What is high cholesterol?
High cholesterol is associated with an increased risk of cardiovascular disease. Seek immediate medical care (call 911) if you, or someone you are with, have symptoms of a stroke or heart attack, such as chest pain, difficulty breathing, dizziness, sweating, fainting, anxiety, sudden numbness or weakness, confusion, trouble speaking or understanding speech, trouble seeing or walking, or severe headache.
Cholesterol is a type of fat, or lipid, which is important for a variety of functions in your body. Your body needs cholesterol to make cell membranes, bile acids, and certain hormones. High cholesterol is when the blood contains more cholesterol than normal. In the United States, approximately one in every three adults (38%) has elevated total cholesterol levels, defined as 240 mg/dL (milligrams per deciliter blood) and higher (borderline high cholesterol is 200-239 mg/dL).
The two main sources of cholesterol are your body and your diet. Your body makes most (75%) of the cholesterol found in your blood. The rest (25%) comes from the foods you eat in the form of animal products. High cholesterol, or hypercholesterolemia, is caused by ingesting too much cholesterol in your diet or by your body making too much cholesterol.
There are two main types of cholesterol: “bad” cholesterol, also known as low-density lipoprotein (LDL), and “good” cholesterol, known as high-density lipoprotein (HDL). When too much LDL is present in your blood, it can build up in a substance called plaque on the walls of the arteries and increase the risk of developing cardiovascular diseases. These include atherosclerosis, coronary heart disease, blood clots, heart attack, and stroke. In contrast, HDL helps prevent LDL from clogging your arteries.
Higher levels of HDL help reduce your risk of heart disease, heart attack, and stroke. Triglycerides are another type of fat that is included in determining your risk of these conditions. When HDL, LDL and triglycerides are present in the right levels and balance in the body, cholesterol functions to protect your health, including cardiovascular health.
There are generally no symptoms of high cholesterol and many people do not realize they have it. This means many U.S. adults do not realize they have an increased risk of heart disease, heart attack, and stroke. Considering the health risks of high cholesterol, it is important to get a cholesterol-screening panel or test at regular intervals. If you know your risks, you can help control them through diet, exercise, lifestyle changes, regular medical care, and sometimes medications.
What are the symptoms of high cholesterol?
For most people, there are no symptoms of high cholesterol, which means you will not know if your cholesterol levels are high. However, a simple blood test, called a lipid panel or cholesterol screening, can determine your cholesterol levels.
Some people with inherited high cholesterol (familial hypercholesterolemia) may develop subcutaneous lipomas, which are slow-growing, fatty lumps that form between the skin and muscle. Additionally, yellowish eyelid skin plaques called xanthelasma also tend to appear early in adulthood. If you have a family history of high cholesterol, your doctor may check for these as an indicator of the condition.
Knowing your levels helps you know if you are at risk of heart disease, heart attack, and stroke. Your healthcare provider will help you understand what your test results mean, what your levels should be, and how to control your level of cholesterol to reduce your health risks.
Serious symptoms that might indicate a life-threatening condition
Some people do not know they have high cholesterol and atherosclerosis until they have a heart attack or stroke.
Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms of a heart attack:
- Change in the level of consciousness, such as passing out, unresponsiveness, or lethargy
- Chest pain, discomfort, pressure or squeezing
- Unexplained discomfort or pain in the upper body (neck, shoulders, back or arms)
- Unusual dizziness or light-headedness that does not go away
Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms of a stroke:
- Change in level of consciousness, such as passing out, unresponsiveness, or lethargy
- Difficulty with memory, thinking, talking, comprehension, writing or reading
- Loss of muscle coordination or balance
- Loss of vision or changes in vision in one or both eyes
- Sudden confusion or dizziness
- Sudden numbness or weakness of the face, arms or legs, particularly if it affects one side of the body
- Sudden, severe headache or worst headache of your life
What causes high cholesterol?
High cholesterol occurs when:
- You get too much cholesterol through your diet. Eating a diet high in saturated fats and animal products can be a source of too much cholesterol. This is called secondary hypercholesterolemia.
- Your body makes too much cholesterol.
- Your body is not able to get rid of enough cholesterol.
In some cases, high cholesterol is caused by a genetic condition passed down through families. This is primary, or familial hypercholesterolemia, which is characterized by a defect in how your body removes low-density lipoprotein (“bad” cholesterol) from the blood, in addition to increased production of cholesterol.
What are the risk factors for high cholesterol?
A number of factors are thought to increase your chances of developing high cholesterol. Common risk factors include:
- Diet high in saturated fats, trans fats, and animal products
- Family history of high cholesterol (familial hypercholesterolemia)
- Male gender
- Middle-age and older, particularly being past the age of menopause in women
- Obesity and being overweight
- Sedentary lifestyle, physical inactivity, or not getting enough exercise
Reducing your risk of high cholesterol
Most cases of high cholesterol are preventable. There are a number of things you can do to help reduce your risk of developing high cholesterol and its potentially life-threatening effects. One of the most important things you can do is have your cholesterol levels checked. Once you know your cholesterol level, your healthcare provider can help you set goals and make lifestyle changes including:
- Getting regular exercise
- Increasing the amount of monounsaturated fats, polyunsaturated fats, and fiber in your diet
- Maintaining a healthy weight
- Not smoking or quitting smoking
- Reducing the amount of saturated fats, trans fats, and dietary cholesterol that you eat
- Treating high cholesterol levels with medications as recommended by your healthcare provider
How do doctors diagnose high cholesterol?
Experts recommend a routine cholesterol screening every 4 to 6 years. A cholesterol screening is an overall look at, or profile of the fats in your blood. It is typically part of a blood test called a full lipid profile, which shows the actual levels of each type of fat in your blood: LDL, HDL, triglycerides, and others, as well as total cholesterol. Depending on your personal health factors and medical history, your doctor may recommend testing your cholesterol more often.
Testing is important because high blood cholesterol is a significant risk factor in heart disease and stroke. Lowering blood cholesterol through increased physical activity, weight loss, smoking cessation, and proper diet decreases that risk. However, blood cholesterol is very specific to each person. For that reason, a full lipid profile is an important part of your medical history and essential information for your doctor to have.
If abnormalities are discovered a second series of blood tests (lipoprotein fractionation) may be ordered to help your doctor better understand your clinical situation. For example, different cholesterol subunits respond better to different medications. Other subunits do not respond to medication and, in that case, none may be prescribed.
The target for good total cholesterol level is 125 to 200 mg/dL for both men and women. Doctors may diagnose high cholesterol at these values:
- 200-239 mg/dL is borderline high cholesterol.
- 239 mg/dL or higher is high cholesterol.
LDL cholesterol (“bad” cholesterol)
A good target LDL level is less than 100 mg/dL for both men and women; a lower limit has not been defined. An LDL value higher than 130 mg/dL is high LDL.
The target level is less than 150 mg/dL. Doctors may diagnose borderline high, high, or very high triglycerides:
- 150-199 mg/dL is borderline high triglycerides.
- 200-499 mg/dL is high triglycerides.
- 500 mg/dL or higher is very high triglycerides.
HDL cholesterol (“good” cholesterol)
The target HDL cholesterol is 40 mg/dL for men and 50 mg/dL for women. The higher the number, the more heart-protective it is.
- Lower than 40 mg/dL is a heart disease risk factor for men and women.
- 40 mg/dL or higher is a heart-healthy goal for men.
- 50 mg/dL or higher is a heart-healthy goal for women.
- 60 mg/dL or higher is optimal and protective.
In some people who already have coronary artery disease and/or who have an increased number of risk factors for coronary heart disease, a doctor may determine that the LDL cholesterol level should be kept lower than 70. Recent studies have shown that those who are at highest risk for a heart attack should lower their LDL cholesterol level to less than 100, and that an LDL cholesterol level of 70 or less may be optimal for people at the very highest level of risk.
What are the treatments for high cholesterol?
Your healthcare provider may recommend treating high cholesterol with lifestyle changes alone or in combination with medications to actively lower your cholesterol level. Lifestyle changes include eating a healthy diet, maintaining a healthy weight, getting adequate physical exercise, and quitting smoking.
However, you may also need treatment with medications. Your doctor may order further blood tests to analyze specific inflammatory biomarkers and determine your individual need for cholesterol-lowering medication.
Medications used to treat high cholesterol include:
- Bile acid resins or sequestrants, such as cholestyramine (Questran) and colesevelam (Welchol), which help your body eliminate or remove cholesterol from the blood
- Ezetimibe (Zetia), which prevents the absorption of cholesterol from the foods you eat
- Fibrates or fibric acid derivatives, such as fenofibrate (Tricor) and gemfibrozil (Lopid), which help reduce triglycerides and increase the amount of high-density lipoprotein (HDL) in your blood
- Niacin or nicotinic acid (type of B vitamin), which helps your body increase HDL levels while decreasing the amount of low-density lipoprotein (LDL) levels and triglycerides in your blood
- Statins, such as simvastatin (Zocor) and atorvastatin (Lipitor), which reduce the amount of cholesterol the liver produces
You can help control your cholesterol levels and reduce your risk of developing cardiovascular disease by following the treatment plan you and your healthcare provider design specifically for you
Natural treatments for high cholesterol
In addition to lifestyle changes and medication, some foods and supplements can help reduce cholesterol levels, research shows. It’s important to note that no natural food or supplement has been proven more effective than most cholesterol medications. Talk with your doctor before adding any supplement or alternative treatment to your routine.
Natural products that can be effective in lowering cholesterol include:
- Flaxseed, which studies show may help lower cholesterol when consumed as whole flaxseed or flaxseed lignans. Flaxseed oil has not been shown to have a significant effect on cholesterol levels. Pregnant women should avoid flaxseed as it may cause hormonal changes.
- Garlic supplements, which one study found lowered overall cholesterol and LDL cholesterol by 10% when taken for more than two months.
- Green tea, which may have moderate benefits for reducing overall cholesterol and LDL cholesterol levels. However, studies have not shown any effect of green tea on increasing HDL cholesterol.
- Oats, which have consistently been shown to help lower total and LDL cholesterol, particularly in people who start with very high cholesterol levels.
- Plant sterols and stanol esters, which are naturally occurring compounds in plant cells. Their structure is similar to that of cholesterol, so when they are absorbed by the body’s digestive system, they block the absorption of actual cholesterol. Sterols and stanols occur naturally in many foods, but supplements deliver the dosage needed to reduce cholesterol levels.
- Red yeast rice, a product that results from yeast grown on white rice. It is touted as an effective supplement for lowering cholesterol because it often contains a substance called monacolin K, which has the same chemical makeup as the prescription cholesterol drug lovastatin. The U.S. Food and Drug Administration warns that red yeast rice that contains significant amounts of monacolin K is considered an unapproved drug and cannot legally be sold as a dietary supplement. Talk with your doctor if you are considering trying red yeast rice for high cholesterol.
- Soy foods, which have been shown to have a small effect on lowering cholesterol levels.
What are the potential complications of high cholesterol?
Complications of high cholesterol are serious and can be life-threatening. Other diseases, disorders and conditions, such as high blood pressure and diabetes, can contribute to your risk of developing complications from high cholesterol.
Serious complications of high cholesterol include:
- Angina (chest pain caused by blocked coronary arteries)
- Atherosclerosis (hardening of the arteries)
- Coronary heart disease
- Heart attack