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High low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, is typically linked to unhealthy lifestyle habits.

American Heart Association. Causes of High Cholesterol. 2017.

However, LDL levels can creep up on any patient. Even those who closely monitor their health can experience unwanted changes to their lipid profiles. Below are the main reasons LDL levels may be high regardless of age or overall health status.

Genetics

High lLDL often runs in families. Research shows that specific genetic mutations are linked to higher cholesterol levels.

MedLine Plus. Familial hypercholesterolemia. May 8, 2024.

People at risk for inherited high LDL, called familial hypercholesterolemia (FH), should have regular lipid panels to check LDL levels. 

Menopause

Hormonal changes can also affect LDL levels.

Currie H, Williams C. Menopause, Cholesterol and Cardiovascular Disease. US Cardiology Review. 2008;5(1):12–14.

Research has shown that LDL levels increase after menopause, when estrogen and anti-Müllerian hormone (AMH) decrease.

El Khoudary SR, Chen X, Qi M, et al. The independent associations of anti-Müllerian hormone and estradiol levels over the menopause transition with lipids/lipoproteins: The Study of Women’s Health Across the Nation. Journal of Clinical Lipidology. 2023;17(1):157–167.

Chronic stress

Elevated cortisol—the body’s primary stress hormone—has been associated with increased LDL. Chronic stress triggers cortisol release, which in turn influences lipid metabolism, promoting higher LDL and potentially contributing to atherosclerosis.

“Patients can support improved cortisol levels during times of mental or physical stress by developing healthy coping mechanisms such as physical activity, meditation, or even reaching out to talk to a friend,” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.

Age and lifestyle

Dr. Miller also shares that suggesting simple changes, such as decreasing alcohol consumption and increasing tea consumption, can help patients with hormonal-, age-, and genetic-related increases in LDL. “Excessive alcohol intake can raise total cholesterol and triglyceride levels, but regular consumption of unsweetened black, green, or cinnamon tea may help lower LDL cholesterol levels,” Miller says.

It’s well-known that metabolism changes with age. This well-documented slowdown in metabolism also affects how the liver removes LDL cholesterol, which can lead to unexpected spikes in LDL.

Goldstein JL, Brown MS. Regulation of low-density lipoprotein receptors: implications for pathogenesis and therapy of hypercholesterolemia and atherosclerosis. Circulation. 1987;76(3):504–507.

Managing hormonal LDL changes

For patients with extremely high LDL levels—especially those with genetic conditions like familial hypercholesterolemia—medication is often necessary from an early age to prevent long-term damage. In addition to statins, newer treatments like PCSK9 inhibitors, ezetimibe, or bempedoic acid may be recommended if LDL remains high despite standard therapy. Regular monitoring and adjustments ensure the best approach for managing cholesterol and reducing overall cardiovascular risk.