Even if Your Cholesterol Is Normal, You Need to Monitor Your Heart Health

If your cholesterol levels are in the low-to-normal range, then you may think that you're safe from heart problems such as blocked arteries, heart attack and more. While having normal cholesterol is certainly good for your heart, there are other factors contributing to your overall heart health.

In fact, about half of people with normal cholesterol levels also have a dangerous level of plaque built up in their arteries, according to a December 2017 ​Journal of the American College of Cardiology​ study with more than 4,100 participants. This further reinforced the notion that people need to pay attention to more than just cholesterol when it comes to heart health.

​Read more:​ 4 Ways to Support Heart Health Post-COVID

One issue at play here, says Susan Besser, MD, a primary care and family medicine doctor with Mercy Personal Physicians in Overlea, Maryland, is that your total cholesterol number isn't the only number that matters.

"One can have normal total cholesterol but high 'bad' (LDL) cholesterol and low 'good' (HDL) cholesterol," she says. "The excess bad cholesterol can cause plaque buildup and, over time, might cause blocked arteries."

Inside the body, the low-density lipoprotein (LDL) cholesterol is the one that can build up on the walls of the blood vessels and form plaque, according to the Centers for Disease Control and Prevention. HDL cholesterol, on the other hand, is the one that can absorb harmful cholesterol and carry it to the liver, where it then gets flushed from the body. This is why it's not only important to have normal or low total cholesterol levels, but also healthy ranges of both HDL and LDL cholesterol.

A whole host of other factors can also lead to clogged arteries, heart attack and other heart problems, even with normal cholesterol or low cholesterol, per Harvard Health Publishing. Some common factors — such as lack of exercise and other physical activity, obesity, high blood pressure, smoking and diabetes — all might play a role. Even factors like secondhand smoke or other forms of air pollution might raise the risk of heart attack. It also appears that heart attack and other heart problems can run in families and be affected by genetic factors that are not yet fully understood.

Cholesterol is also not the only thing that can clog the arteries, says Patrick Fratellone, MD, an integrative cardiologist in practice in New York City. "The inner lining of the arteries can be attacked by many different microorganisms," he says. "This sets up the artery to get a buildup of plaque, which can be made up of cholesterol, platelets, calcium and much more."

If you have an above-average risk for heart disease or heart attack even with normal cholesterol or low cholesterol, medication might be appropriate, according to Harvard Health Publishing. A cholesterol-lowering statin is the primary medication used to reduce the risk for heart attack, even for people who don't necessarily have high cholesterol.

Of course, diet, exercise and other lifestyle factors also play a major role in keeping heart problems under control. Eating a healthy diet, maintaining a healthy weight, managing stress and quitting smoking are all key considerations.

"Make low-cholesterol choices and work on eating foods that contain good cholesterol," Dr. Besser says. "This will help raise good cholesterol, which is protective. Weight loss if you have overweight will also help lower your bad cholesterol. Lastly, add exercise, as that will also help raise good cholesterol."

​Read more:​ 97 High Cholesterol Statistics You Should Know