{"id":32177,"date":"2026-09-18T08:20:34","date_gmt":"2026-09-18T06:20:34","guid":{"rendered":"https:\/\/test.nefrocenter.it\/high-cholesterol-what-to-do\/"},"modified":"2026-09-18T08:20:34","modified_gmt":"2026-09-18T06:20:34","slug":"high-cholesterol-what-to-do","status":"publish","type":"post","link":"https:\/\/test.nefrocenter.it\/en\/high-cholesterol-what-to-do\/","title":{"rendered":"High cholesterol: what to do"},"content":{"rendered":"

High cholesterol: normal LDL and HDL values, causes, symptoms and how to lower it with diet<\/h2>\n

High cholesterol<\/strong> is one of the best-known cardiovascular risk factors, but also one of the most misunderstood. All it takes is picking up your blood test results and finding a value highlighted in red for questions and worries to arise: what should my cholesterol be? What is the difference between LDL and HDL? Does having total cholesterol above 200 mean being ill? Is it possible to lower it with diet? And what is the relationship between high cholesterol, triglycerides and kidney health?<\/p>\n

The first thing to know is that cholesterol is not, in itself, an enemy of the body. It is a lipid substance that is essential for numerous biological functions. The problem arises when some of the lipoproteins that carry it in the blood, especially LDL<\/strong>, reach excessive concentrations and, over time, promote the buildup of lipids in the artery wall.<\/p>\n

This is a process that can go on for years without causing any symptoms. High cholesterol, in fact, does not cause symptoms in most cases<\/strong> and is found through a simple blood test that can be done at the laboratories<\/a> of the Nefrocenter<\/a> Group.<\/p>\n

It is precisely this characteristic that makes checkups especially important. You should not wait until you feel unwell to find out your lipid profile: measuring total cholesterol, LDL, HDL and triglycerides provides information that, interpreted together with other factors such as age, blood pressure, smoking, diabetes and kidney function, helps the doctor estimate your overall cardiovascular risk.<\/p>\n

And today we know that talking about cholesterol means talking about more than just the heart. The cardiovascular system, metabolism and the kidneys are closely connected<\/strong>, so much so that chronic kidney disease<\/a> is one of the conditions to consider when assessing the risk associated with lipid abnormalities.<\/p>\n

What cholesterol is and why our body needs it<\/h2>\n

When we talk about cholesterol, we tend to immediately think of something to get rid of. In reality, our body needs it.<\/p>\n

Cholesterol is part of the structure of cell membranes and is involved in the production of steroid hormones, vitamin D and bile acids. Some of it comes in through food, while a significant share is produced by the body itself, mainly by the liver.<\/p>\n

Because it is a lipid substance, cholesterol cannot circulate freely in the blood, which is made up mostly of water. To be transported it uses particles called lipoproteins<\/strong>.<\/p>\n

And this is where the abbreviations we find on our test report come into play: above all LDL and HDL<\/strong>.<\/p>\n

Simply saying “my cholesterol is 220” therefore gives incomplete information. To really understand the lipid profile you need to know how much of that cholesterol is carried by LDL, how much by HDL, and what the triglyceride level is<\/strong>.<\/p>\n

LDL and HDL cholesterol<\/h2>\n

LDL stands for Low Density Lipoprotein<\/em>. LDL carries cholesterol in the blood to the tissues.<\/p>\n

When present in excessive amounts, it promotes the deposit of cholesterol in the artery wall and takes part in the process that leads to atherosclerosis<\/strong>. For this reason LDL cholesterol is commonly called “bad cholesterol”<\/strong>.<\/p>\n

The progressive buildup of fatty and inflammatory material can contribute to the formation of atherosclerotic plaques. Over time the arteries can narrow and the risk of cardiovascular events, such as heart attack and stroke, increases.<\/p>\n

HDL, High Density Lipoprotein<\/em>, has a different function. It takes part in carrying cholesterol from the tissues back to the liver, where it can be reprocessed and eliminated. This is why it is called, in simplified terms, “good cholesterol”<\/strong>.<\/p>\n

This definition is useful for explaining the concept, but it should not cause a misunderstanding: having high HDL does not automatically cancel out the risk from LDL that is too high<\/strong>. Modern cardiovascular prevention guidelines in fact focus mainly on lowering LDL cholesterol as the treatment goal, while HDL is interpreted within the overall risk profile and is not, on its own, a treatment target.<\/p>\n

Cholesterol: what are the normal values?<\/h2>\n

This is probably the most frequent question: what should my cholesterol be?<\/strong><\/p>\n

For many years the idea spread that it was enough to check whether total cholesterol was below 200 mg\/dL. Today the interpretation is much more personalized.<\/p>\n

There is in fact no single ideal LDL value for everyone.<\/p>\n

European recommendations set different LDL goals according to overall cardiovascular risk<\/strong>. The 2025 ESC\/EAS update kept the LDL goals of the previous guidelines, confirming that the intensity of the reduction must be proportionate to the level of individual risk.<\/p>\n

A guideline table can help in understanding the meaning of the main parameters:<\/p>\n

\n
\n\n\n\n\n\n\n\n\n\n\n\n
Parameter<\/th>\nIndicative value\/goal<\/th>\n<\/tr>\n<\/thead>\n
Total cholesterol<\/strong><\/td>\ngenerally desirable < 200 mg\/dL<\/td>\n<\/tr>\n
LDL \u2013 low cardiovascular risk<\/strong><\/td>\ngoal < 116 mg\/dL<\/td>\n<\/tr>\n
LDL \u2013 moderate risk<\/strong><\/td>\ngoal < 100 mg\/dL<\/td>\n<\/tr>\n
LDL \u2013 high risk<\/strong><\/td>\ngoal < 70 mg\/dL and a significant reduction from the starting value<\/td>\n<\/tr>\n
LDL \u2013 very high risk<\/strong><\/td>\ngoal < 55 mg\/dL and a significant reduction from the starting value<\/td>\n<\/tr>\n
HDL<\/strong><\/td>\nhigher values are generally associated with a more favorable profile, but are not a treatment goal on their own<\/td>\n<\/tr>\n
Triglycerides<\/strong><\/td>\ngenerally considered desirable < 150 mg\/dL when fasting<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n

These numbers should not be used to self-diagnose or to change a treatment on your own<\/strong>.<\/p>\n

A young person with no diabetes, no hypertension and no other conditions may have a different goal from someone who has already had a heart attack or a stroke, or who has diabetes, atherosclerosis or chronic kidney disease.<\/p>\n

It is therefore more correct to ask not just “what is my cholesterol?”<\/strong>, but above all “what is the right LDL value for my level of risk?”<\/strong><\/p>\n

High total cholesterol but high HDL: should you be concerned?<\/h2>\n

This is a fairly common situation.<\/p>\n

A person may have apparently high total cholesterol partly because they have a significant share of HDL. For this reason the total value should not be interpreted in isolation.<\/p>\n

The doctor looks at the whole lipid profile and relates it to the other risk factors.<\/p>\n

Likewise, total cholesterol that does not seem particularly high does not automatically guarantee a low risk if the person has LDL above their target, diabetes, hypertension, smoking, kidney disease or a cardiovascular history.<\/p>\n

The report, in other words, is not a report card where you only need to check which values are in red<\/strong>. It is a set of information that takes on meaning in the person’s clinical context.<\/p>\n

High cholesterol: the causes<\/h2>\n

In most cases there is not just one cause.<\/p>\n

The cholesterol level is the result of the interaction between genetics, diet, metabolism, physical activity, body weight, age, any medical conditions and medications<\/strong>.<\/p>\n

A diet rich in saturated fat can promote an increase in LDL. A sedentary lifestyle, overweight and obesity can also contribute to a less favorable metabolic profile. Smoking is associated with negative changes in the lipid profile and increases cardiovascular risk independently of cholesterol.<\/p>\n

There is also a very important genetic component.<\/p>\n

In some people the liver is less able to remove LDL from the circulation because of inherited alterations. The best-known case is familial hypercholesterolemia<\/strong>, a genetic condition that can cause very high LDL values from a young age and increase the risk of early cardiovascular events.<\/p>\n

That is why knowing your family history is important. Heart attacks or strokes at a relatively young age, or very high cholesterol values in several family members, should be reported to your doctor.<\/p>\n

There are also medical conditions that can change the lipid profile, including diabetes, hypothyroidism, obesity and chronic kidney disease<\/strong>. Some medications can also interfere with cholesterol and triglyceride levels.<\/p>\n

In these cases, simply changing your diet without investigating the cause may not be enough.<\/p>\n

Does high cholesterol cause symptoms?<\/h2>\n

In the vast majority of cases, no<\/strong>.<\/p>\n

And this is one of the most insidious aspects of hypercholesterolemia.<\/p>\n

It is not correct to automatically attribute headaches, fatigue, dizziness or other nonspecific symptoms to high cholesterol. You can have very high LDL and feel perfectly well.<\/p>\n

The problem is what can happen over time.<\/p>\n

If an excess of atherogenic lipoproteins contributes to the formation and progression of atherosclerosis, the manifestations may appear when the vascular disease is already significant, for example in the form of angina, heart attack, stroke or peripheral artery disease.<\/p>\n

In inherited forms characterized by extremely high levels, physical signs may appear such as xanthomas<\/strong>, that is, fatty deposits in the skin or tendons, or a whitish ring around the cornea. These are, however, special situations and are not the usual way hypercholesterolemia is discovered.<\/p>\n

The practical rule is simple: high cholesterol is found with blood tests, not by waiting for a symptom<\/strong>.<\/p>\n

High triglycerides and cholesterol: they are not the same thing<\/h2>\n

Cholesterol and triglycerides both belong to the large family of lipids, but they have different functions.<\/p>\n

Triglycerides<\/strong> are one of the main forms in which the body stores energy. When we take in more energy than we use, part of it can be converted and stored in the form of triglycerides.<\/p>\n

Their levels can increase in the presence of overweight, obesity, poorly controlled diabetes, excessive alcohol consumption, a high intake of sugars and refined carbohydrates, and in certain genetic or metabolic conditions.<\/p>\n

The combination of high triglycerides, high LDL and low HDL<\/strong> can outline a particularly unfavorable profile from a metabolic and cardiovascular standpoint.<\/p>\n

Very high triglyceride values also deserve a specific medical evaluation for risks other than atherosclerosis.<\/p>\n

For this reason the checkup should include the whole lipid profile<\/strong>, not just total cholesterol.<\/p>\n

High cholesterol and the kidneys: a link not to be underestimated<\/h2>\n

For a patient with chronic kidney disease (CKD)<\/strong>, the discussion about cholesterol takes on even greater importance.<\/p>\n

The heart and kidneys do not work as independent systems. Blood pressure, metabolism, diabetes, inflammation, vascular function and kidney function are closely interconnected.<\/p>\n

Chronic kidney disease is associated with an increased cardiovascular risk<\/strong> and can come with complex alterations of lipid metabolism. It is not simply a matter of having “more cholesterol”: as kidney function progressively declines, the composition and metabolism of lipoproteins can also change.<\/p>\n

It is therefore inaccurate to say that the kidneys “filter cholesterol” in the same way they filter other substances from the blood. The relationship is more complex: kidney disease changes lipoprotein metabolism and, at the same time, cardiovascular risk becomes a central part of the management of the kidney patient.<\/p>\n

The KDIGO guidelines in fact devote specific recommendations to the management of dyslipidemia in people with chronic kidney disease, also distinguishing between different clinical conditions, including patients not on dialysis, dialysis patients and transplant recipients.<\/p>\n

Cholesterol and chronic kidney disease<\/h3>\n

In a patient with CKD, evaluating the lipid profile is therefore not only about establishing whether a number is high or low. It must be placed within the broader assessment of cardiovascular and cardio-renal risk<\/strong>.<\/p>\n

This applies especially when reduced kidney function is accompanied by diabetes, hypertension, obesity, advanced age or a previous cardiovascular disease.<\/p>\n

It is another reason why the kidney patient should not rely on do-it-yourself diets or change any treatment on their own.<\/p>\n

Cholesterol and dialysis<\/h3>\n

In dialysis patients too, lipid metabolism has specific characteristics. The evaluation must take into account the stage of the disease, cardiovascular conditions, nutritional status and the treatments already under way.<\/p>\n

In this population, moreover, the simplistic equation that “the lower the cholesterol, the better” does not necessarily hold without considering the overall picture. Malnutrition and inflammation can change lipid parameters and how they are interpreted.<\/p>\n

Management must therefore be nephrological and personalized<\/strong>, especially before starting, stopping or changing a drug treatment.<\/p>\n

How to lower cholesterol with diet<\/h2>\n

Modern nutrition research encourages us to consider the overall dietary pattern<\/strong>, rather than focusing all our attention on eliminating a single food.<\/p>\n

One of the most important measures is to reduce excess saturated fat and replace it, where possible, with unsaturated fat<\/strong>. Saturated fats are found mainly in butter, cream, fatty cheeses, some cuts of meat, cured meats and many industrial products; tropical oils such as coconut and palm also contain significant amounts. A high intake of them can raise LDL cholesterol.<\/p>\n

This does not mean living on “fat-free” foods.<\/p>\n

Extra virgin olive oil, nuts and fish, included in appropriate amounts within a balanced diet, provide mainly unsaturated fats and can be part of an eating pattern aimed at cardiovascular prevention.<\/p>\n

The most recent nutrition guidelines also favor vegetables, fruit, legumes, whole grains, tree nuts and healthy protein sources<\/strong>, limiting ultra-processed foods, excess added sugars and saturated fat.<\/p>\n

Fiber is important<\/h2>\n

An interesting role is played by fiber, especially the soluble fiber found, for example, in oats, barley, legumes, fruit and some vegetables.<\/p>\n

A diet rich in plant foods does not act only on cholesterol. It can help control weight, blood glucose<\/a>, blood pressure and metabolic health<\/a> as a whole.<\/p>\n

This is important because risk factors rarely travel alone.<\/p>\n

A person with high LDL may at the same time have hypertension, abnormal blood glucose, overweight or high triglycerides. Improving the overall quality of the diet therefore makes it possible to act on several fronts.<\/p>\n

What about eggs?<\/h3>\n

For years the message about cholesterol was almost entirely focused on foods that contain cholesterol.<\/p>\n

Today the picture is more nuanced.<\/p>\n

For most people, the focus is more on the overall dietary pattern and the amount of saturated fat<\/strong> than on obsessively counting the cholesterol in every single food. The 2026 AHA nutrition guidelines emphasize precisely that, for most people, dietary cholesterol is no longer the main dietary target in reducing cardiovascular risk.<\/p>\n

This does not mean that everyone can eat any amount of eggs or foods rich in cholesterol. Recommendations must always be adapted to the overall clinical situation.<\/p>\n

Beware of drastic diets<\/h3>\n

Eliminating entire categories of food or following very restrictive diets on your own is not necessarily the solution.<\/p>\n

One example is some ketogenic diets that are very high in saturated fat. In some people they can cause an increase in LDL, which is why major cardiovascular organizations recommend discussing radical dietary changes with health professionals.<\/p>\n

This principle becomes even more important in the presence of chronic kidney disease<\/strong>, where the amount and type of protein, sodium, potassium, phosphorus and energy intake may require specific nutritional guidance.<\/p>\n

A diet generically described as “healthy” on the Internet is not necessarily suitable for every kidney patient.<\/p>\n

What to change at the table<\/h2>\n

Lowering cholesterol does not mean turning every meal into a medical prescription.<\/p>\n

Often it is substitutions repeated over time that produce the most sustainable change.<\/p>\n

A breakfast that usually includes industrial baked goods can more often make room for whole grains, oats, fruit and other alternatives consistent with the person’s needs. Legumes can appear more often during the week in place of some dishes based on processed meats. Fish can be one of the protein sources to alternate with the others.<\/p>\n

For dressing, extra virgin olive oil can more often replace butter and other fats rich in saturated fat.<\/p>\n

Nuts can be used in appropriate amounts as part of a balanced diet, instead of ultra-processed snacks.<\/p>\n

And above all you need to learn to look beyond the “cholesterol-free”<\/strong> label: a product may contain no dietary cholesterol and still be rich in saturated fat, sugar, salt or calories.<\/p>\n

The quality of a diet is not judged by a single line on the package.<\/p>\n

Physical activity, weight, smoking and sleep: cholesterol is not treated only at the table<\/h2>\n

Diet is essential, but it is only one part of lifestyle.<\/p>\n

Regular physical activity<\/strong> contributes to cardiovascular health and to the control of weight, blood glucose and blood pressure, and can improve the lipid profile. The American Heart Association emphasizes that moving regularly can help lower LDL and support more favorable HDL levels.<\/p>\n

Losing weight, when there is overweight or obesity, can also bring significant metabolic benefits.<\/p>\n

Smoking, on the other hand, acts at the same time on numerous cardiovascular mechanisms and its effect cannot be offset by a good diet.<\/p>\n

In recent years there has also been growing attention to sleep<\/strong>: sleeping regularly and adequately is now among the behaviors considered relevant to cardiovascular health.<\/p>\n

The goal is not to chase a single number, but to reduce overall risk.<\/p>\n

When diet and physical activity are not enough<\/h2>\n

One of the most widespread beliefs is that taking a cholesterol medication means having “failed the diet”.<\/p>\n

This is not so.<\/p>\n

There are people in whom lifestyle changes produce a sufficient reduction in LDL, and others in whom, because of genetic characteristics or their level of cardiovascular risk, drug therapy needs to be added.<\/p>\n

Statins<\/strong> have for many years been one of the main classes of drugs used to lower LDL cholesterol and cardiovascular risk. There are also other treatments, used according to the patient’s characteristics and the goals to be reached. The most recent European recommendations include several therapeutic strategies, including options for people who cannot reach their target with initial therapy or who do not tolerate certain drugs.<\/p>\n

The decision therefore does not depend only on the cholesterol value.<\/p>\n

Two people with the same LDL may receive different recommendations because they have different cardiovascular risks<\/strong>.<\/p>\n

And no prescribed therapy should be stopped on your own after seeing your tests improve: the improvement may be precisely the effect of the treatment.<\/p>\n

When to check your cholesterol<\/h2>\n

The lipid profile is assessed with a blood draw.<\/p>\n

The doctor may prescribe total cholesterol, LDL, HDL and triglycerides<\/strong>, supplementing them when necessary with other metabolic, liver and kidney parameters.<\/p>\n

How often to be checked is not the same for everyone.<\/p>\n

Age, family history, previous values, diabetes, blood pressure, smoking, obesity, cardiovascular disease and kidney disease can make more frequent checkups appropriate.<\/p>\n

Getting back to routine after summer can, from a practical standpoint, be a good time to refocus on prevention after weeks in which diet, physical activity and daily routine may have changed. But the time of year matters less than the regularity of checkups over time<\/strong>.<\/p>\n

A single value tells you a snapshot. The history of the values, together with clinical conditions, tells you much more.<\/p>\n

The most common mistakes<\/h2>\n

One of the most frequent mistakes is looking only at total cholesterol.<\/p>\n

The second is thinking that high HDL allows you to ignore LDL that is too high.<\/p>\n

The third is waiting for symptoms to appear before having the tests.<\/p>\n

Another mistake is looking for quick fixes: supplements, “anti-cholesterol” foods, drastic diets or arbitrary eliminations. The American Heart Association, for example, does not recommend dietary supplements as a general strategy for managing cholesterol and urges discussing their use with your health care team, also because of possible interactions with medications.<\/p>\n

Finally, especially in patients with chronic conditions, it is wrong to treat cholesterol as a problem independent of the rest of the body.<\/p>\n

Blood pressure, blood glucose, weight, kidney function and cardiovascular risk are part of the same clinical picture.<\/strong><\/p>\n

High cholesterol FAQ: the most frequently asked questions<\/h2>\n

What should total cholesterol be?<\/h3>\n

A value below 200 mg\/dL<\/strong> is traditionally considered desirable, but today the assessment is not based on total cholesterol alone. The most important figure to put in context is often LDL, whose goal varies according to individual cardiovascular risk.<\/p>\n

What is bad cholesterol?<\/h3>\n

LDL cholesterol<\/strong> is commonly called “bad”, because high concentrations promote the buildup of cholesterol in the artery wall and the development of atherosclerosis.<\/p>\n

What is good cholesterol?<\/h3>\n

HDL<\/strong> is called “good cholesterol” because it takes part in carrying cholesterol to the liver. However, having high HDL does not make excess LDL harmless, and HDL is not used as a treatment goal on its own.<\/p>\n

Does high cholesterol cause symptoms?<\/h3>\n

Generally not. Hypercholesterolemia is often discovered through blood tests. In very severe inherited cases, signs such as xanthomas or fatty deposits around the cornea may appear.<\/p>\n

What should I eat to lower cholesterol?<\/h3>\n

It is helpful to favor a dietary pattern rich in vegetables, fruit, legumes, whole grains, sources of unsaturated fats and adequate protein<\/strong>, reducing mainly saturated fat and ultra-processed products. The diet must be personalized in the presence of diabetes, obesity or kidney disease.<\/p>\n

How long does it take to lower cholesterol?<\/h3>\n

It depends on the starting value, the causes, genetics, diet, weight, physical activity and any drug therapy. There is therefore no time frame that is valid for everyone. The doctor decides when to repeat the tests after a treatment is started.<\/p>\n

Are high cholesterol and high triglycerides the same thing?<\/h3>\n

No. They are different lipids. Triglycerides are mainly a form of energy reserve, while cholesterol has various structural and metabolic functions. When high triglycerides are combined with high LDL or low HDL, the cardiovascular profile can become more unfavorable.<\/p>\n

Is high cholesterol bad for the kidneys?<\/h3>\n

The relationship cannot be reduced to a simple cause and effect. Dyslipidemia, atherosclerosis, diabetes, hypertension and kidney disease share numerous mechanisms and risk factors. In patients with CKD, lipid management is particularly important because of the high cardiovascular risk.<\/p>\n

Can someone with kidney disease follow an anti-cholesterol diet?<\/h3>\n

Yes, but they should not improvise it<\/strong>. Some foods normally recommended in heart-protective diets may need adjustments in certain kidney patients in relation, for example, to potassium, phosphorus, protein or energy intake. The diet must therefore be built around kidney function and the individual clinical picture.<\/p>\n

Prevention means knowing your risk<\/h2>\n

The most important message is probably the simplest: there is not only the cholesterol number, there is the person who has that number<\/strong>.<\/p>\n

An LDL of 120 mg\/dL can have a different meaning in a young person with no other risk factors than in someone who already has cardiovascular disease, diabetes or chronic kidney disease.<\/p>\n

For this reason, reading the report on your own and deciding that the value is “good” or “bad” can be misleading.<\/p>\n

Modern prevention thinks in terms of overall risk<\/strong>.<\/p>\n

Periodically checking the lipid profile, blood pressure, blood glucose and kidney function makes it possible to build a more complete picture of metabolic and cardiovascular health. When abnormalities emerge, diet, physical activity, weight control and, when indicated, drug therapy can reduce risk over time.<\/p>\n

For people with chronic kidney disease<\/strong>, this integrated view becomes even more important: the heart, blood vessels, metabolism and kidneys are part of a balance that must be followed as a whole.<\/p>\n

Advice from the NefroCenter specialists<\/h2>\n

High cholesterol should not cause alarm, but it should not be underestimated either because it “doesn’t bother you”.<\/p>\n

The first step is to know it.<\/p>\n

A simple blood draw makes it possible to measure total cholesterol, LDL, HDL and triglycerides<\/strong>. The medical evaluation that follows makes it possible to interpret these data together with blood pressure, blood glucose, kidney function, family history and the other risk factors.<\/p>\n

In the centers of the NefroCenter Group<\/strong>, the approach to prevention puts this overall view of the person at the center, with particular attention to the interaction between cardiovascular health, metabolism and kidney function<\/strong>.<\/p>\n

Checking your cholesterol does not just mean knowing a number: it means understanding what risk it represents for your health and what can be done to reduce it.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

High cholesterol: normal LDL and HDL values, causes, symptoms and how to lower it with diet High cholesterol is one of the best-known cardiovascular risk factors, but also one of the most misunderstood. 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