What is high cholesterol?

Cholesterol is a waxy, fat-like substance that is found in all cells of the body. It is produced by the liver and also comes from the foods we eat. Cholesterol is essential for overall health – it helps produce hormones, vitamin D, and substances that aid in digestion.

High cholesterol

There are two main types of cholesterol:

LDL cholesterol – Also known as “bad” cholesterol, LDL contributes to a buildup of plaque in the arteries. High levels of LDL raise your risk for heart disease and stroke.

HDL cholesterol – Also called “good” cholesterol, HDL removes LDL cholesterol from the arteries. Higher levels of HDL lower your risk for heart disease.

High cholesterol means that you have unhealthy levels of cholesterol in your blood, specifically high LDL and low HDL levels. The medical term for high cholesterol is hypercholesterolemia.

When you have high cholesterol, fatty deposits called plaque can build up inside your arteries over time. This buildup causes arteries to narrow and harden, a condition known medically as atherosclerosis. Hardened, narrowed arteries restrict blood flow to vital organs and tissues, increasing the risk for heart attack and stroke.

Causes of High Cholesterol

High cholesterol can be caused by a number of factors, including:

  • Diet – Eating foods high in saturated fats and trans fats can raise blood cholesterol levels. These foods include red meat, full-fat dairy, fried foods, and baked goods made with margarine or shortening.
  • Weight – Being overweight or obese typically raises LDL levels and lowers HDL levels. Excess weight puts strain on the heart and promotes inflammation, both of which negatively impact cholesterol.
  • Physical inactivity – Lack of exercise leads to weight gain and does not stimulate HDL production by the body. Just 30 minutes of activity 5 times a week can improve cholesterol.
  • Genetics – Genes can impact how your body produces and manages cholesterol levels. Familial hypercholesterolemia is an inherited form of high cholesterol.
  • Age – Cholesterol levels typically rise as we age. In men, cholesterol often starts to increase after age 45. In women, cholesterol tends to rise after menopause.
  • Diabetes – Having diabetes makes you more likely to have unhealthy cholesterol levels, often due to insulin resistance and inflammation.
  • Smoking – Smoking damages blood vessels and depresses HDL levels. Quitting can raise HDL.
  • Medications – Certain prescription drugs can unintentionally increase cholesterol, like drugs for high blood pressure, birth control pills, corticosteroids, and more.
  • Stress – Chronic stress encourages behavioral habits that cause high cholesterol, like poor eating, inactivity, smoking, and drinking.
  • Kidney or liver disease – These conditions can impact the body’s ability to remove LDL cholesterol.

Symptoms of High Cholesterol

High cholesterol often does not produce obvious symptoms, which is why many people are unaware they have this condition. Symptoms typically appear after cholesterol has done silent damage to blood vessels and arteries.

Possible high cholesterol symptoms include:

  • Chest pain, tightness, pressure, or discomfort – Signs of angina, indicates arteries are narrowed.
  • Shortness of breath – Occurs when blood flow is limited to the lungs.
  • Leg pain – Caused by peripheral artery disease from plaque buildup in leg arteries.
  • Bulging arteries – Visible large arteries around elbows and knees.
  • Erectile dysfunction – Impaired blood flow can affect sexual performance and desire in men.
  • Fatty skin deposits – Yellowish patches around eyelids, knees, buttocks, elbows, etc.
  • Memory loss – Impaired brain function from reduced blood flow.

Without treatment, high cholesterol also does not have overt symptoms as it progresses to more dangerous conditions like heart attack and stroke. This makes routine screening critical for early detection and prevention.

Diagnosis of High Cholesterol

High cholesterol-3

High cholesterol is diagnosed with a simple blood test called a lipid panel or lipid profile. This test measures levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.

Diagnosis is based on the following lipid profile results:

  • Total cholesterol of 240 mg/dL and above
  • LDL cholesterol of 160 mg/dL and above
  • HDL cholesterol of less than 40 mg/dL for men and less than 50 mg/dL for women
  • Triglycerides above 200 mg/dL

Some additional tests may be ordered to check for underlying causes of high cholesterol, such as liver disease, kidney disease, diabetes, or hypothyroidism.

Doctors also use blood testing to calculate your risk of developing cardiovascular disease in the next 10 years. This helps determine the urgency of treatment.

Treatment Options for High Cholesterol

The main goals of high cholesterol treatment are to lower LDL and raise HDL levels to reduce your risk of heart attack, stroke, and related conditions. Treatment options include:

Lifestyle Changes

Making dietary changes, losing excess weight, quitting smoking, and being more physically active can significantly improve cholesterol levels. Lifestyle treatment is recommended for anyone diagnosed with high cholesterol.


If lifestyle changes alone do not lower cholesterol sufficiently, cholesterol-lowering medications may be prescribed. Common options include:

  • Statins – Very effective at lowering LDL cholesterol levels by up to 60%. Brand names include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).
  • Bile acid resins – Bind to bile in the digestive tract to remove cholesterol from the body. Brands include cholestyramine (Prevalite) and colesevelam (Welchol).
  • Cholesterol absorption inhibitors – Reduce cholesterol absorption in the intestines. The drug ezetimibe (Zetia) works this way.
  • PCSK9 inhibitors – Block proteins that prevent LDL cholesterol breakdown. Brands are evolocumab (Repatha) and alirocumab (Praluent). Used for stubborn high cholesterol.
  • Niacin – Boosts HDL while lowering LDL and triglycerides. May cause side effects like facial flushing.
  • Fibrates – Lower triglycerides significantly and can also reduce LDLs. Gemfibrozil (Lopid) is a common fibrate.


Some dietary supplements can improve cholesterol levels, especially when combined with medication and lifestyle changes. These include omega-3 fish oil, soluble fiber supplements, plant sterols, and stanols.

Discuss all medical and complementary treatment options with your doctor to create the most effective cholesterol management plan for your health needs and goals.

Preventing High Cholesterol

Making certain lifestyle choices can help prevent high cholesterol in the first place. Important prevention tips include:

  • Eat a heart-healthy diet – Emphasize fiber-rich fruits, vegetables, whole grains. Avoid trans fats, limit red meat and dairy.
  • Limit processed foods – Heavily processed foods often contain hidden unhealthy fats and sodium.
  • Watch your weight – Excess weight drives up LDL and triglycerides. Losing just 5-10% of body weight offers big benefits.
  • Exercise regularly – Get 150 minutes of moderate activity per week to boost HDL levels.
  • Don’t smoke – Smoking damages blood vessels and depresses HDL.
  • Drink alcohol in moderation – Heavy drinking can increase triglycerides significantly.
  • Manage conditions – Keep conditions like diabetes, high blood pressure, and hypothyroidism under control.
  • Take medications as prescribed – Ask about cholesterol-friendly options if needed.
  • Reduce stress – Manage stress to avoid unhealthy coping behaviors. Practice self-care.
  • Get regular screening – Starting at age 20, get cholesterol checked every 4-6 years.

Following a heart smart lifestyle makes a big difference in preventing high cholesterol and its complications.

What happens if your cholesterol is high?

Untreated high cholesterol can lead to dangerous, even fatal, consequences over time. Here’s what can happen if your cholesterol levels remain elevated:

  • Atherosclerosis – Cholesterol plaque buildup causes hardening and narrowing of arteries throughout the body. This restricts blood flow and oxygen delivery.
  • Heart attack – Plaque rupture in the arteries of the heart leads to clot formation and blockages. This damages or destroys heart muscle.
  • Angina – Plaque in the heart’s arteries causes chest pain with exertion or stress from reduced blood flow.
  • Stroke – Cholesterol plaque in arteries in the brain can block blood flow, killing brain tissue.
  • Peripheral artery disease – Plaque buildup narrows arteries in the limbs, causing leg pain with walking.
  • Aneurysms – Weakened cholesterol-filled arteries in the aorta or brain are prone to bulging or rupture.
  • Heart failure – High cholesterol increases the workload on the heart over time, weakening the heart muscle.

Without treatment through lifestyle changes and medication, high cholesterol sets the stage for debilitating, life-threatening cardiovascular disease through its effects on arteries.

What are the 5 signs of high cholesterol?

While high cholesterol often has no obvious symptoms, here are 5 possible signs that may indicate your cholesterol is elevated:

1. Chest pain or discomfort – Tightness, pressure, squeezing, or pain in the chest is a hallmark symptom of angina, which often occurs with high cholesterol. It happens when narrowed heart arteries cannot supply enough oxygen-rich blood to meet the heart’s needs.

2. Numbness in limbs – Plaque buildup from cholesterol can narrow arteries supplying blood to the arms and legs. This can cause tingling, numbness or pain, especially in the legs.

3. Yellowish patches on skin – Cholesterol deposits in skin cause flat yellow bumps called xanthomas, often seen around eyelids and joints. This can indicate very high cholesterol levels.

4. Bulging arteries – With advanced atherosclerosis, large arteries around the knees, elbows or ankles may visibly bulge from plaque buildup.

5. Erectile dysfunction – Men with high cholesterol are at increased risk for erectile dysfunction due to reduced blood flow. High cholesterol impairs arteries in the pelvis and penis.

Keep in mind that many people with high cholesterol experience no symptoms at all and discover the problem through screening tests. Do not rely on symptoms alone to identify high cholesterol. Get tested regularly as your doctor recommends.

How can I lower my high cholesterol?

Here are 10 effective ways to lower unhealthy LDL and triglyceride levels while raising protective HDL cholesterol:

1. Follow a heart-healthy diet – Emphasize vegetables, fruits, whole grains. Avoid trans fats and limit saturated fats, red meat, sweets, and salt.

2. Exercise most days of the week – Aim for 30-60 minutes per day of brisk walking, jogging, cycling, or swimming to boost HDL cholesterol.

3. Lose extra weight – Losing just 5-10% of your body weight can improve cholesterol numbers.

4. Quit smoking and limit alcohol – Smoking and excessive drinking both depress HDL.

5. Increase soluble fiber – Eat more beans, oats, barley, and veggies. Soluble fiber reduces LDL absorption.

6. Take plant sterols/stanols – Found in supplements and some margarines, these plant compounds lower LDL cholesterol absorption.

7. Increase omega-3 fatty acids – Fatty fish or fish oil supplements provide omega-3s shown to lower triglycerides and reduce plaque buildup.

8. Try stress-reduction techniques – Chronic stress encourages unhealthy cholesterol-raising behaviors. Try meditation, yoga, or deep breathing.

9. Take prescribed medications – If heart-healthy lifestyle changes are not enough, cholesterol medications like statins may be needed.

10. Get regular screening – Schedule cholesterol checks at least every 5 years to monitor your levels and treatment.

Combining lifestyle strategies and medication if prescribed by your doctor offers the best results in lowering high cholesterol and protecting your heart.

The Role of Diet in Managing High Cholesterol

Diet plays a central role in both preventing and managing high cholesterol. By making smart dietary choices, you can lower LDL and triglycerides while boosting protective HDL cholesterol.

Key diet tips include:

  • Focus on heart-healthy unsaturated fats like olive oil, avocados, nuts, seeds, and fatty fish. Avoid saturated and trans fats.
  • Eat plenty of soluble fiber from oats, beans, Brussels sprouts, apples, and flaxseed. Soluble fiber prevents intestinal absorption of cholesterol.
  • Increase antioxidant-rich fruits and vegetables, which discourage LDL oxidation and plaque formation.
  • Limit simple sugars, refined carbohydrates, and excess calories, which all increase triglyceride levels.
  • Choose low-fat or nonfat dairy products to limit saturated fat and cholesterol intake.
  • Limit red meat to 1-2 lean servings per week and avoid processed meats high in saturated fat and sodium.
  • Minimize fried foods, fast food, frozen meals, and store-bought baked goods, which usually contain trans fats harmful to cholesterol levels.
  • Cook with healthy oils like olive, avocado, safflower, sunflower, or canola oil instead of butter or shortening.
  • Season foods with herbs, spices, lemon juice, and vinegar instead of salt to avoid high sodium intake.
  • If alcohol is consumed, limit intake to 1 drink per day for women or 2 for men to avoid triglyceride increases.

Making heart-smart food choices for high cholesterol protection should become part of your daily lifestyle and eating habits. Consult a nutritionist or registered dietitian for personalized dietary recommendations.

Lifestyle Changes to Lower High Cholesterol

High cholesterol-4

Along with a healthy diet, other lifestyle habits can significantly impact high cholesterol. Here are some important lifestyle changes for better cholesterol management:

Exercise regularly – Get at least 30-60 minutes per day of moderate exercise to boost HDL and lower LDL. Brisk walking, jogging, cycling, swimming, aerobics, and dancing are great choices.

Lose excess weight – Losing just 5-10% of your body weight can improve cholesterol numbers if overweight. Focus on permanent lifestyle changes, not fad diets.

Quit smoking – Smoking depresses HDL cholesterol while also damaging blood vessels. Quitting can quickly boost HDL.

Limit alcohol – Drinking more than moderate levels will raise harmful triglycerides. Limit intake to 1 drink daily for women, 2 for men.

Manage stress – Chronic stress encourages poor diet, inactivity, smoking, and drinking. Adopt stress-reducing practices like meditation, yoga, or deep breathing.

Monitor blood sugar – Manage diabetes and prediabetes through diet, exercise, and medication to avoid unhealthy cholesterol caused by high blood sugar.

Get good sleep – Not getting 7-9 hours of quality sleep encourages weight gain and stresses the body. Maintain good sleep hygiene habits.

Take medications as prescribed – If cholesterol medications are needed, take them consistently to protect your health. Discuss any side effects with your doctor.

Committing to heart-healthy lifestyle improvements provides benefits beyond just improving cholesterol levels for your overall wellbeing.

Complications of High Cholesterol

Left untreated, persistently high cholesterol levels can lead to life-threatening complications over time, especially heart attack and stroke. Possible complications include:

Heart attack – Cholesterol plaque ruptures in a coronary artery, causing a blood clot that blocks blood flow. This damages or destroys heart muscle.

Stroke – Plaque ruptures or a clot blocks an artery leading to or within the brain. This deprives the brain of oxygen, killing brain cells.

Angina – Chest pain, tightness or discomfort with exertion, due to reduced blood flow in the heart’s arteries.

Heart failure – The overworked heart muscle weakens over time and struggles to pump efficiently. Fluid can back up into the lungs causing shortness of breath.

Peripheral artery disease (PAD) – Plaque narrows arteries in the limbs, especially the legs. This causes pain with walking that goes away with rest.

Aneurysms – Weak, cholesterol-filled arteries can bulge and stretch, forming a sac-like aneurysm that may rupture.

Atherosclerosis – Widespread plaque throughout arteries. This causes reduced blood flow that can damage any area of the body including the heart, brain, limbs, kidneys, and eyes.

High cholesterol substantially increases the risk for serious cardiovascular conditions. Following your doctor’s treatment plan, which will likely include cholesterol medications, can help avoid these dangerous complications.


Although high cholesterol does not usually produce obvious symptoms initially, it is a major modifiable risk factor for life-threatening heart disease and stroke. Through lipid panel screening tests, elevated LDL, triglyceride, and total cholesterol levels can be identified and treated early before they cause atherosclerosis and related complications.

By adopting lifestyle improvements like heart-healthy eating, exercise, weight control, smoking cessation, and stress reduction, high cholesterol can often be well-managed. When lifestyle alone is not enough, cholesterol-lowering medications are very effective when taken consistently.

With routine screening and properly managed treatment, high cholesterol can be controlled before it leads to serious cardiovascular complications. Work closely with your doctor on diet, lifestyle changes, medications and ongoing monitoring to achieve healthy cholesterol levels and protect your heart.