Common Questions about Cholesterol, Heart Disease, and Diet

This article answers common questions about cholesterol levels, eating a heart-healthy diet, and other heart-health-related topics.
Common Questions about Cholesterol, Heart Disease, and Diet - Articles

Updated: August 14, 2017

Common Questions about Cholesterol, Heart Disease, and Diet

Should Children's Cholesterol Levels Be Checked?

Most children do not need to have their blood cholesterol checked (although all children should be encouraged to eat in a heart-healthy way along with the rest of the family). Children who should be tested at age 2 or older include those who have:

  • at least one parent who has been found to have high blood cholesterol (240 mg/dL or greater)
  • a family history of early heart disease (before age 55 in a parent or grandparent)

Also, if the parent's medical history is not known, a doctor may want to check the child's blood cholesterol level, especially in children with other risk factors like obesity.

How High Is a Child's "High" Blood Cholesterol?

If your child does need to have a cholesterol test, it can be part of a regular doctor's visit. Your doctor will likely
measure your child's total cholesterol level first. However, if your family has a history of early heart disease, the doctor may measure your child's LDL cholesterol level right from the start. Otherwise, your child's LDL level should be measured if his or her total cholesterol level was checked and found to be 170 mg/dL or greater. The blood cholesterol categories for children from families with a history of high blood cholesterol or early heart disease are shown below.

Total and LDL Cholesterol Levels in Children and Teenagers
Total CholesterolLDL Cholesterol
AcceptableLess than 170 mg/dLLess than 110 mg/dL
Borderline170 to 199 mg/dL110 to 129 mg/dL
High200 mg/dL or greater130 mg/dL or greater

Note: These blood cholesterol levels apply to children 2 to 19 years old.

Your pediatrician may also want to check your child's blood pressure and compare his or her BMI to growth charts. If these are above the 95th percentile for the child's age, sex, and height, then your doctor will probably recommend a heart-healthy diet and increased exercise for both you and your child.

Is It Safe to Eat in a Heart-Healthy Way?

Eating more fruits, vegetables, and whole grains, so that your diet is lower in saturated and trans fat and cholesterol, is safe. This diet is more nutritious than one higher in these kinds of fats and cholesterol. It will even meet the higher needs that women, children, and teenagers have for nutrients like calcium, iron, and zinc. An eating pattern with higher fruit and vegetable intakes will reduce the risk for other chronic diseases, such as cancer. It can still provide enough calories for the proper growth and development of children ages 2 and above. Children younger than 2 years have special nutrient needs for fat and should not be fed a low-fat diet.

What Are Plant Sterols and Stanols?

Plant sterols and stanols are waxy compounds that are closely related to cholesterol. They are natural components of vegetable oils, nuts, and seeds, but people who eat a "Western" diet consume only about 200-400 mg per day. Nutritional scientists have demonstrated that including sufficient amounts in your diet will lower your absorption of any dietary cholesterol you eat.

Sterols and stanols appear to compete with dietary cholesterol for sites on particles called micelles, which carry cholesterol into your intestinal cells. Thus, they reduce the amount of cholesterol absorbed from your diet.

You will find added sterols or stanols in certain margarines and yogurts in the grocery store. Different levels of sterols and stanols are needed in a product to have an effect on blood cholesterol (3.4 grams of stanols and 1.3 grams of sterols). Sterols have been found to interfere with statins, drugs that inhibit cholesterol synthesis in the liver. If you are taking a statin, check with your doctor about eating foods enriched with sterols and stanols.

How Important Is Blood Pressure as a Risk for Heart Disease?

Blood pressure is a powerful risk factor for coronary heart disease. Although 140/90 or higher is the level used to define high blood pressure, even people who have what is called pre-hypertension--120-139 for systolic (top) and 80-89 for diastolic (bottom)--are at increased risk for heart disease compared to those with more desirable and lower levels. If a doctor has told you that you have high blood pressure, seek out and take the appropriate medication.

On the dietary side, control the sodium that you eat. Most of the sodium in our diets comes from the manufactured foods we eat. Manufactured foods with labels have a Nutrition Facts panel that clearly states the amount of sodium in a serving. Look for those products supplying less than 10 percent of the Daily Value for sodium. A variety of low-sodium products are in the marketplace. Keeping the total sodium content in a meal to no more than 600 mg total is a good target.

What Is the Mediterranean Diet?

The Mediterranean Diet was originally defined as the typical dietary pattern observed on the island of Crete, in the rest of Greece, and in Italy during the early 1960s. People eating this diet lived long lives and had low rates of chronic disease. The diet featured plant foods (fruit, vegetables, whole grain breads, other grains, potatoes, beans, nuts, and seeds), fresh fruit for dessert, olive oil, cheese and yogurt, and some eggs. Fish and poultry were eaten in moderate amounts and red meat in low amounts. Wine was drunk at meals in moderate amounts.

The diet was low in saturated fat (at most 7-8 percent of energy from fat) and had almost zero trans fat. This eating pattern or patterns similar to it have been shown to reduce a person's risk of coronary heart disease. However, keep in mind that when this diet was common in Mediterranean regions, the people were expending much energy in gathering and making their foods and were getting more exercise in general. Thus, exercise was an important complement to this dietary pattern.

How Much Will My Cholesterol Change If I Take This Advice?

Generally, your blood cholesterol level should begin to drop in a few weeks after you start eating the heart-healthy way. How much it drops depends on the amount of saturated and trans fat you used to eat, how high your blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your cholesterol level by 5 to 35 mg/dL or even more.

Approximate LDL Cholesterol Reduction Possible with Dietary Modification
Dietary componentDietary changeApproximate LDL reduction
Major factors
Saturated fatLess than 7% calories8-10%
Dietary cholesterolLess than 200 mg3-5%
Weight reductionLose 10 pounds5-8%
Other options
Viscuous fiber*5-10 grams a day3-5%
Plant sterols/stanolsAbout 2 grams per day6-15%

*Also called soluble fiber. Examples are pectin, psyllium as in Metamucil, and beta-glucan in oats.

How to Find Out More

  1. The National Health Lung and Blood Institute has a wide variety of helpful publications on its Web site.
  2. To find the nutrient content of specific foods go to the USDA Food Composition Database.
  3. Check with your county Penn State Extension office to learn about programs to help you with weight management, diabetes and physical activity.


Dietary Guidelines Committee. 2010. Dietary Guidelines Report June 2010.

Grundy SM, Cleeman JI, Merz CN et al. 2004. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 110 (2), 227-239.

Kavey RW, Daniels SR, Lauer RM et al. 2003. American Heart Association Guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 107 (11), 1562-1566.

Mente A, de Koning L, Shannon HS, Anand SS. 2009. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Archives of Internal Medicine 169 (7), 659-669.

Miettinen TA, Gylling H. 2009. The effects of statins and sitosterols: Benefit or not? Current Atherosclerosis Reports 11 (1), 23-27.

NCEP Expert panel. 2002. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 106 (25), 3143-3421.

Parikh P, McDaniel MC, Ashen MD et al. 2005. Diet and cardiovascular disease: An evidence-based assessment. Journal of the American College of Cardiology 45 (9), 1379-1387.

Phytosterol Esters (Plant Sterol and Stanol Esters). 2005. Institute of Food Science and Technology.

Sabate J et al. 2010. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Archives of Internal Medicine 170 (9), 821-827.

Schaefer EJ. 2002. Lipoproteins, nutrition and heart disease. American Journal of Clinical Nutrition 75 (2), 191-212.

Welsh JA, Sharma S, Abramson JL et al. 2010. Caloric sweetener consumption and dyslipidemia among US adults. New England Journal of Medicine 303 (15), 1490-1497.

Willett WC, Sacks F, Trichopoulou et al. 1995. Mediterranean diet pyramid: a cultural model for healthy eating. American Journal of Clinical Nutrition 61 (6 Suppl), 1402S-1406S.

Prepared by J. Lynne Brown, PhD, RD, professor of food science