If you're a middle-aged person with symptoms, having higher 'bad' cholesterol (LDL) means you're more likely to have heart problems over the next four years — but only if scans show you already have plaque in your heart arteries.

In healthy-looking middle-aged Americans with low heart disease risk, higher 'bad' cholesterol is linked to more buildup in heart arteries — and the more cholesterol, the more common these buildups are.

If a middle-aged person has heart symptoms but no calcium buildup in their arteries, things like diabetes, smoking, and low 'good' cholesterol are linked to future heart problems — but their 'bad' cholesterol level doesn’t seem to matter, which might mean other non-plaque-related issues are causing the heart trouble.

Even if you're healthy and don't have typical heart disease risks, having higher 'bad' cholesterol (LDL) might still mean you're more likely to have early signs of artery buildup — and the higher the LDL, the greater the chance.

Even if your heart looks healthy and you have no major risk factors, higher 'bad' cholesterol (LDL) — even when it's considered 'normal' — is linked to more hidden artery buildup. For every 10-point rise in LDL, the odds go up by about 15%.

Middle-aged adults who feel fine but have very high 'bad' cholesterol might be more likely to have hidden heart plaque, even if they don’t have symptoms.