High cholesterol is a condition where levels of LDL ("bad") cholesterol in your blood are elevated. This can increase your risk of developing health problems, like
heart disease and
stroke.
Cholesterol is a waxy substance that supports many functions in your body, including building healthy cells. There are two main types of cholesterol: low-density lipoprotein (LDL), or "bad" cholesterol, and high-density lipoprotein (HDL), or "good" cholesterol.
Too much LDL cholesterol or too little HDL cholesterol can cause plaque to build up in your arteries. Without management, this buildup can eventually lead to cardiovascular disease.
Signs and Symptoms of High Cholesterol
Typically, high cholesterol doesn’t cause any symptoms. Eventually, plaque buildup in your arteries can increase your risk of
coronary artery disease, heart attack, and stroke.
A blood test is the only way to know if your cholesterol is high.
Causes and Risk Factors of High Cholesterol
Lifestyle habits like eating an unhealthy diet and not exercising regularly are the most common causes of high cholesterol. But other factors like your family history, certain medical conditions, and race or ethnicity can also increase your risk.
Lifestyle Habits
Unhealthy lifestyle factors are the most common causes of high LDL or "bad" cholesterol, including:
- A diet high in saturated fat
- Lack of physical activity
- Smoking
- Excessive alcohol intake
Medical Conditions
Some medical conditions increase your risk of high cholesterol, including:
Medications
Some medications that treat other conditions can raise your LDL levels or lower you HDL levels, including:
Other Factors That Increase Your Risk
Some factors that you can't control increase your risk of high cholesterol, such as:
- Family History If other members of your family have high cholesterol, you are more likely to have high cholesterol. Although rare, some people also have an inherited genetic condition called familial hypercholesterolemia (FH) that causes very high LDL cholesterol at a young age.
- Age As you age, your body can't clear cholesterol from your blood as well, leading to higher cholesterol levels.
- Sex Until menopause, women tend to have lower LDL cholesterol than men. Men at any age have lower HDL cholesterol than women.
How Is High Cholesterol Diagnosed?
Your doctor will perform a physical exam and ask questions to assess your risk of cardiovascular disease. They may ask about your:
- Eating habits
- Physical activity level
- Family history
- Current medications
To test for high cholesterol, your doctor may order a blood test called a lipid profile, or lipid panel. You may need to fast (not eat or drink) for 8 to 12 hours before your blood is drawn.
A lipid panel measures levels of HDL and LDL cholesterol and
triglycerides in your blood. Higher than normal cholesterol and triglyceride levels are signs you may have an increased risk of coronary heart disease.
An HDL level of 50 to 80 mg/dL for women and 40 to 80 mg/dL for men is considered normal.
The following table shows total and LDL cholesterol ranges in mg/dL.
How often you have a screening for high cholesterol depends on your age and other risk factors. In general:
- People under age 45 should be screened every 5 years.
- Women ages 55 to 65 and men ages 45 to 65 should be screened every 1 to 2 years.
- People over age 65 should be screened every year.
Treatment and Medication Options for High Cholesterol
The main treatments for high cholesterol are lifestyle changes to improve cardiovascular health, like eating a healthy diet and getting regular exercise, and medications to lower cholesterol, like statins.
Lifestyle Changes
Making the following lifestyle changes can help lower your cholesterol levels:
- Eat a Heart-Healthy Diet Reduce your intake of saturated and trans fats and increase your fiber intake. Focus on plant-based foods, whole grains, and lean proteins.
- Get Regular Exercise Getting 150 minutes of moderate-intensity physical activity per week helps clear cholesterol from your blood and reduce your risk of heart disease and stroke.
- Maintain a Healthy Weight Losing weight can help lower your cholesterol.
- Quit Smoking Smoking lowers your HDL cholesterol and worsens other problems, like high blood pressure and diabetes.
- Limit Alcohol Intake Having more than one drink a day for women or more than two drinks a day for men can raise your total cholesterol.
- Get Enough Sleep Poor sleep is linked to lower HDL and higher LDL and triglycerides.
Medications
Medications can help treat high cholesterol and lower your risk of heart attack and strokes. Common cholesterol medications include the following:
- Statins inhibit cholesterol production in your liver and help remove LDL cholesterol from your bloodstream. Examples include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).
- Cholesterol absorption inhibitors, such as ezetimibe (Zetia), lower the amount of cholesterol absorbed from food into your blood stream.
- PCSK9 inhibitors help your liver absorb more LDL cholesterol, lowering cholesterol in your blood. Examples include alirocumab (Praluent), evolocumab (Repatha), and inclisiran (Leqvio).
- Bempedoic acid (Nexletol) works similarly to statins by inhibiting an enzyme involved in cholesterol production in the liver. It may be an option if you experience serious side effects of statins.
- Bile acid sequestrants prompt your liver to use up extra cholesterol to make more bile acids. This lowers cholesterol in your blood. Examples include cholestyramine (Prevalite), colesevelam (Welchol), and colestipol (Colestid).
- Fibrates speed up the removal of triglycerides from your blood and also help to increase HDL cholesterol. Examples include fenofibrate (Lipofen) and gemfibrozil (Lopid).
High doses of
omega-3 fatty acids have been shown to lower triglyceride levels and are available without a prescription. But prescription omega-3 supplements may be more effective, as the doses in over-the-counter options can vary widely.
Talk with your doctor before taking omega-3 supplements to make sure they are a safe option for you.
Lifestyle Changes and Prevention of High Cholesterol
Lifestyle changes to lower your cholesterol can also help prevent high cholesterol. These include eating a healthy diet low in saturated fat, getting regular physical activity, limiting alcohol intake, and avoiding smoking.
Regular screenings can also help you maintain healthy cholesterol levels. In general, healthy adults should check their cholesterol every four to six years. But your doctor may recommend more frequent screenings depending on your age, overall health, and other risk factors.
How Long Does High Cholesterol Last?
You will need to manage your cholesterol for the rest of your life. It's important to schedule follow-up visits with your doctor to discuss your treatment and monitor your cholesterol levels. Taking medications as directed and making healthy lifestyle changes can help lower your cholesterol and avoid serious health problems.
Complications of High Cholesterol
High cholesterol can cause plaque to build up in your arteries, leading to a condition called
atherosclerosis. Without treatment, this can lead to the following cardiovascular problems:
