Can you Have High Cholesterol but Still be Healthy?

Does hearing the words “high cholesterol” make you instantly think of heart disease? You’re not alone. For years, cholesterol has been painted as the villain, blamed for clogged arteries and heart attacks. But here’s the reality, cholesterol is not the enemy. In fact, it’s essential for your body, helping to build cell membranes, produce hormones and keep your brain functioning. So, if your cholesterol levels are high, does that automatically mean you’re unhealthy? Not necessarily. It’s time to dig deeper into what really matters.

The Cholesterol Confusion

For decades, cholesterol has been misunderstood. The idea that high cholesterol directly causes heart disease has been widely accepted, but modern research challenges this outdated view. Cholesterol is a natural and necessary part of your body’s processes. The problem arises when it’s out of balance, particularly when combined with inflammation, insulin resistance or metabolic dysfunction.

Looking at total cholesterol alone doesn’t tell the whole story. Some people with high cholesterol live long, healthy lives, while others with “normal” cholesterol end up with heart disease. This is why it’s so important to look beyond the basic numbers and understand what’s really happening inside your body.

Understanding Cholesterol: LDL, HDL, and Triglycerides

Not all cholesterol is created equal. Low-density lipoprotein (LDL) is often labelled as “bad” cholesterol, but that’s an oversimplification. There are different types of LDL: small, dense LDL, which is more likely to contribute to plaque buildup in arteries, and large, fluffy LDL, which is far less concerning. Rather than fixating on LDL levels alone, it’s more useful to assess LDL particle size and number.

High-density lipoprotein (HDL), on the other hand, is known as “good” cholesterol because it helps remove excess cholesterol from the bloodstream. Higher levels of HDL are generally beneficial, offering protection against cardiovascular disease.

Then there are triglycerides, a type of fat in the blood. If triglyceride levels are high, especially when combined with low HDL, it’s a strong sign of insulin resistance and metabolic dysfunction. Many experts now consider triglyceride levels to be a more accurate predictor of heart disease risk than total cholesterol alone.

When High Cholesterol is NOT a Problem

Not everyone with high cholesterol is in danger. In people with good metabolic health, cholesterol levels may be elevated, but other markers suggest the body is handling it well. Low inflammation, stable blood sugar and good insulin sensitivity all indicate that cholesterol is being properly used rather than stored in arteries.

Genetics play a role too. Some people naturally have higher LDL levels without an increased risk of heart disease. Familial hypercholesterolemia, a genetic condition that causes extremely high LDL from birth, does increase cardiovascular risk, but many other genetic variations lead to higher cholesterol without negative effects.

Lifestyle is another major factor. If you exercise regularly, eat a balanced diet, manage stress and get good sleep, high cholesterol may not be something to worry about. The body is complex, and cholesterol is just one piece of the bigger picture.

When High Cholesterol is a Warning Sign

Cholesterol becomes a concern when it’s accompanied by other metabolic red flags. If high LDL is paired with high triglycerides and low HDL, it often signals insulin resistance and poor metabolic health. This pattern is commonly seen in people with type 2 diabetes or metabolic syndrome, both of which significantly raise the risk of heart disease.

Inflammation is another major issue. Chronic inflammation, measured by markers like high-sensitivity C-reactive protein (hs-CRP), contributes to arterial plaque buildup. When LDL is high and hs-CRP is elevated, it suggests that cholesterol is more likely to cause problems in the arteries.

Other risk factors, like high blood pressure, excess belly fat and poor blood sugar control, also indicate that cholesterol might be part of a bigger health issue. Addressing these problems through lifestyle changes can do more to improve heart health than simply trying to lower cholesterol levels.

The Best Tests to Assess Cardiovascular Risk (Beyond Standard Cholesterol Panels)

A standard cholesterol test won’t give you the full picture. If you really want to understand your heart disease risk, consider more advanced tests.

An LDL particle size test can determine whether your LDL is mostly small and dense (which is more dangerous) or large and fluffy (which is less concerning). The ApoB test measures the actual number of LDL particles in your blood, offering a more accurate predictor of heart disease risk than total LDL alone.

Inflammation should also be checked. The hs-CRP test measures systemic inflammation, which is a key driver of cardiovascular disease. If hs-CRP is high, cholesterol is more likely to contribute to plaque formation.

One of the most valuable tests is a coronary artery calcium (CAC) scan. This imaging test identifies existing plaque in the arteries, providing a direct measure of whether cholesterol is accumulating where it shouldn’t be. A high CAC score indicates greater risk, while a low or zero score suggests minimal risk, even if cholesterol levels are high.

How to Support Heart and Metabolic Health Naturally

Rather than obsessing over lowering cholesterol, a better approach is to focus on overall metabolic health. Insulin resistance, inflammation and poor lifestyle habits have a far greater impact on cardiovascular risk than cholesterol levels alone.

A nutrient-dense diet that prioritises whole foods, healthy fats and fibre can help keep cholesterol levels in balance. A Mediterranean-style diet rich in omega-3s, leafy greens and fermented foods has been shown to support heart health and reduce inflammation. Cutting back on processed foods, refined sugars and seed oils can also help stabilise blood sugar and prevent metabolic dysfunction.

Exercise is another powerful tool. Strength training improves insulin sensitivity, while aerobic activity helps regulate lipid levels and enhances circulation. A mix of both provides the best protection against cardiovascular disease.

Stress and sleep are often overlooked but are crucial for heart health. Chronic stress raises cortisol, which can increase blood pressure and contribute to metabolic issues. Prioritising relaxation techniques and ensuring quality sleep can help keep stress levels in check.