Does Smoking Cause High Cholesterol?

You’ve probably heard by now that smoking is bad for your health. You might also know that having high cholesterol is bad for your health. But can smoking raise your cholesterol levels? Let’s dig in.

What is cholesterol, and why is too much harmful?

Before we get into smoking’s effects on cholesterol, let’s cover the basics. First, what is it?

Cholesterol is a waxy substance that the body needs to build cell membranes. Your liver makes it, and it also comes from animal products you eat, like meat and eggs. 

Cholesterol can be measured in the blood. There are two different types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). To simplify things, think of LDL as “bad” and HDL as “good.” 

Too much LDL causes fatty buildup in your arteries (also known as “plaque”), which increases the risk of heart attack, stroke, and other diseases. HDL can help remove some of the LDL by transporting it back to your liver, which then removes it from your body. 

Triglycerides are another form of fat that can be dangerous if there’s too much. High triglycerides combined with high LDL or low HDL can contribute to fatty buildup in arteries. 

Overall, the number of adults in the U.S. with high cholesterol has decreased in recent years, and the use of cholesterol-lowering medications has increased. But high cholesterol is still a problem — especially for people who smoke.

How does smoking affect cholesterol?

There’s been a lot of research on cholesterol levels in people who smoke. The gist is that people who smoke tend to have higher concentrations of LDL (bad) and lower concentrations of HDL (good) in their blood. This puts them at higher risk for plaque buildup and related health problems. 

It’s not entirely clear why this happens, but it seems that smoking affects how cholesterol is transported in the blood. Additionally, studies have shown that people who smoke don’t get as much benefit from the cholesterol-lowering medications statins.

What if you smoke and already have high cholesterol?

Both smoking and high cholesterol increase your risk of cardiac events.

It’s important to know that smoking damages the lining of blood vessels. When you combine that damage with high cholesterol in the blood, it sets the stage for cardiovascular problems like heart attack and stroke. In fact, research suggests that the combination of smoking and high cholesterol results in more vessel damage than would be expected individually.

So you can see why smoking and high cholesterol increase the risk for major health problems and even death.

Does quitting smoking lower cholesterol?

Quitting smoking improves your cholesterol. Any time is a good time to quit smoking, because it will dramatically improve your health. In terms of effects on cholesterol, research shows that quitting smoking can:

• Improve HDL levels 

• Improve the health of blood vessels

• Reduce the risk of heart disease and death

If you need help quitting smoking, speak with your primary care doctor, or visit the American Heart Association for resources.

There are ways you can lower your cholesterol on your own, such as eating a healthy diet and getting plenty of regular exercise. But if those aren’t enough, you can also speak with your primary care doctor about cholesterol-lowering medications.

How long does it take for cholesterol to improve after you quit smoking?

Quitting smoking can lead to an improvement in HDL in as little as 3 weeks. But the effects on LDL are less clear. Some studies don’t find a significant decrease in LDL, but others indicate an improvement at about 1 year or even 5 years.

Will the damage to your arteries be reversed after you quit smoking?

Yes. Research shows that damage to blood vessels can improve 1 year after quitting smoking. Even though people who quit smoking were more likely to gain weight, the benefit of quitting smoking on their overall heart health still outweighed the risks of any weight gain.

Quitting smoking may not reverse existing damage from previous heart attacks or strokes, but the risk of further events will be lower.

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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