Is it true that smoking increases cholesterol levels?
fumo e colesterolo

The benefits of quitting smoking for the heart

Smoking is unfortunately still a widespread vice, and it is now known that it causes many diseases to our body. In particular, it is responsible for cardiovascular events. But how does smoking harm us so much and what are the advantages of giving up cigarettes forever?
Smoking has a negative impact on the inner wall of blood vessels, on coagulation, on inflammation, and on disorders of the motility of the vessels. Some effects are reversible, totally or partially, but the damage to the vessel walls that lead to the formation of atherosclerotic plaques are not completely reversible lesions. Thus, it can be said that even if you quit smoking, your heart risk level will never be like that of a person who has never smoked.


Cholesterol and cardiovascular risk

Cholesterol is contained and transported in the blood by particular “boats”, the lipoproteins:

  • Low density lipoproteins (LDL) move cholesterol from the liver towards the cells of our body
  • High density lipoproteins (HDL), transfer excess cholesterol from the tissues and carry it to the liver, where it is eliminated.

The reference values for blood cholesterol are:

  • Total cholesterol: within 200 mg/dl
  • LDL cholesterol: within 100 mg/dl
  • HDL cholesterol: no less than 50 mg/dl.

The variation in terms of increase in LDL values is to be associated with the formation of atheromas, that is deposits of cholesterol in the walls of blood vessels. Having high cholesterol (hypercholesterolemia), particularly LDL, represents a strong risk factor for coronary heart disease, involving the arteries that carry blood to the heart, while high triglycerides are a potential danger especially when you also have low HDL values.
High cholesterol does not cause clear and obvious symptoms, so many people are unaware of having this important risk factor.


What is the relationship between smoking and cholesterol?

Smoking can lower the HDL cholesterol level; smoking also increases LDL cholesterol and triglyceride levels. Recent studies have observed that these negative effects on LDL, HDL and triglycerides can be observed not only in adult smokers, but also in adolescents, at which age this very bad habit often begins.

Not only cigarettes
Tobacco is harmful regardless of the type, including the so-called light cigarettes, cigarettes with filters, cigars and pipes. The risk increase is greater the greater the consumption of tobacco, but there is no lower limit below which we can say we can rest assured.

Secondhand smoke
Exposure to secondhand smoke is also unhealthy: being near a smoker while he or she is smoking increases the risk for the heart and blood vessels over time. The reduction of cigarette smoke (and of other kinds of tobacco) in the environment in which you spend a lot of time results, in fact, in great health benefits.


Reasons why it would be better to quit smoking

Although quitting smoking can increment body weight, this lifestyle change can improve blood cholesterol levels, especially HDL. This effect is especially noticeable in women.
Eliminating cigarette smoke can therefore improve our health. Some effects are immediate, others are visible after some time; for those who stop smoking, while it is true that the cardiovascular risk is reduced, it is not eliminated, and is basically halfway between that of smokers and that of those who have never smoked.
Men or women who have been diagnosed with a cardiovascular disease should definitely stop smoking. Support from a professional and family members can be very important in achieving this goal. Other interventions seem to be less effective (for example, acupuncture, acupressure, laser therapy, hypnosis or electrostimulation).

Electronic cigarettes
The electronic cigarette is a device that vaporizes a nicotine-based liquid that can be inhaled. It does not contain the harmful chemicals found in tobacco so it is less harmful to the body than a traditional cigarette. These cigarettes can be a useful tool for quitting smoking and seem to have similar efficacy to transdermal nicotine patches. To date, however, there are still no long-term observations to assess their impact on health.

Not only smoke
In addition to quitting smoking, it is important to act on your lifestyle in order to reduce the main risk factors for atherosclerosis and cardiovascular problems: high cholesterol, high blood pressure, obesity and overweight.
The four fundamental points to keep in mind for the correct prevention of cardiovascular risk:

  • Follow a balanced and healthy diet
    • reduce the intake of foods rich in saturated fats (cheese, cold cuts)
    • increase the consumption of fruit, vegetables and fiber
    • limit the consumption of sugar, by avoiding, for instance soft drinks
    • avoid excessive consumption of alcohol.
  • Maintain an ideal body weight by getting the right amount of physical activity coupled with the diet
  • Reduce high cholesterol levels
  • Keep high blood pressure under control, by limiting salt consumption as well

If you have been diagnosed with diabetes mellitus it is important you keep blood sugar levels monitored and under control.
In some cases, changing your lifestyle isn’t enough to lower cholesterol levels. Based on your health conditions, your family physician may recommend a drug treatment to regulate the amount of lipids in the blood and keep your levels under control.


  • Società Europea di Cardiologia, Società sulla Prevenzione delle Malattie Cardiovascolari nella Pratica Clinica, Associazione Europea per la Prevenzione e Riabilitazione Cardiovascolare (EACPR). Linee guida europee 2016 sulla prevenzione delle malattie cardiovascolari nella pratica clinica. SG Ital Cardiol 2017;18(7-8):547-612.
  • Merianos, AL,e t al. Tobacco Smoke Exposure Association with Lipid Profiles and Adiposity Among U.S. AdolescentsJ Adolesc Health. 2018 April ; 62(4): 463–470. doi:10.1016/j.jadohealth.2017.10.001.
  • Istituto Superiore di Sanità – EPICENTRO- colesterolo e ipercolesterolemia: disponibile al link