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According to the CDC, 2 in 5 adults in the US are living with high cholesterol, putting them at increased danger of serious health conditions such as heart attack and stroke. Not all cholesterol is the same—HDL cholesterol is good, LDL cholesterol is bad. "HDL is responsible for reverse cholesterol transport, which means it removes bad cholesterol from the bloodstream and takes it to the liver, which gets rid of it," says Joe Miller III, MD, a cardiologist and expert in preventative medicine at Piedmont Heart Institute. LDL cholesterol leads to plaque buildup in the arteries, which can lead to coronary artery disease. "HDL is a vacuum cleaner and LDL is fuel for the fire." An LDL level below 130 mg/dL is ideal, while an HDL level below 40 mg/dL for men, or 50 mg/dL for women, is considered low.So most people do not have genetically high cholesterol," says cardiologist Leslie Cho, MD. "Most people get it the good old fashioned way, which is diet, which is lack of exercise, and also the whole beautiful process of aging. There are those of us that are genetically inclined to have high cholesterol. The worst case scenario is something called familial hypercholesterolemia, and people who have that have heart attacks at the age of 18 and they have LDL, the bad cholesterol, the lousy cholesterol, that are greater than 200 at a very, very young age. And those are people that we put on medicines aggressively because they tend to have very bad outcomes. Now, some people can have something called the heterozygous FH. That means you have a milder version of that genetic cholesterol defect, and those people, their LDL is somewhere hanging out in the high one hundreds. So they can have somewhere around one seventies and above. And those people come to us usually in their 30s and 40s, because they've had a cholesterol screening from their job or when they were trying to get life insurance and they were astounded to find their cholesterol level so high." While cholesterol levels can't be diagnosed without a full lipid panel, there are certain factors strongly linked to dangerously high cholesterol. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.Smoking not only raises bad LDL cholesterol and makes it stickier (and therefore more dangerous), it also lowers good HDL cholesterol. According to Johns Hopkins Medicine, smokers are 2 to 4 times more likely to get heart disease and at doubled risk for having a stroke. "We know that smoking is a risk factor for cardiovascular disease and that cessation leads to decreases in cardiovascular disease and the risk of death," says Dr. Mayank Sardana, a cardiac electrophysiology fellow at the University of California San Francisco School of Medicine. "But only a minority of smokers are receiving counseling in cardiology clinics and assistance in trying to quit."My experience has been that for cardiologists, tobacco has sort of been the forgotten risk factor," says Dr. Nancy Rigotti, a professor of medicine and internist at Harvard Medical School and Massachusetts General Hospital.