'High' cholesterol: 5 claims that science clarifies (and what really matters to monitor)

By the Lionzen team 10.08.2026 · 3 min read

Salud cardiovascular, corazón y circulación sanguínea

"Your cholesterol is high"—you've probably been told this in an alarming tone, with a prescription for statins waiting. But the story of cholesterol is considerably more complex than what the total number on a lab report suggests. There are widely held claims about cholesterol that modern cardiovascular science qualifies—or directly contradicts.

Myth 1: "LDL cholesterol is bad cholesterol"

LDL cholesterol is not a single entity. There are large, buoyant LDL particles (pattern A) and small, dense particles (pattern B). The former have little impact on cardiovascular risk; the latter do penetrate the arterial wall and contribute to atherosclerotic plaque.

A total LDL analysis that does not distinguish particle phenotype—which is the standard analysis in most clinics—can classify someone with elevated but benign pattern A LDL as "at risk," and give a clean bill of health to someone with normal LDL but atherogenic pattern B. The most predictive marker of cardiovascular risk in recent studies is ApoB (apolipoprotein B), which does reflect the number of atherogenic particles regardless of size.

Myth 2: "A low-fat diet improves cholesterol"

This idea has been entrenched for decades—and has caused a lot of harm. Saturated fats raise LDL, yes. But they also raise HDL. The real problem in the lipid profile of the modern population is not saturated fats: it is refined carbohydrates and added sugars.

Excessive consumption of sugar and refined flour raises triglycerides, reduces HDL, and increases small, dense LDL particles (the risky pattern B). Multiple epidemiological studies—including the analysis by Krauss et al. in the American Journal of Clinical Nutrition—show that replacing saturated fats with refined carbohydrates worsens the cardiovascular risk profile, it does not improve it.

The most problematic fats for the heart are artificial trans fats (found in ultra-processed foods) and excessively refined vegetable seed oils.

Myth 3: "Triglycerides only matter if they are very high"

The standard reference value for fasting triglycerides is <150 mg/dl. But the risk begins to rise much sooner. Recent evidence suggests that fasting triglycerides >100 mg/dl, combined with low HDL, already indicate incipient insulin resistance—one of the most potent predictors of cardiovascular disease.

The triglyceride/HDL ratio is a functional marker of insulin resistance and the predominance of small LDL particles. A ratio >3 (in mg/dl) is a warning sign even when total LDL is in range. A ratio <2 is very favorable. This data is in your standard lab report, but it is rarely calculated or discussed.

Myth 4: "If the total number is fine, the heart is fine"

Total cholesterol on its own has little predictive value. What matters is the distribution. The total cholesterol/HDL ratio is a classic predictor: values >5 increase cardiovascular risk regardless of the total. HDL below 40 mg/dl in men or 50 in women is an established risk factor even with normal LDL.

A "heart-healthy" profile is not simply low LDL: it is low LDL + high HDL + low triglycerides + low ApoB. These four together are what truly drive risk.

Myth 5: "The options are statins or nothing"

Statins have a clear role in secondary prevention (people who have already had a cardiovascular event) and in certain high-risk primary prevention profiles. But they are not the only tool, and presenting them as the only alternative to "doing nothing" ignores the evidence on lifestyle intervention and evidence-based supplementation:

Omega-3 (EPA/DHA): They reduce triglycerides in a dose-dependent manner. With 2-4 g/day of EPA+DHA, the reduction can be 20-30% in people with elevated triglycerides. The REDUCE-IT trial (2018) showed a 25% reduction in cardiovascular events with pure EPA in high doses.
Berberine: It activates AMPK and inhibits PCSK9, the same mechanism as new, next-generation lipid-lowering drugs. Several meta-analyses show LDL reductions of 15-25% and triglyceride reductions of 20-30% in 2-4 month studies.
Red yeast rice: It contains monacolin K, a natural statin. It can reduce LDL by 15-25%. It requires the same precautions as statins (liver monitoring, drug interactions).
Plant sterols: They compete with cholesterol for intestinal absorption. With 2 g/day, they reduce LDL by between 7 and 12%.

What really moves the cardiovascular profile

Before any drug or supplement: aerobic exercise raises HDL more powerfully than any pharmacological intervention; reducing sugar and ultra-processed foods lowers triglycerides in weeks; weight control improves the entire lipid distribution; adequate sleep regulates the liver function involved in cholesterol synthesis.

Lionzen Heart integrates high-concentration omega-3, berberine, and CoQ10—the latter especially useful for those taking statins, which reduce endogenous CoQ10 synthesis—as support for cardiovascular health from within.