4 reasons your ‘healthy’ patient’s LDL isn’t so healthy
Key Takeaways
Industry Buzz
"Excessive alcohol intake can raise total cholesterol and triglyceride levels, but regular consumption of unsweetened black, green, or cinnamon tea may help lower LDL cholesterol levels.” - Megan Miller, MBA, RDN, LD
“Patients can support improved cortisol levels during times of mental or physical stress by developing healthy coping mechanisms such as physical activity, meditation, or even reaching out to talk to a friend.” - Megan Miller, MBA, RDN, LD
High low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, is typically linked to unhealthy lifestyle habits.[] However, LDL levels can creep up on any patient, surprising them. Even those who closely monitor their health can experience unwanted changes to their lipid profiles. Below are the main reasons patients may experience higher LDL levels, regardless of age or overall health status.
Related: Doctors—and their patients—are losing faith in statins: 3 reasons they fall shortGenetics
High LDL often runs in families. Research shows that specific genetic mutations are linked to higher cholesterol levels.[] People at risk for inherited high LDL, called familial hypercholesterolemia (FH), should have regular lipid panels to check LDL levels.
Related: Tackling rare lipids disorders with the help of specialistsMenopause
Hormonal changes can also affect LDL levels.[] Research has shown that LDL levels increase after menopause, when estrogen and anti-Müllerian hormone (AMH) decrease.[]
Related: The hidden heart risk lurking after menopauseChronic stress
Elevated cortisol—the body’s primary stress hormone—has been associated with increased LDL. Chronic stress triggers cortisol release, which in turn influences lipid metabolism, promoting higher LDL and potentially contributing to atherosclerosis.
“Patients can support improved cortisol levels during times of mental or physical stress by developing healthy coping mechanisms such as physical activity, meditation, or even reaching out to talk to a friend,” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD
Managing hormonal LDL changes
For patients with extremely high LDL levels—especially those with genetic conditions like familial hypercholesterolemia—medication may be necessary to prevent long-term damage. In addition to statins, newer treatments like PCSK9 inhibitors, ezetimibe, or bempedoic acid may be recommended if LDL remains high despite standard therapy. Additional options like CETP inhibitors are in the drug development pipeline. Regular monitoring and adjustments ensure the best approach for managing cholesterol and reducing overall cardiovascular risk.
Related: Evolving perspectives on lipids: What should doctors advise now?