Does Smoking Raise Cholesterol?

Smoking increases your risk of heart disease. So does high cholesterol. But does smoking also increase your risk of getting high cholesterol? And if you quit, could that take both risk factors off the table? 

This has been a popular area of research for decades. In this article, we’ll tell you what you need to know about how smoking affects your cholesterol levels — and, ultimately, your risk of heart disease. 

How does smoking affect cholesterol?

Smoking raises cholesterol. But it affects different types of cholesterol in different ways. People who smoke tend to have:

• Higher triglycerides: This is a type of fat in your blood that raises your risk of heart disease, just like cholesterol. 

• Higher low-density lipoprotein (LDL) cholesterol: This is the “bad” type of cholesterol in your blood that also raises your risk of heart disease.

• Lower high-density lipoprotein (HDL) cholesterol: This is the “good” type of cholesterol that helps remove the bad cholesterol from your body.

Research has consistently shown that smoking has a bigger effect on your triglyceride and HDL cholesterol levels. It seems to have a smaller effect on your LDL cholesterol. That being said, smoking may make the LDL particles in your blood more harmful. 

This brings us to the most important point: Why does this all matter? 

Heart disease occurs when cholesterol builds up inside your blood vessels. This cuts off blood flow to your heart and brain, which can lead to heart attacks and strokes. Smoking raises the risk of these conditions because it:

• Raises the amount of fat and cholesterol particles in your blood

• Changes the chemistry of those cholesterol particles, making them more likely to build up in your blood vessels

• Damages the inside of your blood vessels, which also makes the cholesterol more likely to stick to the injured areas

So, even if smoking only raises your cholesterol by a small margin, it can still increase your risk for heart disease by a large margin. 

Why does smoking raise cholesterol?

Exactly how smoking raises cholesterol levels is still unclear. But researchers have identified several different ways smoking may raise cholesterol. 

Smoking causes hormonal changes and inflammation in your body that can:

• Stimulate your liver to make more cholesterol

• Prevent your body from breaking down cholesterol and removing it from your body

• Affect how cholesterol is transported in your blood

• Increase insulin resistance, which can then increase cholesterol levels

How does quitting smoking affect cholesterol?

When you quit smoking, you’ll improve both your cholesterol levels and heart health. Research shows that quitting smoking can:

• Improve HDL levels, the good cholesterol 

• Improve the health of your blood vessels

• Reduce your risk of heart disease and death

Interestingly, quitting smoking may not lower triglyceride levels. Some studies have shown a small decrease in triglycerides within a month of quitting. But this effect doesn’t appear to last in the months that follow. 

Researchers think this may be because many people gain weight when they quit smoking. Weight gain usually raises triglyceride levels. Although some studies have shown a decrease in triglycerides, it may also take more time for your levels to come down — sometimes over a year.

But don’t let this discourage you. Just as smoking’s effects on cholesterol go beyond the numbers, so do the benefits of quitting. Many of smoking’s harmful effects are reversed when you stop.

What’s more, lifestyle changes that can help you prevent weight gain will also naturally lower your cholesterol. These include:

• A balanced diet: A Mediterranean-style diet is a great blueprint for a heart-healthy diet. Eating more fiber-rich foods and nutritious fats can help lower cholesterol. 

• Physical activity: Regular exercise — even something as simple as a 20-minute walk — can increase good cholesterol and lower bad cholesterol.

• High-quality sleep: Not getting enough sleep increases your weight and your cholesterol levels. So, this is a good time to evaluate your nighttime routine.

If all of these changes feel overwhelming, take them one at a time. And start with the most important one: quitting smoking. Remember that there are multiple ways to stop smoking, so reach out to your healthcare team for help. There are treatments that can make it easier.

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Written by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Mandy Armitage, MD

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

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