Hidden Causes of High Cholesterol

1. Thyroid Disorders

An often-overlooked contributor to elevated cholesterol is hypothyroidism, a condition where the thyroid gland produces insufficient hormones. The thyroid plays a crucial role in regulating metabolism, including the breakdown and removal of cholesterol from the bloodstream. When thyroid hormone levels are low, the liver’s ability to clear LDL (“bad”) cholesterol diminishes, leading to higher blood cholesterol levels even in those with a healthy diet and lifestyle. According to the National Institutes of Health, untreated hypothyroidism is a well-established secondary cause of hyperlipidemia.

For example, a patient described in a New England Journal of Medicine case study presented with persistently high cholesterol despite dietary changes and exercise. After being diagnosed with hypothyroidism and starting thyroid hormone replacement therapy, her cholesterol levels normalized within months, highlighting the direct connection between thyroid health and cholesterol metabolism.

If you or someone you know has unexplained high cholesterol, especially in the absence of obvious lifestyle factors, it is advisable to request a thyroid function test from your healthcare provider. Early identification and treatment of thyroid disorders can significantly improve cholesterol profiles and reduce cardiovascular risk.

2. Genetic Mutations

Familial hypercholesterolemia (FH) is a genetic disorder that significantly elevates LDL (“bad”) cholesterol levels, often from birth. This inherited condition affects approximately 1 in 250 people worldwide, yet it remains widely underdiagnosed. Mutations in genes such as the LDL receptor gene impair the body’s ability to remove LDL cholesterol from the blood, leading to early and persistent hypercholesterolemia. Individuals with FH can develop cholesterol deposits in the skin, tendons, and around the eyes, and are at much higher risk for premature heart disease.

A notable family case featured by the American Heart Association described three generations affected by FH. Despite a healthy lifestyle, all members had very high LDL cholesterol. After genetic testing confirmed the diagnosis, targeted therapies such as statins and PCSK9 inhibitors were initiated, resulting in significant cholesterol reduction and prevention of cardiovascular events within the family.

If you have a close relative with early heart disease or high cholesterol, it is important to consider early screening for FH. Early detection allows for timely intervention and can dramatically reduce the risk of heart attacks and strokes related to this genetic condition.

3. Chronic Kidney Disease

Chronic kidney disease (CKD) is another hidden factor that can lead to elevated cholesterol levels. When kidneys are not functioning properly, their ability to regulate lipid metabolism is impaired. This dysfunction often results in higher levels of triglycerides and LDL cholesterol, as well as lowered HDL (“good”) cholesterol. According to the National Kidney Foundation, lipid abnormalities are common in people with CKD, even in the early stages, increasing their risk for atherosclerosis and cardiovascular disease.

Studies have shown that individuals with CKD are more likely to experience adverse cardiovascular events compared to those with normal kidney function. For example, research published in Frontiers in Medicine found that CKD patients with high cholesterol were at a significantly greater risk of heart attack and stroke than healthy peers with similar cholesterol profiles. This increased risk is due to both the direct effects of kidney impairment on lipid metabolism and the presence of other related complications like hypertension and inflammation.

Regular kidney function check-ups are essential, especially for those with risk factors such as diabetes or high blood pressure. Early detection and management of CKD can help control cholesterol levels and reduce the risk of cardiovascular disease.

4. Liver Disease

The liver plays a central role in regulating cholesterol levels by producing, processing, and clearing cholesterol from the bloodstream. When liver function is impaired—due to conditions such as fatty liver disease, cirrhosis, or hepatitis—its ability to manage cholesterol is compromised. This disruption can cause abnormal lipid profiles, often resulting in elevated total cholesterol and LDL (“bad”) cholesterol, while sometimes reducing protective HDL cholesterol. According to the National Institutes of Health, chronic liver diseases are frequently associated with significant changes in cholesterol metabolism.

For instance, hepatitis infections can trigger shifts in cholesterol levels. Research published in Gastroenterology has shown that individuals with chronic hepatitis C often exhibit altered cholesterol processing, which may increase their risk for cardiovascular events. In some cases, liver disease leads to decreased cholesterol production, but as the disease progresses and liver cells are damaged, cholesterol and other lipids can build up in the blood.

Regular monitoring of liver function is important, especially for those with risk factors such as obesity, alcohol use, or a history of viral hepatitis. Early detection and management of liver issues can help maintain healthier cholesterol levels and support overall cardiovascular health.

5. Diabetes (Especially Type 2)

Type 2 diabetes is closely linked to disturbances in cholesterol and overall lipid control. Insulin resistance, a hallmark of type 2 diabetes, interferes with the body’s ability to process fats efficiently. As a result, people with diabetes often have high levels of triglycerides, increased LDL (“bad”) cholesterol, and lower HDL (“good”) cholesterol. According to the American Diabetes Association, these cholesterol abnormalities significantly increase the risk for cardiovascular disease among individuals with diabetes.

A common scenario involves a patient with newly diagnosed type 2 diabetes who, despite a reasonable diet and exercise routine, experiences a sharp spike in cholesterol levels. Research published in Frontiers in Endocrinology details how poor blood sugar control directly contributes to higher cholesterol and triglyceride readings. This relationship underscores the importance of targeting both blood glucose and cholesterol when managing diabetes.

Managing blood sugar effectively can help improve cholesterol levels and reduce heart risk. Regular monitoring of blood glucose, along with dietary changes, increased physical activity, and medication when necessary, are essential steps for individuals with diabetes to maintain healthier cholesterol profiles and protect their cardiovascular system.

6. Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age, and it is frequently associated with elevated cholesterol levels. The hormonal imbalances seen in PCOS, particularly higher levels of androgens and insulin resistance, disrupt normal lipid metabolism. This often leads to increased LDL (“bad”) cholesterol and triglycerides, as well as decreased HDL (“good”) cholesterol. According to the Centers for Disease Control and Prevention, women with PCOS have a greater risk of developing metabolic syndrome, which includes abnormal cholesterol levels.

A notable case published in the Journal of Clinical Medicine described a young woman diagnosed with PCOS who also exhibited high cholesterol despite a healthy diet and regular exercise. With integrated treatment targeting both her hormonal imbalance and lipid levels, her cholesterol numbers improved significantly, reducing her overall cardiovascular risk.

Given the strong connection between PCOS and cholesterol abnormalities, it is crucial for women with PCOS to undergo regular cholesterol screenings. Early detection and management of lipid issues can help prevent long-term complications such as heart disease and stroke, improving both reproductive and metabolic health.

7. Menopause

Menopause marks a significant hormonal transition in a woman’s life, most notably characterized by a decline in estrogen levels. Estrogen plays a key protective role in maintaining healthy cholesterol profiles by helping to keep LDL (“bad”) cholesterol levels low and HDL (“good”) cholesterol levels high. As estrogen decreases after menopause, women often experience unfavorable shifts in their cholesterol, with rising LDL and total cholesterol, and sometimes decreased HDL. The American Heart Association notes that this hormonal change is a major reason why cardiovascular risk increases for women after menopause.

Comparative studies, such as one published in Menopause: The Journal of The North American Menopause Society, have found that postmenopausal women tend to have significantly higher LDL cholesterol and lower HDL cholesterol than premenopausal women of the same age group and lifestyle. These changes can occur even in women with no prior history of cholesterol problems.

Given these risks, it is wise for women to have their cholesterol levels checked regularly during the menopausal transition. Early intervention and lifestyle adjustments can help mitigate the increased cardiovascular risk associated with menopause.

8. Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) is a sleep disorder characterized by repeated interruptions in breathing due to airway blockage, leading to poor oxygenation during sleep. This chronic lack of oxygen disrupts normal metabolic processes, including lipid metabolism. As a result, individuals with OSA often experience unfavorable changes in cholesterol levels, such as increased LDL (“bad”) cholesterol and triglycerides. According to a study published in Circulation, people with untreated sleep apnea demonstrated significantly higher LDL cholesterol compared to those without the disorder.

The metabolic disruptions caused by OSA are thought to stem from repeated episodes of low oxygen, which trigger stress responses in the body and alter the way fats are processed. These changes not only elevate cholesterol but also increase the risk for cardiovascular diseases. The link between OSA and high cholesterol persists even after accounting for confounding factors such as obesity and age, highlighting the independent effect of sleep apnea on lipid profiles.

For individuals with persistent, unexplained high cholesterol, a sleep study may be warranted to check for OSA. Early diagnosis and treatment, such as continuous positive airway pressure (CPAP), can improve both sleep quality and cholesterol levels.

9. Certain Medications

Several commonly prescribed medications can inadvertently raise cholesterol levels as a side effect. Notable examples include corticosteroids (such as prednisone), certain antipsychotics (like olanzapine and quetiapine), and some beta-blockers used for heart conditions. These drugs can affect lipid metabolism by increasing the production of LDL (“bad”) cholesterol and triglycerides, or by lowering HDL (“good”) cholesterol. As detailed by the Cleveland Clinic, medication-induced hyperlipidemia is a frequent and often overlooked contributor to abnormal cholesterol levels.

A real-world example involves a patient with asthma who began long-term corticosteroid therapy and subsequently experienced a marked increase in cholesterol and triglyceride levels, despite no changes in diet or lifestyle. After a medication review, her healthcare provider adjusted her treatment plan and introduced cholesterol-lowering therapies, resulting in improved lipid levels.

If you are taking medications known to influence cholesterol, it is important to discuss these risks with your healthcare provider. Regular medication reviews allow for early identification of side effects, and potential adjustments or alternative therapies can be explored to help maintain a healthy cholesterol profile while still effectively managing the underlying condition.

10. Chronic Stress

Chronic stress is a frequently underestimated factor that can lead to higher cholesterol levels. When a person is under prolonged stress, the body releases increased amounts of stress hormones such as cortisol and adrenaline. Elevated cortisol, in particular, has been shown to stimulate the production of cholesterol and triglycerides in the liver. According to research published by the National Institutes of Health, individuals with chronic psychological stress often exhibit significantly higher total cholesterol and LDL (“bad”) cholesterol compared to those with lower stress levels.

Workplace stress provides a clear real-world example: employees in high-pressure jobs, such as those in finance or healthcare, commonly report elevated cholesterol levels despite maintaining healthy diets and exercise routines. A study in Occupational Medicine found a strong association between job-related stress and unfavorable lipid profiles, highlighting the physiological impact of psychological strain.

To support heart health, it’s important to incorporate stress management techniques such as mindfulness, regular physical activity, and adequate sleep. Recognizing and addressing chronic stress not only benefits overall well-being but can also help maintain healthier cholesterol levels and reduce cardiovascular risk.

11. Excessive Alcohol Intake

Excessive alcohol consumption is a significant but often overlooked contributor to unhealthy cholesterol profiles. Regular heavy drinking can raise triglyceride levels and, in some cases, increase LDL (“bad”) cholesterol. Alcohol is metabolized in the liver, and high intake can interfere with the liver’s ability to process fats, leading to the accumulation of triglycerides in the bloodstream. According to the American Heart Association, excessive alcohol use is directly linked to elevated cholesterol and greater risk of heart disease.

A practical scenario involves individuals who engage in binge drinking on weekends. Even if they abstain during the week and follow a healthy diet, episodes of heavy drinking can cause sudden spikes in triglyceride and LDL cholesterol levels. Over time, this pattern increases the risk of developing fatty liver disease and cardiovascular complications. Research published in Nutrients confirms the association between high alcohol intake and disrupted lipid metabolism.

For optimal heart health, moderating alcohol consumption—or abstaining altogether if at risk—is recommended. Limiting intake not only supports healthy cholesterol but also reduces the likelihood of other alcohol-related health problems.

12. Smoking (Including Vaping)

Smoking, including the use of electronic cigarettes (vaping), is a major risk factor for elevated cholesterol and cardiovascular disease. The chemicals found in tobacco products, such as nicotine and carbon monoxide, damage the inner lining of blood vessels, making it easier for cholesterol to build up as plaque. This process not only increases LDL (“bad”) cholesterol but also lowers HDL (“good”) cholesterol, further raising the risk of atherosclerosis and heart attack. According to the Centers for Disease Control and Prevention, smokers are significantly more likely to have unhealthy cholesterol levels compared to non-smokers.

Comparative studies, such as one published in Circulation: Cardiovascular Quality and Outcomes, consistently show that smokers have higher total cholesterol and LDL cholesterol, and lower HDL cholesterol, than their non-smoking peers. Vaping is not a safe alternative; e-cigarettes also contain substances that harm blood vessels and disrupt lipid metabolism.

Quitting smoking or vaping can rapidly improve cholesterol levels and overall heart health. Support programs, professional counseling, and nicotine replacement therapies are available to help individuals successfully quit, offering substantial long-term cardiovascular benefits.

13. Sedentary Lifestyle

A sedentary lifestyle is a major contributor to unhealthy cholesterol profiles, particularly low HDL (“good”) cholesterol and elevated LDL (“bad”) cholesterol. Lack of regular physical activity slows down the body’s metabolism, decreases the efficiency of fat processing, and encourages the buildup of cholesterol in the bloodstream. According to the Centers for Disease Control and Prevention, adults who engage in little to no physical activity are at a much higher risk for developing high cholesterol and heart disease compared to their more active counterparts.

Studies have consistently demonstrated that active individuals tend to have higher HDL cholesterol and lower LDL cholesterol than those who are sedentary, even when dietary habits are similar. For example, research featured in the journal Circulation highlights the positive impact of just moderate exercise on cholesterol levels and cardiovascular health.

Incorporating regular movement—such as brisk walking, cycling, or swimming—into daily routines can significantly improve lipid profiles and reduce cardiovascular risk. Even small increases in physical activity can yield meaningful health benefits, making regular exercise a key strategy for cholesterol management.

14. Ultra-Processed Foods

Ultra-processed foods, which include packaged snacks, sugary cereals, fast food, and baked goods, are often high in trans fats, added sugars, and artificial ingredients. Trans fats, in particular, are notorious for raising LDL (“bad”) cholesterol and lowering HDL (“good”) cholesterol, significantly increasing the risk of heart disease. These unhealthy fats are commonly found in margarine, fried foods, and many processed baked products. The Harvard T.H. Chan School of Public Health warns that even small amounts of trans fats in ultra-processed foods can have a substantial negative impact on cholesterol levels.

A large-scale study published in the BMJ found a direct correlation between higher consumption of ultra-processed foods and an increased risk of cardiovascular events, including elevated cholesterol and heart attacks. The study emphasized that individuals who consumed the most ultra-processed foods had a significantly higher risk of developing heart problems than those who ate mostly whole, unprocessed foods.

To protect heart health and manage cholesterol, it’s important to read food labels carefully and limit intake of products containing trans fats, hydrogenated oils, and excessive additives. Choosing minimally processed, whole foods can make a meaningful difference in cholesterol management and overall well-being.

15. Sleep Deprivation

Sleep deprivation is an often underestimated factor in the regulation of cholesterol and overall lipid metabolism. Inadequate sleep disrupts the body’s hormonal balance, increasing stress hormones like cortisol, which in turn can lead to higher LDL (“bad”) cholesterol and triglycerides, and lower HDL (“good”) cholesterol. According to the Sleep Foundation, chronic sleep loss impairs the liver’s ability to process fats, contributing to unhealthy cholesterol profiles and a higher risk of cardiovascular disease.

Research comparing shift workers—who frequently experience irregular sleep patterns and sleep deprivation—with individuals who maintain regular sleep schedules, reveals a clear difference in cholesterol levels. A study published in the Journal of Clinical Lipidology found that shift workers had significantly higher LDL cholesterol and lower HDL cholesterol than their well-rested counterparts, even after accounting for factors like diet and physical activity.

Prioritizing sufficient, high-quality sleep is essential for maintaining healthy cholesterol and supporting overall heart health. Establishing a consistent sleep routine and addressing sleep disorders can play a critical role in cholesterol management and the prevention of cardiovascular disease.

16. Chronic Infections

Chronic infections can significantly impact cholesterol metabolism by triggering ongoing inflammation in the body. Persistent infections activate the immune system, leading to the release of inflammatory markers and cytokines that alter how the liver processes and transports cholesterol. This can result in higher LDL (“bad”) cholesterol, lower HDL (“good”) cholesterol, and increased triglycerides. According to the National Institutes of Health, chronic inflammation is a key driver of atherogenic lipid changes, even in individuals without traditional cardiovascular risk factors.

A clear example involves patients with HIV or chronic hepatitis C virus (HCV) infection. Research in CDC HIV Basics and the World Journal of Gastroenterology shows that both HIV and HCV can disrupt lipid profiles, resulting in abnormal cholesterol and higher cardiovascular risk. These changes may persist even with antiretroviral or antiviral therapy, underscoring the importance of comprehensive care.

Addressing and treating underlying infections is crucial not only for managing the primary condition but also for restoring healthier cholesterol levels. Regular monitoring and appropriate therapy can help reduce inflammation and improve lipid metabolism in those affected by chronic infections.

17. Autoimmune Diseases

Autoimmune diseases such as systemic lupus erythematosus (lupus) can profoundly affect cholesterol metabolism and increase cardiovascular risk. Chronic inflammation caused by autoimmune activity disrupts normal lipid processing, often resulting in higher LDL (“bad”) cholesterol, elevated triglycerides, and lower HDL (“good”) cholesterol. According to the Lupus Foundation of America, individuals with lupus and similar autoimmune disorders have a significantly greater risk of developing heart disease, even at a younger age.

A patient story published in the Journal of Clinical Lipidology details the journey of a young woman with lupus who developed persistently high cholesterol despite lifestyle changes. Her care team discovered that both the disease process and the corticosteroid medication used to control her symptoms contributed to her abnormal lipid profile. With regular cholesterol monitoring and targeted therapy—including changes to her medication regimen—she was able to achieve better cholesterol control and reduce her cardiovascular risk.

For those living with autoimmune diseases, regular lipid screenings are essential. Proactive cholesterol management, alongside treatment for the underlying autoimmune condition, can help lower the risk of heart complications and support long-term health.

18. High-Sugar Diets

High-sugar diets are a significant but sometimes overlooked contributor to elevated cholesterol and triglyceride levels. Consuming large amounts of added sugars—found in sweetened beverages, desserts, and processed snacks—can lead to higher triglycerides and increase LDL (“bad”) cholesterol while reducing HDL (“good”) cholesterol. The American Heart Association warns that excessive sugar intake promotes fat production in the liver, which then raises blood triglyceride levels and contributes to heart disease risk.

Research published in JAMA compared individuals following high-sugar diets to those who consumed less added sugar. The study found that participants on high-sugar diets had significantly higher triglyceride levels and lower HDL cholesterol, regardless of their overall fat intake or body weight. These results underscore the impact of sugar on lipid metabolism and cardiovascular health.

To protect your heart and maintain healthier cholesterol levels, it’s recommended to reduce the consumption of sugary foods and drinks. Focusing on whole fruits, vegetables, and minimally processed foods can help keep triglycerides and cholesterol in check, while supporting overall well-being.

19. Vitamin D Deficiency

Vitamin D deficiency has emerged as a potential contributor to unhealthy cholesterol profiles and increased cardiovascular risk. Low levels of vitamin D have been associated with higher LDL (“bad”) cholesterol and triglycerides, as well as lower HDL (“good”) cholesterol. Researchers believe that vitamin D may help regulate lipid metabolism and reduce inflammation, which are both critical for maintaining heart health. The Cleveland Clinic notes that people with low vitamin D often experience less favorable cholesterol levels.

A clinical study published in the American Journal of Clinical Nutrition found that vitamin D supplementation led to modest improvements in cholesterol and triglyceride levels among participants with baseline vitamin D deficiency. While the benefits varied depending on the individual, the findings suggest that correcting deficiency may support better lipid profiles and reduce cardiovascular risk.

For those at risk of vitamin D deficiency—such as individuals with limited sun exposure or certain medical conditions—regular testing is recommended. Supplementation or dietary adjustments to raise vitamin D levels can be a simple yet effective strategy for improving cholesterol and supporting overall cardiovascular health.

20. Gut Microbiome Imbalance

The gut microbiome, composed of trillions of bacteria and other microorganisms, plays a vital role in regulating cholesterol absorption and metabolism. An imbalance in gut bacteria—often caused by poor diet, antibiotics, or illness—can increase the absorption of cholesterol from the digestive tract and interfere with its breakdown, leading to higher blood cholesterol levels. According to the National Institutes of Health, specific gut bacteria produce compounds that help remove cholesterol from the body, while others may promote its accumulation.

Recent research published in the European Journal of Clinical Nutrition found that taking probiotics—beneficial bacteria supplements—can improve lipid profiles by reducing LDL (“bad”) cholesterol and increasing HDL (“good”) cholesterol in some individuals. These effects are attributed to the ability of certain probiotics to break down bile acids and limit cholesterol absorption in the gut.

Supporting gut health is an emerging strategy for cholesterol management. Consuming a diet rich in fiber, fermented foods, and prebiotics, as well as considering probiotics, can help maintain a healthy microbiome and support optimal cholesterol regulation.

21. Anabolic Steroid Use

Anabolic steroids, often used by bodybuilders and athletes to enhance muscle growth and performance, can have a profound negative impact on cholesterol levels. These synthetic hormones disrupt normal lipid metabolism by significantly raising LDL (“bad”) cholesterol and lowering HDL (“good”) cholesterol, which accelerates the development of atherosclerosis and increases cardiovascular risk. According to the Centers for Disease Control and Prevention, anabolic steroid use is associated with a markedly higher risk of adverse heart events due to these changes.

Real-world sports doping cases have highlighted these risks. For example, a study in the British Journal of Sports Medicine examined athletes who used anabolic steroids and found that their LDL cholesterol levels were significantly higher, while HDL levels were lower compared to non-users. These lipid abnormalities persisted even after discontinuing steroids, underscoring the long-term risks associated with unsupervised use.

Given these dangers, unsupervised or recreational use of anabolic steroids is strongly discouraged. Individuals considering or currently using anabolic steroids should seek medical advice and understand the significant cardiovascular risks associated with these substances, prioritizing safer, evidence-based approaches to fitness and performance.

22. Hormonal Contraceptives

Hormonal contraceptives, particularly certain birth control pills, can influence cholesterol levels in women. These medications typically contain synthetic estrogen and progestin, which may alter lipid metabolism. In some women—especially those who are genetically predisposed or have other risk factors—oral contraceptives can lead to increased LDL (“bad”) cholesterol and triglycerides, while sometimes lowering HDL (“good”) cholesterol. The National Institutes of Health notes that the extent of these changes varies depending on the hormonal formulation and individual sensitivity.

Comparisons between different types of pills reveal that those with higher estrogen content or certain progestins tend to have a greater impact on lipid profiles. For example, combined oral contraceptives are more likely to raise cholesterol levels than progestin-only pills. A study published in the journal Circulation found that women using newer, lower-dose contraceptive pills generally experienced milder effects on cholesterol than those using older, higher-dose formulations.

It’s advisable for women using hormonal contraceptives—especially those with a personal or family history of high cholesterol—to have their lipid levels monitored regularly. Discussing contraceptive options with a healthcare provider can help minimize any adverse impact on heart health.

23. Rapid Weight Loss

Rapid weight loss, often achieved through crash diets or very low-calorie regimens, can paradoxically lead to a temporary rise in cholesterol levels. When the body loses weight quickly, it breaks down fat stores at a high rate, releasing fatty acids into the bloodstream. This process prompts the liver to convert these fatty acids into cholesterol, elevating both LDL (“bad”) cholesterol and total cholesterol. According to the Mayo Clinic, these changes are usually transient and cholesterol levels often normalize with sustained, healthy weight loss.

Comparing gradual and rapid weight loss, research published in The American Journal of Clinical Nutrition found that individuals who lost weight slowly and steadily experienced more favorable and stable improvements in their cholesterol profiles than those who lost weight abruptly. Gradual weight loss allows the body to adjust and process fats more efficiently, reducing the risk of sharp cholesterol increases.

For optimal heart health, it is recommended to pursue weight management under professional supervision and to aim for gradual, consistent progress rather than extreme or rapid loss. This approach supports both sustainable results and healthier cholesterol levels.

24. Pregnancy

During pregnancy, it is normal for cholesterol levels to rise as part of the body’s adaptation to support fetal growth and development. Increased estrogen and other hormonal changes stimulate the liver to produce more cholesterol, which is essential for building cell membranes and producing hormones for both the mother and the developing baby. According to the National Institutes of Health, total cholesterol, LDL (“bad”) cholesterol, and triglycerides naturally increase, especially in the second and third trimesters.

When comparing cholesterol levels before, during, and after pregnancy, studies show a marked rise during gestation, followed by a gradual normalization several weeks to months postpartum. Research published in Circulation indicates that these physiological changes are typically temporary and resolve after delivery. However, extremely high cholesterol during pregnancy may signal underlying metabolic issues that warrant further evaluation.

Routine lipid monitoring during pregnancy can help distinguish between normal physiological changes and potential concerns. Healthcare providers can offer guidance on maintaining healthy cholesterol and managing any risks, ensuring both maternal and fetal well-being throughout pregnancy and beyond.

25. Cushing’s Syndrome

Cushing’s Syndrome is a rare endocrine disorder characterized by prolonged exposure to high levels of cortisol, a stress hormone. Excess cortisol disrupts normal lipid metabolism by stimulating the liver to produce more cholesterol and triglycerides while impairing the removal of LDL (“bad”) cholesterol from the bloodstream. As a result, individuals with Cushing’s Syndrome are at increased risk for elevated cholesterol, atherosclerosis, and cardiovascular disease. The Endocrine Society highlights abnormal lipid profiles as a common complication of this condition.

A case study published in the World Journal of Endocrine Surgery reported a patient with persistent high cholesterol, weight gain, and classic Cushingoid features such as a rounded face and abdominal fat. After extensive evaluation, the patient was diagnosed with Cushing’s Syndrome. Targeted treatment led to normalization of both cortisol and cholesterol levels, demonstrating the direct link between cortisol excess and lipid abnormalities.

If high cholesterol occurs alongside symptoms like rapid weight gain, muscle weakness, or easy bruising, it’s important to consider testing for Cushing’s Syndrome. Early diagnosis and management can improve both cholesterol levels and overall health outcomes.

26. Certain Cancers

Certain cancers can profoundly disrupt the body’s metabolism, including the regulation of cholesterol and other blood lipids. Tumors may alter hormone levels, trigger inflammatory responses, or directly affect organs such as the liver, all of which can lead to abnormal cholesterol profiles. According to the National Cancer Institute, metabolic disturbances are common in cancer patients and can impact cholesterol metabolism even before treatment begins.

A notable example is lymphoma, a cancer of the lymphatic system. Research published in the Journal of Clinical Medicine documents cases where patients with lymphoma developed significant changes in cholesterol and triglyceride levels. These lipid abnormalities often resolved or improved with successful cancer treatment, further confirming the metabolic link. Other malignancies, particularly those affecting the liver or endocrine system, may also contribute to elevated or altered cholesterol.

For individuals living with or recovering from chronic cancer, routine cholesterol monitoring is recommended. Early detection of lipid disturbances allows for timely intervention, which can help reduce cardiovascular risks and support overall health during and after cancer care.

27. Overuse of Coconut Oil

Coconut oil has gained popularity as a health food, but its high saturated fat content can contribute to increased cholesterol levels if consumed in excess. Unlike unsaturated fats found in oils like olive oil, the saturated fats in coconut oil raise LDL (“bad”) cholesterol—a key risk factor for heart disease. According to the Harvard T.H. Chan School of Public Health, multiple studies have shown that coconut oil significantly elevates LDL cholesterol compared to oils low in saturated fats.

Comparative research published in the BMJ found that while coconut oil may raise HDL (“good”) cholesterol more than some other fats, it also increases LDL and total cholesterol more than olive oil or vegetable oils. Olive oil, rich in monounsaturated fats, has a well-established record of improving lipid profiles and reducing cardiovascular risk, making it a healthier choice for regular use.

To protect your heart and cholesterol levels, it’s best to use coconut oil in moderation and favor oils with proven cardiovascular benefits, such as olive oil. Reading nutrition labels and varying fat sources can help maintain a balanced and heart-healthy diet.

28. Environmental Pollutants

Long-term exposure to environmental pollutants, such as air pollution and certain industrial chemicals, has been linked to increased cholesterol levels and greater cardiovascular risk. Fine particulate matter (PM2.5), ozone, and toxic substances found in polluted air can trigger inflammation and oxidative stress in the body, disrupting normal lipid metabolism. Research highlighted by the U.S. Environmental Protection Agency (EPA) shows that areas with poorer air quality often experience higher rates of heart and metabolic diseases, including conditions related to abnormal cholesterol.

Numerous studies have associated elevated cholesterol and triglycerides with exposure to air pollution and chemicals such as polychlorinated biphenyls (PCBs) or heavy metals. For example, a review in the International Journal of Environmental Research and Public Health documented higher LDL (“bad”) cholesterol in populations living near major highways or industrial zones compared to those in cleaner environments.

To reduce risk, individuals can monitor local air quality using resources like the EPA’s AirNow and limit outdoor activity on days with high pollution. Minimizing exposure to industrial chemicals and supporting policies for cleaner air can help safeguard both cholesterol levels and long-term heart health.

29. Low Fiber Intake

Dietary fiber, especially soluble fiber, plays a crucial role in lowering cholesterol by binding to cholesterol molecules in the digestive tract and promoting their excretion. Without adequate fiber, the body reabsorbs more cholesterol, leading to higher LDL (“bad”) cholesterol levels. According to the American Heart Association, individuals who consume diets low in fiber are at greater risk for elevated cholesterol and related cardiovascular issues.

Comparative dietary studies consistently show that people with higher fiber intake—primarily from whole grains, fruits, and vegetables—have healthier cholesterol profiles than those whose diets are low in fiber. Research published in the Nutrition Journal found that increasing daily fiber intake by as little as 5-10 grams can significantly reduce LDL cholesterol, independent of other dietary changes.

To improve cholesterol levels and overall heart health, it is recommended to incorporate more whole grains, fruits, vegetables, legumes, and nuts into daily meals. Gradually increasing fiber intake and choosing minimally processed foods can make a substantial difference in promoting cholesterol excretion and supporting cardiovascular wellness.

30. Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that occur together, significantly raising the risk of heart disease, stroke, and type 2 diabetes. It is defined by the presence of at least three of the following risk factors: high blood pressure, elevated fasting blood sugar, excess abdominal fat, high triglycerides, and low HDL (“good”) cholesterol. According to the Centers for Disease Control and Prevention (CDC), metabolic syndrome is increasingly common and closely tied to both obesity and unhealthy cholesterol levels.

A typical patient scenario involves an individual with a sedentary lifestyle who develops abdominal obesity, borderline high blood pressure, and abnormal cholesterol levels during routine health screening. Over time, these risk factors interact to accelerate atherosclerosis and increase cardiovascular risk. Research published in the Journal of the American College of Cardiology emphasizes the importance of early identification and intervention in patients with metabolic syndrome to prevent long-term complications.

Comprehensive risk management—including lifestyle changes, weight loss, blood sugar regulation, and cholesterol-lowering strategies—is essential for individuals with metabolic syndrome. Working with healthcare professionals to address all risk factors can dramatically reduce the likelihood of serious cardiovascular events.

31. Bile Acid Malabsorption

Bile acids, produced in the liver from cholesterol, are essential for digesting fats and are normally reabsorbed in the intestine and recycled. When this recycling process is disrupted—a condition known as bile acid malabsorption—cholesterol metabolism can be adversely affected, potentially leading to cholesterol buildup in the blood. Impaired bile acid reabsorption means the liver must use even more cholesterol to replace lost bile acids, but if the digestive tract is also compromised, this balance can be lost, resulting in abnormal cholesterol levels. The Guts UK Charity explains that such malabsorption is often linked to disorders like Crohn’s disease, celiac disease, or after certain bowel surgeries.

For example, a patient with Crohn’s disease who underwent surgery to remove a portion of the small intestine developed bile acid malabsorption and subsequently experienced a rise in LDL (“bad”) cholesterol. This scenario, reported in the World Journal of Gastroenterology, underscores the connection between digestive disorders and altered cholesterol handling.

Individuals with digestive symptoms and unexplained high cholesterol should consider consulting a gastroenterologist. Proper diagnosis and management of bile acid malabsorption can help restore cholesterol balance and improve both digestive and cardiovascular health.

32. Overconsumption of Red Meat

Eating excessive amounts of red meat, such as beef, pork, and lamb, is a well-established contributor to elevated cholesterol levels. Red meat is typically high in saturated fat, which raises LDL (“bad”) cholesterol and increases the risk of heart disease when consumed frequently. According to the American Heart Association, diets high in red meat are linked to higher rates of heart attack and stroke, mainly due to their impact on blood lipid profiles.

Dietary swap studies have shown that replacing red meat with healthier protein sources—such as fish, poultry, beans, and lentils—can lead to significant improvements in cholesterol levels. For example, research published in the BMJ demonstrated that individuals who substituted red meat with plant-based proteins experienced lower LDL cholesterol and reduced cardiovascular risk over time.

To support optimal heart health, it is advisable to limit red meat consumption and focus on leaner or plant-based proteins. Moderation, along with a balanced diet rich in fruits, vegetables, and whole grains, can help manage cholesterol and reduce long-term health risks.

33. Certain Antidepressants

Some antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), have been found to influence cholesterol and overall lipid profiles. These drugs may increase triglyceride and LDL (“bad”) cholesterol levels or decrease HDL (“good”) cholesterol, especially with long-term use. The National Institutes of Health reports that metabolic side effects are more frequently observed with certain TCAs and SSRIs such as paroxetine.

A real-world example involves a patient treated with amitriptyline, a common TCA, for chronic depression. Despite a stable diet and physical activity, her cholesterol levels rose significantly several months after starting the medication. Upon routine bloodwork, her physician identified the change and implemented regular cholesterol monitoring as part of her ongoing treatment plan. Adjustments to her antidepressant regimen, combined with dietary interventions, eventually helped restore healthier lipid levels.

For individuals prescribed antidepressants, especially those with other cardiovascular risk factors, periodic cholesterol and lipid screenings are recommended. Regular monitoring allows healthcare providers to balance mental health needs with cardiovascular safety, ensuring comprehensive and individualized care.

34. Plant-Based Diets Low in Omega-3

While plant-based diets are generally heart-healthy, those that lack sufficient omega-3 fatty acids may not optimally support cholesterol management. Omega-3s, particularly EPA and DHA found in fish, play a crucial role in lowering triglycerides and improving overall lipid profiles. Many strict vegan or vegetarian diets can be low in these long-chain omega-3s, as plant sources like flaxseed, chia seeds, and walnuts provide only ALA, which the body converts inefficiently to EPA and DHA. The National Institutes of Health notes that low omega-3 intake can be a hidden factor affecting cholesterol and heart health in plant-based eaters.

Comparative research published in the BMJ Nutrition, Prevention & Health found that while vegans often have lower LDL (“bad”) cholesterol than omnivores, they may also experience higher triglycerides and lower HDL (“good”) cholesterol if their diets are low in omega-3s.

To optimize cholesterol on a plant-based diet, it’s important to include omega-3-rich foods such as flaxseed, chia seeds, hemp seeds, walnuts, and consider algae-based omega-3 supplements, which provide direct sources of EPA and DHA suitable for vegans and vegetarians.

35. Chronic Pain

Chronic pain conditions can contribute to elevated cholesterol levels by increasing the body’s production of stress hormones such as cortisol and adrenaline. Persistent pain signals stimulate the hypothalamic-pituitary-adrenal (HPA) axis, leading to long-term hormonal imbalance that disrupts lipid metabolism. This stress response may raise LDL (“bad”) cholesterol and triglycerides while lowering HDL (“good”) cholesterol, heightening cardiovascular risk. The National Institutes of Health highlights the connection between chronic pain, inflammation, and metabolic changes that impact heart health.

A notable example is seen in individuals with fibromyalgia, a chronic pain disorder. Research published in Pain Research & Management found that patients with fibromyalgia often have higher cholesterol and triglyceride levels compared to healthy controls. These changes are attributed not only to pain-induced hormonal shifts but also to decreased physical activity and disrupted sleep, both common in chronic pain syndromes.

Comprehensive pain management—including physical therapy, lifestyle changes, medication, and psychological support—is essential for individuals living with chronic pain. Addressing pain holistically may help normalize stress hormone levels, improve cholesterol profiles, and promote overall well-being.

36. Dehydration

Dehydration, or inadequate fluid intake, can lead to the concentration of various substances in the blood, including cholesterol. When the body loses water—due to insufficient drinking, excessive sweating, or illness—the blood becomes more viscous, resulting in temporarily higher measured cholesterol levels. According to the National Institutes of Health, dehydration can affect laboratory tests and may give a misleading impression of chronic hypercholesterolemia.

For example, during a heatwave, individuals who do not maintain adequate hydration may notice elevated cholesterol readings at their next routine blood test. A case highlighted in Mayo Clinic resources described a patient with unexpectedly high cholesterol during a period of intense summer heat, which normalized after the patient increased water intake and rehydrated.

To ensure accurate cholesterol assessments and support overall health, it is essential to maintain adequate daily hydration, especially during hot weather, illness, or periods of increased activity. Drinking water regularly throughout the day helps keep blood volume optimal and supports the body’s natural cholesterol regulation processes.

37. Low Testosterone in Men

Testosterone, the primary male sex hormone, plays a significant role in regulating lipid metabolism and maintaining healthy cholesterol levels. Low testosterone, or hypogonadism, has been linked to unfavorable changes in cholesterol profiles—specifically, increased LDL (“bad”) cholesterol and triglycerides, and decreased HDL (“good”) cholesterol. The National Institutes of Health reports that men with low testosterone are at higher risk for metabolic syndrome and cardiovascular disease, partially due to these lipid disturbances.

Clinical cases, such as those documented in the journal Circulation: Cardiovascular Quality and Outcomes, show that men presenting with symptoms of fatigue, reduced libido, and muscle loss often have both low testosterone and elevated cholesterol. In some instances, testosterone therapy has been associated with improvements in cholesterol profiles, though it must be prescribed and monitored by a healthcare professional due to potential risks.

Men experiencing symptoms of low testosterone along with unexplained high cholesterol should consider hormone testing as part of a comprehensive health evaluation. Addressing hormonal imbalances through lifestyle changes or medical therapy can support both cardiovascular and overall well-being.

38. Chronic Use of Antiretroviral Drugs

Long-term use of antiretroviral drugs, which are essential for managing HIV infection, can have significant effects on lipid metabolism and cholesterol levels. Certain classes of antiretrovirals, particularly protease inhibitors and some older medications, are known to raise LDL (“bad”) cholesterol, total cholesterol, and triglycerides, while sometimes lowering HDL (“good”) cholesterol. According to the Centers for Disease Control and Prevention, these changes can increase the risk of heart disease for people living with HIV, even when the virus is well controlled.

A clinical study published in the Journal of Antimicrobial Chemotherapy found that patients on long-term antiretroviral therapy were more likely to develop abnormal lipid profiles compared to HIV-negative controls. The risk was highest among those using protease inhibitors, but newer drug regimens may have a milder impact on cholesterol.

Regular cholesterol monitoring is strongly recommended for anyone on chronic antiretroviral therapy. Working closely with healthcare providers to adjust treatments, manage diet, and incorporate exercise can help reduce cardiovascular risk while maintaining effective HIV control.

39. Certain Antiepileptic Drugs

Certain antiepileptic drugs (AEDs), commonly prescribed to manage seizure disorders, have been shown to adversely affect cholesterol and lipid metabolism. Medications such as carbamazepine, phenytoin, and valproic acid may increase LDL (“bad”) cholesterol and triglyceride levels, while some may also lower HDL (“good”) cholesterol. According to the National Institutes of Health, these effects are more pronounced with older, enzyme-inducing AEDs.

Real-world examples include patients with epilepsy who experience rising cholesterol levels after starting long-term antiepileptic therapy. A study published in the Journal of the Neurological Sciences found that adults on carbamazepine or phenytoin had significantly elevated lipid profiles compared to those not on AEDs, independent of diet or exercise habits. In some cases, switching to newer antiepileptic medications with a lower risk of dyslipidemia led to improvements in cholesterol levels.

Patients taking antiepileptic drugs should discuss cholesterol and cardiovascular risks with their neurologist. Regular lipid monitoring and exploring alternative medications or additional therapies may help minimize the cardiovascular side effects while maintaining effective seizure control.

40. Chronic Inflammatory Diseases

Chronic inflammatory diseases, such as rheumatoid arthritis (RA), psoriasis, and inflammatory bowel disease, can significantly influence cholesterol levels and overall heart health. Persistent inflammation alters lipid metabolism, often resulting in increased LDL (“bad”) cholesterol, decreased HDL (“good”) cholesterol, and higher triglycerides. This pro-inflammatory state accelerates the development of atherosclerosis, raising the risk of cardiovascular events even in the absence of traditional risk factors. The American College of Rheumatology highlights that individuals with RA are up to twice as likely to develop heart disease compared to the general population.

A key study published in the Annals of the Rheumatic Diseases demonstrated that patients with active RA had more pronounced abnormalities in cholesterol profiles compared to those in remission. Effective treatment of the underlying inflammation, such as through disease-modifying antirheumatic drugs (DMARDs) or biologics, contributed to improved lipid levels and reduced cardiovascular risk.

Coordinated care between rheumatologists, cardiologists, and primary care providers is essential for patients with chronic inflammatory diseases. Regular lipid monitoring and aggressive management of inflammation can help protect both joint and cardiovascular health.

41. Dietary Cholesterol Sensitivity

While dietary cholesterol has a modest effect on blood cholesterol for most people, a subset known as “hyper-responders” experiences significant increases in LDL (“bad”) cholesterol when consuming cholesterol-rich foods such as eggs, shellfish, and organ meats. Genetics play a major role in determining whether someone is sensitive to dietary cholesterol. According to the National Institutes of Health, hyper-responders absorb more cholesterol from food and have less efficient regulatory mechanisms, resulting in greater changes to their lipid profiles compared to typical individuals.

Studies comparing hyper-responders to people with average cholesterol metabolism show that while most individuals experience minimal increases in blood cholesterol after eating foods high in cholesterol, hyper-responders can see marked rises in both LDL and total cholesterol. Research published in The American Journal of Clinical Nutrition found that about 25% of people fall into this sensitive group.

For those who notice significant cholesterol changes after consuming certain foods, individualized nutrition plans are recommended. Working with a healthcare provider or registered dietitian can help tailor dietary choices to optimize cholesterol management and overall cardiovascular health.

42. Lack of Sunlight Exposure

Insufficient sunlight exposure is a common cause of vitamin D deficiency, which has been linked to unfavorable cholesterol profiles and increased cardiovascular risk. Sunlight triggers the skin’s production of vitamin D, a nutrient important for regulating cholesterol metabolism. When sunlight is scarce—such as during winter months or in northern latitudes—vitamin D levels can drop, potentially leading to higher LDL (“bad”) cholesterol and lower HDL (“good”) cholesterol. The National Institutes of Health highlights this connection, noting the importance of both sun and diet for maintaining adequate vitamin D status.

For instance, people living in regions with limited sunlight, such as Scandinavia or northern Canada, often experience higher rates of vitamin D deficiency, especially in winter. A study published in the American Journal of Medicine found that residents of northern latitudes were more likely to have both low vitamin D and increased cholesterol, which improved with supplementation or seasonal sun exposure.

To support healthy cholesterol and vitamin D levels, aim for safe, regular sun exposure and consider vitamin D supplements during periods of low sunlight. Discussing individual needs with a healthcare provider ensures optimal heart and metabolic health throughout the year.

43. Aging

Aging is a natural factor that contributes to rising cholesterol levels, even in individuals who maintain healthy lifestyles. As the body ages, metabolic processes slow down and the liver becomes less efficient at removing LDL (“bad”) cholesterol from the bloodstream. Hormonal changes, such as declining estrogen in women and testosterone in men, further affect cholesterol regulation. According to the Centers for Disease Control and Prevention (CDC), the prevalence of high cholesterol increases steadily with age, particularly after age 40.

Comparative studies show that adults in their 40s and 50s typically have higher total cholesterol and LDL cholesterol than younger age groups. For example, research published in the journal Circulation: Cardiovascular Quality and Outcomes found a marked rise in cholesterol levels between the ages of 20 and 60, with the steepest increases occurring in midlife.

Given these age-related changes, it’s important to increase the frequency of cholesterol screening and cardiovascular risk assessment after age 40. Early detection allows for timely intervention, supporting heart health as part of healthy aging.

44. Chronic Use of Immunosuppressants

Chronic use of immunosuppressant medications—such as corticosteroids, cyclosporine, or tacrolimus—is often necessary for individuals with autoimmune diseases or those who have undergone organ transplantation. However, these drugs can disrupt lipid metabolism and significantly increase cholesterol and triglyceride levels. According to the National Institutes of Health, immunosuppressants may increase the production of LDL (“bad”) cholesterol while impairing its clearance from the bloodstream, thereby raising cardiovascular risk.

Clinical examples include transplant recipients who develop hyperlipidemia after starting long-term immunosuppressive therapy. A study published in the journal Kidney International reported that patients on cyclosporine or tacrolimus frequently experienced elevated cholesterol and triglycerides, necessitating additional lipid-lowering therapy.

For those taking immunosuppressants, regular monitoring of blood lipids is essential to detect and manage emerging cholesterol problems early. Coordinated care between specialists ensures that both immune health and cardiovascular risk are addressed, allowing for necessary treatment while minimizing long-term complications.

45. Chemotherapy

Chemotherapy, a cornerstone of cancer treatment, can have unintended effects on cholesterol and overall lipid metabolism. Certain chemotherapy agents—such as corticosteroids, asparaginase, and some targeted therapies—can raise LDL (“bad”) cholesterol and triglyceride levels, sometimes significantly. These changes may be temporary or persist long after treatment ends, depending on the drug regimen and individual response. The American Cancer Society notes that abnormal lipid profiles are a recognized side effect of several cancer treatments.

Patient experiences frequently highlight these effects. For instance, individuals receiving chemotherapy for lymphoma or leukemia often report unexpected spikes in cholesterol, even when diet and activity remain unchanged. A study published in the Journal of Clinical Lipidology described cancer patients who developed hyperlipidemia during therapy, sometimes requiring additional lipid-lowering medications to manage the risk.

Proactive cholesterol and lipid monitoring during chemotherapy is important for both short-term and long-term heart health. Discussing potential side effects with oncologists and coordinating care can help ensure that abnormal cholesterol levels are identified early and managed appropriately during cancer treatment.

46. Iron Overload (Hemochromatosis)

Iron overload, particularly in the context of hereditary hemochromatosis, can adversely affect cholesterol metabolism and cardiovascular health. Excess iron accumulates in organs such as the liver, where it causes tissue damage, inflammation, and impaired liver function. Since the liver plays a central role in cholesterol production and breakdown, iron-induced liver dysfunction can result in elevated LDL (“bad”) cholesterol and triglycerides. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) highlights this connection between iron overload and metabolic disturbances.

A clinical case reported in the Journal of Hepatology described a patient with hereditary hemochromatosis who developed high cholesterol and liver enzyme abnormalities. After diagnosis and treatment with therapeutic phlebotomy to reduce iron stores, both liver function and cholesterol levels improved, underscoring the link between iron overload and lipid metabolism.

Individuals with a family history of hemochromatosis or unexplained high cholesterol should consider both iron and cholesterol screening. Early detection and management of iron overload can help protect the liver and promote healthier cholesterol profiles, reducing the risk of long-term complications.

47. Severe Burns or Trauma

Severe burns or major trauma trigger an intense physiological stress response that can significantly elevate cholesterol and other lipid levels in the blood. This response includes the release of stress hormones such as cortisol and catecholamines, which increase the breakdown of fat stores and the production of cholesterol by the liver. According to the National Institutes of Health, patients with extensive burns or trauma often develop hyperlipidemia as part of the acute metabolic response to injury.

For example, a study published in Burns journal described patients admitted with severe burn injuries who experienced substantial increases in total cholesterol and triglyceride levels during the recovery period. These changes can persist for weeks or months, influenced by both the extent of injury and individual metabolic response.

Close monitoring of cholesterol and lipid profiles is recommended for individuals recovering from major trauma or burn injuries. Early identification and management of lipid abnormalities can help reduce the risk of secondary complications and support optimal healing and long-term cardiovascular health.

48. HIV Infection

HIV infection itself, independent of antiretroviral therapy, can lead to significant changes in cholesterol and lipid metabolism. The virus drives chronic inflammation and immune activation, which disrupt the normal processing of fats in the body. As a result, people living with HIV often experience elevated LDL (“bad”) cholesterol, increased triglycerides, and reduced HDL (“good”) cholesterol, even before starting treatment. According to the National Institutes of Health (NIH), this altered lipid profile contributes to a higher risk of cardiovascular disease in the HIV-positive population.

Research has shown that the presence of active HIV increases cytokine production and oxidative stress, both of which can impair liver function and worsen cholesterol management. For example, studies cited by the NIH highlight that untreated HIV is associated with more pronounced lipid abnormalities than those seen in the general population, further elevating cardiovascular risk.

Given these risks, regular cholesterol and lipid screenings are recommended for all individuals living with HIV, regardless of therapy status. Early detection and proactive management—including lifestyle changes and, when necessary, lipid-lowering medications—are essential parts of comprehensive HIV care to reduce long-term heart disease risk.

49. Eating Disorders

Eating disorders such as anorexia nervosa and bulimia nervosa can profoundly disrupt cholesterol metabolism, sometimes leading to unexpectedly high cholesterol levels despite low dietary intake. In anorexia, severe calorie restriction and malnutrition cause the body to break down fat stores for energy, which can increase LDL (“bad”) cholesterol and total cholesterol. Bulimia, characterized by cycles of bingeing and purging, can also result in erratic changes to lipid profiles due to metabolic stress and frequent fluctuations in nutrition. According to the National Institutes of Health, these cholesterol abnormalities are common in patients with active eating disorders.

A clinical case published in the International Journal of Eating Disorders described a young woman with anorexia nervosa who, despite consuming very little fat, had persistently high cholesterol. Upon nutritional rehabilitation and restoration of healthy eating patterns, her cholesterol levels normalized, highlighting the metabolic link between eating disorders and lipid imbalances.

Anyone struggling with an eating disorder should seek professional help as soon as possible. Early intervention can restore not only psychological well-being but also correct metabolic disturbances, including abnormal cholesterol, and reduce the risk of long-term health complications.

50. Certain Herbal Supplements

While many people turn to herbal supplements for their perceived health benefits, certain natural products can unpredictably affect cholesterol levels. Ingredients such as licorice root, ginseng, and some traditional Chinese medicine blends have been shown to interact with lipid metabolism, sometimes raising LDL (“bad”) cholesterol or causing other unwanted changes. For instance, licorice can cause fluid retention and increase cholesterol, while some ginseng products may alter fat absorption in the gut. An academic review published in Pharmacognosy Review notes that the effects of herbal supplements on cholesterol are highly variable and often depend on dosage, preparation, and individual response.

There have been reported cases of patients experiencing unexpected cholesterol increases after using certain herbal remedies for prolonged periods. These effects may go unnoticed since many supplements are not subject to the same regulatory scrutiny as prescription medications, and their interactions with existing treatments are not always well understood.

It is essential to disclose all herbal supplement use to healthcare providers, especially when managing cholesterol or other chronic health conditions. Open communication ensures that possible interactions or side effects are promptly identified, supporting safer and more effective health management.

Conclusion

Recognizing the many hidden causes of high cholesterol is crucial for effective prevention and treatment of cardiovascular disease. As highlighted by the CDC, high cholesterol often goes undetected until complications arise, underscoring the need for early identification. Regular screening, open communication with healthcare providers, and awareness of less obvious risk factors can lead to more accurate diagnoses and tailored prevention strategies. By embracing a personalized approach—addressing lifestyle, genetic, medical, and even environmental factors—individuals can significantly lower their risk of heart disease and improve overall well-being. Proactive management is the key to staying ahead of cholesterol-related health risks and supporting lifelong cardiovascular health.

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