What Can Cause High Cholesterol Besides Diet?

Cholesterol is a lipid that travels in the bloodstream. It has many functions, including fat metabolism, hormone production, vitamin D synthesis, and maintenance of cell walls.

Lipids are insoluble, so when cholesterol travels in the bloodstream, they must be packaged in a shell of protein. Many types of cholesterol differ in their structure and function. 

The two main types of cholesterol are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). HDL is called “good cholesterol” because it takes cholesterol away from the bloodstream and back to the liver. On the other hand, LDL is called “bad cholesterol” because it brings cholesterol into the bloodstream and the body.

Too much cholesterol in your bloodstream can lead to poor health outcomes such as heart attacks and strokes. 

Cholesterol can stick to blood vessels, migrate into them, and cause local inflammatory responses leading to blockages of blood flow. High LDL and low HDL levels have been significantly implicated in atherosclerotic disease. 

What is high cholesterol?

Dyslipidemia is a medical term when your cholesterol levels exceed a healthy limit. It is diagnosed with a blood test called a lipid panel test¹ that measures your cholesterol levels. Your results would show the following: 

• Total cholesterol > 200 mg/dL

• LDL > 100 mg/dL

• Triglycerides > 150 mg/dL

• HDL < 60 mg/dL

Data from the National Health and Nutrition Survey² in 2011–2012 found that 11.1% of men and 14.4% of women in the United States have high cholesterol levels. It is essential to understand what can cause high cholesterol and how to keep it under control. 

The health consequences of poorly controlled cholesterol can be life-threatening.

What can cause high cholesterol besides diet?

Diet has been one factor that health professionals have long associated with dyslipidemia. Extensive research has found that a poor diet will increase your risk of poor health outcomes. 

For example, studies³ have found that increased consumption of saturated fats will increase the amount of circulating LDL. 

However, there are many other reasons why your cholesterol levels could be high. Here are some of the lifestyle factors that can cause your cholesterol to go up.

Living a sedentary lifestyle

A sedentary lifestyle has been found to increase your risk of dyslipidemia. If you are not burning enough energy by moving around, you will begin to gain weight and strain your body, resulting in alterations in its biochemical makeup.

A sedentary lifestyle can contribute to a reduction in HDL levels. 

A study⁴ published in BMC Public Health in 2017 investigated the role of a sedentary lifestyle on dyslipidemia in over 240,000 people. They separated the participants depending on the physical intensity of their job and the amount of their sedentary leisure time. 

They found that those who spent three to four hours per day of their leisure time sedentary, for example, watching TV, playing games, or using the internet, were at a statistically higher risk of dyslipidemia.

Drinking too much alcohol

Alcohol can interfere with lipid metabolism, but it varies on the amount you drink and over what period you drink it. Generally speaking, the more alcohol you consume, the greater your risk for dyslipidemia. 

The dietary guidelines⁵ for alcohol consumption for Americans is one standard drink for women and two for men on a day when alcohol is consumed. Consuming more than recommended would be considered heavy consumption during that occasion.

A heavy alcohol intake can lead to increased triglycerides and total cholesterol levels. 

Having too much stress

Stress is another contributing factor that has been well-researched. It is a daily occurrence in our modern world, coming from various sources, from relationships and the workplace to your finances. It is vital to manage stress because it can lead to poorer health choices, including consuming more calories and exercising less. 

It has been extensively researched⁶ that increased stress will increase your risk of dyslipidemia. A study⁷ published in Medicine (Baltimore) in 2017 investigated the relationship between psychological and physical stress and lipid levels. 

The researchers divided the study participants into five groups:

• G1—Mild psychological stress

• G2—Mild physical work with no psychological stress

• G3—Mild psychological stress and mild physical work

• G4—Moderate physical work without psychological stress

• G5—Heavy physical work without psychological stress

They found that psychological stress was a statistical risk factor for dyslipidemia, while physical stress was a statistical protective factor.

Taking medications

Taking medications can sometimes come with unwanted side effects. Several medications have been found to increase cholesterol levels, including:

• Cardiovascular medications like beta-blockers and diuretics

• Antipsychotics

• Anticonvulsants 

• Antiviral therapies 

• Certain immunosuppressants

• Hormone medications, including oral contraceptive pills

Smoking and/or vaping

Smoking is a significant risk factor for many conditions, including dyslipidemia. It has been reported⁸ that smoking decreases HDL levels and increases LDL levels. 

It is important to note that smoking can also affect other factors that lead to an increased risk of atherosclerotic disease.

Pre-existing health conditions 

Pregnancy

Raised cholesterol and triglyceride levels are expected during pregnancy, especially in the second and third trimesters. It allows for increased production of sex hormones—progesterone and estrogen—and increases the energy metabolism required for fetal development.

Due to the natural increase, you will experience during pregnancy, it is not recommended to check your cholesterol levels while pregnant. This is because it will not be a true reflection of your normal levels. 

Thyroid issues

The thyroid produces hormones that are responsible for regulating our metabolism. It has also been found to affect cholesterol levels. People with hypothyroidism have been found⁹ to have high levels of cholesterol and triglycerides. 

Diabetes

Diabetes is a common cause of dyslipidemia. Type 2 diabetes is known as insulin-resistant diabetes. The cells in the body cannot use the circulating insulin to push glucose inside, resulting in chronically elevated blood glucose levels. 

A lesser-known fact is that insulin plays a vital role in cholesterol metabolism. Often, it acts as an inhibitory signal to prevent fat breakdown. 

People with diabetes have been found to have increased LDL and triglycerides and decreased HDL levels. There are multiple reasons why this occurs. 

For instance, insulin resistance reduces the inhibitory effect on lipoprotein lipase activity within the cells. This leads to increased fat metabolism and upregulation of cholesterol. 

Menopause

When you go through menopause, the body no longer produces sex hormones such as progesterone and estrogen. Research¹⁰ has found that post-menopausal women have a higher concentration of lipids than pre-menopausal women. 

Liver problems

Because the liver plays a significant role in cholesterol metabolism, any liver problems you might have will affect your cholesterol profile and lipid metabolism. 

Prevention of high cholesterol

There are many lifestyle changes you can implement that can have a significant effect on your cholesterol profile. They include:

• Eating a healthier diet

• Exercising more

• Following your doctor’s advice, including taking any medications prescribed

• Monitoring your cholesterol levels

How is dyslipidemia treated?

There are several types of medications that can help reduce your cholesterol levels. 

The first-line medications are called statins. They work by reducing the production of LDL. Furthermore, reducing LDL tricks the liver into thinking that it needs more and begins to take cholesterol from the bloodstream. 

This medication is very effective and has been found¹¹ to reduce LDL levels by 25%–50%, depending on the dose and type of statin.

It is common to be worried about the side effects of taking medication. However, research¹² has found that statin adherence does save lives. 

There are other alternative medications available. They include:

• Ezetimibe (Zetia)

• Bile Acid Sequestrant (Welchol)

• PCSK9 inhibitor (Repatha, Praluent)

• Bempedoic Acid (Nexletol)

• Bempedoic Acid + Ezetimibe (Nexlizet)

When you should see a doctor

The Centers for Disease Control and Prevention¹³ (CDC) recommends that you get your cholesterol levels screened every five years when you are over 20 years of age and more frequently if you have risk factors for cardiovascular disease. 

The American Heart Association Guidelines Cardiovascular Risk Calculator¹⁴ is a helpful tool to estimate your ten-year risk of atherosclerotic cardiovascular disease.

However, this is no substitute for visiting your local doctor. Consult your doctor if you are concerned about your cholesterol levels.

The lowdown

Dyslipidemia is medical jargon for having too much cholesterol in your bloodstream. It can lead to adverse health outcomes such as heart attacks and strokes. 

Factors that increase your risk include a sedentary lifestyle, excessive alcohol consumption, stress, and smoking and/or vaping. However, all these options can be modified and give positive health outcomes. Other factors include medical conditions and medications, which require discussing with your doctor.