Why do some people have high cholesterol and triglycerides? High levels may result from genetic makeup or lifestyle choices or both. Heredity may endow people with cells that do not remove LDL or VLDL cholesterol from the blood efficiently, or with a liver that produces too much cholesterol as VLDL particles or too few HDL particles.

Lifestyle factors such as a high-fat diet, obesity, smoking, and physical inactivity also can cause or contribute to high cholesterol levels, increasing an individual’s risk for atherosclerosis. For a more complete picture of cardiovascular health, other risk factors—beyond cholesterol and triglycerides— must be considered.

The more risk factors an individual has in combination with undesirable lipid levels, the greater the chances for development of cardiovascular disease. The risk factors for cardiovascular disease are divided into those that can be changed and those that cannot.

Risk Factors That Can Be Changed or Treated

Smoking cigarettes damages the walls of the blood vessels, making them more receptive to the accumulation of fatty deposits. Smoking also may lower the HDL by as much as 15 percent. Quitting smoking may return the HDL to a higher level.

High blood pressure damages the walls of the arteries, thus accelerating the development of atherosclerosis. Some medications for high blood pressure increase LDL and triglyceride levels and decrease HDL levels. Others do not. Blood pressure that is properly managed decreases the progression and risk for cardiovascular disease.

Sedentary lifestyle is associated with a decrease in HDL. Aerobic exercise is one way to increase HDL. Aerobic activity is any exercise that requires continuous movement of the arms and legs and increases the rate of breathing. Even 30 to 45 minutes of brisk walking every other day helps protect the cardiovascular system.

Obesity is a risk to cardiovascular health. Excess body fat increases total cholesterol, LDL cholesterol, and triglyceride levels. It also lowers the HDL cholesterol level. Obesity increases blood pressure and the risk for diabetes, which can increase the chances of heart disease developing.

Losing just 10 percent of excess body weight can improve triglyceride and cholesterol levels. Diabetes can increase the triglyceride level and decrease the HDL cholesterol level. Good control of blood sugar helps reduce increased triglyceride levels.

Estrogen deficiency and menopause increase the risk of heart disease. Conversely, estrogen replacement lowers the risk in certain groups of estrogen-deficient women.

Risk Factors That Cannot Be Changed

Aging—Aging usually increases the level of LDL cholesterol, although the reasons are not understood. It could be the aging process itself that causes this, or an increase in body fat with advancing age. Sex—Cardiovascular disease is not only a man’s disease, as once thought.

It is the number one killer of women, claiming the lives of 500,000 women every year. Cardiovascular disease occurs in women almost as often as it does in men. It just happens later in life. Before menopause, a woman’s risk of coronary artery disease is lower than that of a man.

Menopause results in an increase in LDL cholesterol and a decrease in the protective HDL cholesterol. After menopause, a woman’s risk of heart disease is the same as that of a man.

Treatment with estrogen helps to return the risk to premenopausal levels. Family history—A family history of abnormal lipid levels or early heart disease increases the risk of heart attack and stroke.