmful LDL levels and lower beneficial HDL levels.

The Impact of Saturated and Trans Fats

Saturated Fats: Found in foods like fatty cuts of red meat, full-fat dairy products (butter, cheese), chocolate, and certain baked and processed foods. These fats directly reduce the liver's ability to remove cholesterol, leading to a buildup in the blood. Limiting red meat and opting for lean cuts or plant-based proteins can help manage cholesterol levels.
Trans Fats: These artificial fats, often found in fried and processed foods like pastries, cookies, and margarine, are particularly harmful. They are known to increase LDL cholesterol while simultaneously lowering HDL cholesterol, significantly elevating the risk of blocked arteries. The FDA has banned artificial trans fats, but some processed items may still contain trace amounts, so checking labels for "partially hydrogenated oil" is essential.

The Importance of Soluble Fiber and Healthy Fats

Conversely, a diet rich in certain nutrients can actively help lower cholesterol.

Soluble Fiber: This type of fiber binds to cholesterol and its precursors in the digestive system, preventing their absorption into the bloodstream. Excellent sources include oats, barley, beans, lentils, apples, and citrus fruits.
Healthy Unsaturated Fats: Replacing saturated fats with polyunsaturated and monounsaturated fats can significantly lower LDL levels. These are found in liquid vegetable oils (like olive, canola, and sunflower oil), avocados, nuts, and seeds.
Omega-3 Fatty Acids: Found in fatty fish such as salmon, mackerel, and sardines, omega-3s primarily help lower triglycerides, another type of blood fat, and may also increase HDL levels.

Lifestyle Factors and Their Impact

While diet plays a large role, daily habits have a powerful influence on cholesterol levels.

Lack of Physical Activity: A sedentary lifestyle is directly linked to higher LDL and lower HDL levels. Regular exercise, even moderate activities like brisk walking, can help increase HDL cholesterol and reduce LDL and triglyceride levels.
Smoking: This habit is extremely detrimental to heart health. Smoking damages the lining of blood vessels, making it easier for plaque to stick to artery walls. It also lowers HDL cholesterol, especially in women. Quitting smoking is one of the most effective ways to improve cholesterol and overall cardiovascular health.
Excess Alcohol Consumption: Drinking too much alcohol can raise total cholesterol and triglyceride levels. Moderating alcohol intake is recommended to protect your heart.
Chronic Stress: High levels of stress hormones, like cortisol, can indirectly increase cholesterol levels by influencing unhealthy coping behaviors, such as poor diet, smoking, and drinking. Implementing stress management techniques, like meditation or yoga, can be beneficial.

Genetic Predisposition and Medical Conditions

For some individuals, high cholesterol isn't primarily a result of lifestyle but is inherited or caused by other health issues.

Familial Hypercholesterolemia (FH): This is a genetic condition that causes very high LDL cholesterol levels from birth. People with FH have a faulty gene that prevents their body from properly clearing cholesterol from the blood. For these individuals, lifestyle changes are often not enough, and medication is necessary to manage the condition and prevent early heart disease.
Underlying Health Conditions: Several medical issues can contribute to high cholesterol, including:
- Type 2 Diabetes: Lowers HDL and increases LDL and triglycerides.
- Obesity: Linked to higher LDL and triglyceride levels and lower HDL.
- Hypothyroidism: An underactive thyroid can lead to elevated cholesterol.
- Chronic Kidney or Liver Disease: These conditions can affect how the body processes cholesterol.
Age and Gender: The liver becomes less efficient at removing LDL cholesterol with age, making high cholesterol more common over 40. Hormonal changes, particularly menopause in women, can also lead to increased LDL and decreased HDL levels.

Controllable vs. Uncontrollable Contributors to High Cholesterol


Category	Controllable Factors	Uncontrollable Factors
Diet	High intake of saturated and trans fats, low intake of fiber and healthy fats.	N/A
Lifestyle	Sedentary lifestyle, smoking, excessive alcohol consumption, chronic stress.	N/A
Genetics	N/A	Inherited conditions like Familial Hypercholesterolemia (FH).
Health Conditions	Obesity, Type 2 diabetes (can be managed with lifestyle changes).	Other diseases like hypothyroidism, chronic kidney disease.
Demographics	N/A	Age, sex, and family history.

Conclusion: Taking a Proactive Approach

High cholesterol is a multi-faceted health issue influenced by a combination of factors. While genetics and age are uncontrollable, the biggest contributors—poor diet and an unhealthy lifestyle—are well within your power to change. Adopting a heart-healthy diet rich in soluble fiber and unsaturated fats, getting regular exercise, and avoiding smoking and excessive alcohol are powerful steps toward lowering your cholesterol and reducing your risk of serious cardiovascular events. Regular monitoring through blood tests is also crucial, especially if you have a family history or other risk factors. By understanding these key drivers, you can work with your healthcare provider to create a comprehensive plan that protects your long-term heart health. For more detailed guidance, consult reliable health resources like the American Heart Association.

Frequently Asked Questions

LDL (low-density lipoprotein) is often called 'bad' cholesterol because it contributes to plaque buildup in arteries. HDL (high-density lipoprotein) is considered 'good' cholesterol because it helps remove excess cholesterol from the bloodstream and transport it to the liver for disposal.

Yes, chronic stress can indirectly contribute to high cholesterol. Elevated stress hormones like cortisol may influence your body's cholesterol production and can lead to unhealthy coping mechanisms like overeating fatty foods, smoking, or drinking too much alcohol.

Some people have a genetic condition called Familial Hypercholesterolemia (FH), which is inherited and causes very high LDL cholesterol levels from a young age. While a healthy lifestyle is important, those with FH often require medication to manage their cholesterol.

To help lower cholesterol, you should limit foods high in saturated fats, such as fatty red meats, full-fat dairy, and butter. Avoiding foods with artificial trans fats, often found in processed and fried snacks, is also critical.

Yes, regular physical activity is a powerful tool for managing cholesterol. It helps increase your level of 'good' HDL cholesterol while lowering 'bad' LDL cholesterol and triglycerides.

Conditions like type 2 diabetes and obesity can disrupt the balance of lipids in your blood. Diabetes can lower HDL and raise LDL and triglycerides, while obesity is linked to higher LDL and triglycerides and lower HDL.

As you age, your body's metabolism changes, and your liver becomes less efficient at removing 'bad' LDL cholesterol from the blood. For women, hormonal changes after menopause can also lead to higher cholesterol levels.