Understanding the Difference Between “Good” and “Bad” Cholesterol

September is Cholesterol Awareness Month. At The Texas Heart Institute at Baylor College of Medicine, we want to empower patients with the knowledge to make informed heart-health decisions.

What is Cholesterol?

Cholesterol is a waxy substance made by the liver and found in every cell of the body. It’s essential for building cells, producing hormones, digesting fat, and generating vitamin D. About 25% of cholesterol comes from your diet, and the rest of it, your body manufactures naturally.

LDL vs. HDL: What Do They Mean?

• LDL (Low-Density Lipoprotein) Known as “bad” cholesterol, LDL can accumulate in artery walls, forming plaque that narrows vessels and increases the risk of heart disease, heart attack, and stroke.
• HDL (High-Density Lipoprotein) Called “good” cholesterol, HDL helps remove excess LDL from the bloodstream and carry it to the liver for disposal. Higher HDL levels are associated with lower cardiovascular risk.

Importantly, having high HDL doesn’t negate the risk posed by high LDL. They must both be interpreted together.

Why Balance Matters

The ratio of HDL to LDL is more significant than total cholesterol alone. A profile with high LDL and low HDL is more dangerous, even if total cholesterol appears acceptable. That’s why physicians analyze full lipid panels. This includes HDL, LDL, triglycerides and total cholesterol, to assess risk.

How to Improve Cholesterol Levels

Lifestyle Habits

• Eat more soluble fiber and avoid saturated and trans fats. Focus on whole grains, fruits, vegetables, lean protein, nuts, seeds, olive oil, and fatty fish.
• Aim for at least 150 minutes of moderate aerobic exercise per week to boost HDL and reduce LDL.
• Maintain a healthy weight: losing 5–10% of body weight can meaningfully improve cholesterol numbers.
• Quit smoking and minimize alcohol intake.

Medical Management

• Get a lipid panel screening, especially starting in your 20s or if you have risk factors like family history, high blood pressure, or diabetes.
• For those whose levels don’t improve through lifestyle alone, medications such as statins may be prescribed to lower LDL and reduce cardiovascular risk.

Joseph G. Rogers, MD, Director of The Texas Heart Institute at Baylor College of Medicine tell us, “Many patients assume that if their total cholesterol is normal, they’re in good shape. But often, a high LDL or low HDL means risk is still present. Our goal isn’t just to lower the number, but rather to shift the balance. Higher HDL and lower LDL together means better protection for your arteries.”

When to Get Checked

• Adults should get screened every 4–6 years starting at age 20.
• If you have family history or conditions like diabetes or hypertension, screenings should be more frequent.
• Don’t wait for symptoms. Cholesterol-related artery narrowing typically occurs silently until advanced disease appears.

Final Thoughts & Call to Action

Understanding the difference between LDL and HDL and how to manage them is critical for preventing cardiovascular disease. Cholesterol Awareness Month is the perfect time to:

• Schedule a cholesterol screening
• Review your lipid panel with your healthcare provider
• Take steps through food, exercise, and possibly medications, to improve your balance

Take control of your heart health. Share this story, schedule a check-up, and empower yourself with knowledge.