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High Cholesterol in Men

Medically Reviewed by James Beckerman, MD, FACC on August 24, 2020

Why Should I Care About High Cholesterol in Men?

High cholesterol, also called hypercholesterolemia, puts men at higher risk for heart attacks, strokes, and peripheral artery disease. For many men, the risk from high cholesterol starts in their 20s and goes up with age.

High cholesterol tends to run in families, so genes play a role. But a variety of lifestyle choices -- including diet, activity, and weight -- also affect cholesterol levels. The only way to know how high your cholesterol levels are is to get a blood test. Everyone over 20 should get a cholesterol test at least once every 5 years. If your numbers are high, your doctor may recommend the test more often.

What Is High Cholesterol?

Cholesterol is a waxy, fat-like substance made in the liver and other cells. It’s also found in certain foods, such as dairy products, eggs, and meat.

Your body needs some cholesterol to make hormones, vitamin D, and the bile acids that help you digest fat. But the body needs only a limited amount of cholesterol. When there’s too much, health problems, such as heart disease, may develop.

There are different kinds of cholesterol, and if there’s too much of certain kinds in your blood, a fatty deposit called plaque can build up on the walls of your arteries. It’s like rust on the inside of a pipe. This plaque buildup can block blood flow to the heart muscle, reducing its oxygen supply. If levels of blood and oxygen to the heart drop far enough, you may start feeling chest pain or find yourself short of breath.

A heart attack happens when the plaque completely blocks a blood vessel feeding a section of the heart muscle. If the plaque blocks a blood vessel going to your brain, you can have a stroke.

The cholesterol that blocks arteries is called low-density lipoprotein (LDL). Another kind of cholesterol called high-density lipoprotein (HDL) is known as good cholesterol because it helps remove LDL from the blood and from the body. For good health, you want to keep the LDL levels down and the HDL levels up. If this balance isn’t maintained, especially if it’s reversed, you are said to have high cholesterol.

What Are the Risk Factors for Having High Cholesterol?

Your risk of having high cholesterol goes up if:

  • Your diet is high in saturated fat. These fats, found in meat and full-fat dairy products, raise LDL cholesterol. Dietary cholesterol, found in eggs and organ meats, can also raise blood cholesterol levels, but not as much as saturated fat does.
  • You eat foods with trans fats. These are human-made fats found in partially hydrogenated oils. They raise LDL cholesterol and lower HDL cholesterol -- exactly the wrong combination.
  • You eat processed foods or foods high in carbohydrates. These types of foods have also been shown to increase LDL cholesterol.
  • You are overweight or obese. Extra weight increases LDL and lowers HDL.
  • You don’t get much exercise. Studies show that frequent exercise can boost HDL, the good cholesterol. Lack of exercise can lead to weight gain.

What’s the Link Between Testosterone and High Cholesterol?

Testosterone is an important hormone for men. It helps control growth and development and is linked to sex drive, muscle, and bone mass. Researchers are studying the idea that it's also linked to cholesterol in some way. Some think it might help prevent heart disease.

Studies have found that testosterone doesn't seem to have any effect on LDL -- "bad" -- cholesterol. But higher testosterone can lead to lower levels of "good" cholesterol in healthy men between the ages of 20 and 50. Researchers haven't seen that happen in older men who take testosterone supplements, though.

Testosterone and heart disease

As men age, their bodies make less testosterone. Older men are also more likely to have heart problems and high cholesterol. Testosterone can help get rid of fat and build muscle mass, both of which can make you less likely to have a heart attack.

So, can boosting the hormone help prevent heart disease?

In 2015, the American Association of Clinical Endocrinologists, who study hormones and how they affect your body, tried to answer that question. They learned that there's a strong link between low testosterone and heart attacks and other heart problems, especially in older men.

But other studies suggest that some men might be more likely to have heart trouble if they take testosterone supplements.

In 2010, researchers cut short a study of testosterone supplements in older men who had problems getting around. Of the 209 men in the study, 23 men who were getting testosterone treatments developed high blood pressure or abnormal heart rhythms or had heart attacks.

Since the trial involved a small number of men who were older and unhealthy in other ways, scientists said they couldn't learn much from the results.

The bottom line is that more study is needed for doctors to better understand the risks and benefits of using testosterone supplements.

 

 

How Does the Doctor Know I Have High Cholesterol?

There are two different types of cholesterol tests. The simplest measures total cholesterol levels in the blood. Most doctors use a lipoprotein analysis, which includes:

  • Total cholesterol level
  • LDL cholesterol level
  • HDL cholesterol level
  • Triglycerides (another fat in your blood that raises the risk of heart disease)

How Can I Prevent High Cholesterol?

Eat a healthier diet. To reduce your cholesterol, one of the most important changes to make is to cut back on the amount of saturated fat and trans fats in your diet. That means cutting back on meat and poultry -- either by eating smaller portions or eating them less often -- and choosing skim or low-fat dairy products. It also means eating less fried food, processed food, and foods high in sugar.

It is also important to increase the amount of soluble fiber you eat. This form of fiber, found in oatmeal, kidney beans, and apples, for example, helps remove LDL from the body.

Lose weight. If you are overweight or obese, losing even just a few pounds can help lower your cholesterol levels. There is no magical formula for weight loss, of course, but reducing portion sizes and cutting out things you can easily live without, such as beverages sweetened with sugar, are good places to start. The average American now gets more than 20% of calories from beverages. Switching to water is painless and can make a big difference in total calories.

Get regular exercise. As little as a brisk 30-minute walk most days raises HDL and may slightly lower LDL. Exercise is especially important if you have high triglyceride and LDL levels and more than your share of abdominal fat.

What Are the Treatments for High Cholesterol?

The first treatment of choice for high cholesterol is adopting a healthier lifestyle. In many men  who have cholesterol in the borderline high category, healthier habits can bring the numbers down to normal. If lifestyle changes are not enough, a variety of cholesterol-lowering medications are available.

The leading choice -- statin drugs -- are very effective at lowering LDL. Recent studies have confirmed that, in addition to lowering cholesterol levels, these drugs reduce the risk of heart disease. The medications are most effective when combined with a low-cholesterol diet.

WebMD Medical Reference

Sources

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National Heart Lung and Blood Institute: “High Blood Cholesterol.”

National Cholesterol Education Program: “High Blood Cholesterol: What you Need to Know.”

Harvard School of Public Health: “Fats & Cholesterol.”

American Heart Association: "Good vs. Bad Cholesterol."

Ekelund and others Diabetes Care, February 2007.

Nicholls and others JAMA, Feb 7, 2007.

David Ludwig, MD, professor of endocrinology, Children’s Hospital, Boston.

CDC: "About high cholesterol."

Rubinow, K. Clinical Lipidology, September-October 2012.

American Association of Clinical Endocrinologists: "Position Statement on the Association of Testosterone and Cardiovascular Risk," 2015.

Harvard Health Publications: "Testosterone and the Heart."

News release, The Endocrine Society.

News release, U.S. National Institutes of Health.

Basaria, S. New England Journal of Medicine, July 2010.

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Thirumalai, A. Clinical Lipidology, May-June 2016.

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