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HomeHealth ConditionsHigh Cholesterol

Does Smoking Cause High Cholesterol?

Mandy Armitage, MDSophie Vergnaud, MD
Written by Mandy Armitage, MD | Reviewed by Sophie Vergnaud, MD
Updated on February 2, 2023

Key takeaways:

  • Smoking and high cholesterol are both risk factors for cardiovascular disease and events like heart attack and stroke. 

  • People who smoke often have lower levels of the “good” cholesterol HDL and higher levels of the “bad” cholesterol LDL.

  • Quitting smoking can improve your cholesterol and decrease your risk of cardiovascular events. 

Older man smoking a cigarette outside during sunset.
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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.

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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.

The bottom line

Smoking is bad for your body in many ways, including a negative effect on your cholesterol. Both smoking and high cholesterol are risk factors for cardiovascular disease. But quitting smoking can improve your HDL levels and possibly your LDL levels. And it can lower your risk for related health problems. 

References

American Heart Association. (2020). HDL (good), LDL (bad) cholesterol and triglycerides

American Heart Association. (2020). Prevention and treatment of high cholesterol (hyperlipidemia)

View All References (11)

American Heart Association. (2018). Help! I want to quit smoking! 

Athyros, V. G., et al. (2013). Effect of tobacco smoking and smoking cessation on plasma lipoproteins and associated major cardiovascular risk factors: A narrative review. Current Medical Research and Opinion. 

Benjamin, E. J., et al. (2017). Heart disease and stroke statistics– 2017 update. Circulation. 

Centers for Disease Control and Prevention. (2004). The health consequences of smoking: A report of the surgeon general

Foray, B. A., et al. (2013). The effect of quitting smoking on HDL-cholesterol- A review based on within-subject changes. Biomarker Research. 

Gepner, A. D., et al. (2012). Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial. American Heart Journal. 

Heitzer, T., et al. (1996). Cigarette smoking potentiates endothelial dysfunction of forearm resistance vessels in patients with hypercholesteromia. Role of oxidized LDL. Circulation. 

Johnson, H. M., et al. (2010). Effects of smoking and smoking cessation on endothelial function: One-year outcomes from a randomized clinical trial. Journal of the American College of Cardiology. 

Komiyama, M., et al. (2016). Time-dependent changes of atherosclerotic LDL complexes after smoking cessation. Journal of Atherosclerosis and Thrombosis. 

Milionis, H. J., et al. (2016). Smoking diminishes the beneficial effect of statins: Observations from the landmark trials. Angiology. 

Nakamura, M., et al. (2021). Relationships between smoking status, cardiovascular risk factors, and lipoproteins in a large Japanese population. Journal of Atherosclerosis and Thrombosis.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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