Everything to Know About Hypercholesterolemia

Medically Reviewed By Megan Soliman, MD

Hypercholesterolemia refers to high levels of cholesterol in the blood. Having hypercholesterolemia can increase your risk of cardiovascular diseases such as stroke and heart attack. Cholesterol is a type of fat, also known as lipids. The body needs a small amount of cholesterol for cell function, hormone production, and other processes.

However, too much LDL (bad) cholesterol can cause cause blockages, known as hypercholesterolemia or high cholesterol.

This article explains hypercholesterolemia, including its causes, treatment, prevention, and outlook.

Key facts about hypercholesterolemia

  • Hypercholesterolemia refers to high LDL (bad) cholesterol levels.
  • Hypercholesterolemia doesn’t usually cause noticeable symptoms.
  • Hypercholesterolemia can result from hereditary genetic variations or lifestyle factors, such as diet.
  • Treatment for hypercholesterolemia typically includes lifestyle approaches, such as a low cholesterol diet and medication.

Types of hypercholesterolemia

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The two primary types of hypercholesterolemia are:

  • Acquired: Acquired hypercholesterolemia means you have developed the condition throughout life. This can be due to lifestyle factors, such as smoking.
  • Genetic: Genetic hypercholesterolemia, or familial hypercholesterolemia, is a hereditary genetic condition that causes high cholesterol. Familial hypercholesterolemia typically causes much higher cholesterol levels than acquired hypercholesterolemia.

Read more about familial hypercholesterolemia, including its causes, treatment, and outlook.

Hypercholesterolemia vs. hyperlipidemia

Many types of lipids or fats can build up in the body.

Hypercholesterolemia refers to high levels of LDL (bad) cholesterol. Hyperlipidemia refers to high levels of cholesterol or other lipids, such as triglycerides. Hypercholesterolemia is a type of hyperlipidemia.

Cholesterol levels and symptoms

Hypercholesterolemia doesn’t usually cause noticeable symptoms. Most people find out they have hypercholesterolemia after a blood test for cholesterol levels.

Doctors may diagnose hypercholesterolemia if you have:

  • LDL cholesterol levels over 190 milligrams per deciliter (mg/dL) Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of blood
  • LDL cholesterol levels over 160 mg/dL and one major risk factor for cardiovascular disease
  • LDL cholesterol levels over 130 mg/dL with two major risk factors for cardiovascular disease

Familial hypercholesterolemia may cause very high cholesterol levels, such as up to 400 mg/dL Trusted Source American Heart Association Highly respected national organization Go to source of blood.

Risk factors for cardiovascular disease include:

  • being 45 years old or over and male
  • being 55 years old or over and female
  • a family history of early cardiovascular disease
  • high blood pressure
  • diabetes
  • smoking
  • low HDL cholesterol levels

If your cholesterol levels are very high, you may also notice symptoms such as:

  • fatty bumps called xanthoma
  • gray or whitish rings around the eye’s cornea

If you have very high cholesterol or have had high cholesterol for a while, you may develop another cardiovascular condition as a result. Due to this, you may have other cardiovascular symptoms.

Read more about cardiovascular disease symptoms.

Causes of hypercholesterolemia

The cause of hypercholesterolemia can depend on the type.

Genetic hypercholesterolemia

Familial hypercholesterolemia is caused by genetic variations Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source you inherit from one or both biological parents.

Different genetic variations can cause high cholesterol levels in different ways. For example, some variations may decrease the liver’s ability to remove LDL from the blood.

Sometimes, other genetic conditions also cause hypercholesterolemia as a secondary effect, such as nephrotic syndrome or hereditary cholestasis.

Acquired hypercholesterolemia

Acquired hypercholesterolemia is when factors you experience throughout life cause high cholesterol.

Examples of factors that may cause or increase the risk of high cholesterol include:

  • eating a diet high in saturated or trans fats
  • not getting enough physical activity
  • smoking
  • pregnancy
  • taking certain medications, such as:
    • cyclosporine (Gengraf, Neoral)
    • thiazide (Aquazide H, Microzide)
    • diuretics or “water” pills
  • having certain health conditions, such as:

Multiple factors can contribute to high cholesterol

High cholesterol sometimes develops due to a mix of factors.

Also, specialists say some people may have unidentified genetic susceptibilities to high cholesterol. These genetic factors may sometimes combine with lifestyle factors to increase your overall risk of high cholesterol.

Risk factors for hypercholesterolemia

Factors that may increase the risk of having high cholesterol include:

  • older age
  • being male
  • physical inactivity
  • smoking
  • having health conditions such as:

High cholesterol is also more common in South Asian people, possibly due to higher levels of genetic and lifestyle risk factors.

Diagnosing hypercholesterolemia

Doctors can diagnose hypercholesterolemia with a fasting or non-fasting blood test to check your cholesterol levels.

They may also ask about your symptoms, medical history, and family medical history.

Experts recommend cholesterol screenings if you experience certain risk factors for cardiovascular disease. Talk with a doctor about whether you should have a cholesterol blood test.

Learn more about cholesterol levels and what your results mean.

Treatment and management of hypercholesterolemia

Key treatments for hypercholesterolemia include lifestyle approaches, such as:

  • getting regular physical activity, such as at least 150 minutes Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source of moderate-intensity activity per week
  • maintaining a moderate weight
  • getting enough sleep
  • avoiding smoking
  • limiting alcohol intake
  • having regular checkups with your medical team and following their recommendations
  • eating a diet that is low in saturated and trans fats and high in fiber and omega-3 fatty acids

Your medical team may also prescribe medications to help lower your cholesterol levels — especially if you have familial hypercholesterolemia or very high cholesterol levels.

Learn more about low cholesterol diets.

Medical treatments

Medications to help lower cholesterol include:

  • Statins: Statins are the most common cholesterol medication. They work by reducing the amount of cholesterol the liver makes.
  • Bile acid sequestrants: Bile acid sequestrants stop the blood from absorbing bile acid from your stomach. This makes the liver use up excess cholesterol to make bile acid instead.
  • Proprotein convertase subtilisin/kexin 9 (PCKS9) inhibitors: These medications stop a protein called PCKS9 from destroying LDL receptors in the liver. This allows the liver to keep removing LDL from the blood.
  • Medications for familial hypercholesterolemia: Doctors may prescribe other medications if you have familial hypercholesterolemia, such as:
    • mipomersen (Kynamro)
    • ezetimibe (Zetia)
    • bempedoic acid (Nexletol)
    • lomitapide (Juxtapid)

Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis. This procedure circulates your blood through a machine to remove LDL cholesterol.

Outlook of hypercholesterolemia

The outlook of hypercholesterolemia can vary per person and depends on its cause and treatment.

The primary risk of high cholesterol levels is developing further cardiovascular disease and events, such as a stroke or heart attack.

Cardiovascular complications are more likely if you have familial hypercholesterolemia Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source or do not receive effective treatment for high cholesterol.

Learn more about the health effects and risks of high cholesterol.

Preventing hypercholesterolemia

Not all cases of high cholesterol are preventable, and familial hypercholesterolemia is not preventable.

However, some approaches can help reduce risks Trusted Source Centers for Disease Control and Prevention (CDC) Governmental authority Go to source for high cholesterol, such as:

  • eating a diet low in saturated and trans fats
  • maintaining a moderate weight
  • avoiding smoking
  • limiting alcohol intake
  • getting regular physical activity
  • managing other health conditions you may have

Also, early diagnosis and genetic testing can help reduce the risk of heart disease by up to 80% in people with familial hypercholesterolemia.


Hypercholesterolemia refers to having high LDL (bad) cholesterol levels. It can occur due to a genetic condition called familial hypercholesterolemia or lifestyle factors such as a diet high in saturated and trans fats.

High cholesterol doesn’t typically cause noticeable symptoms. Cholesterol screening tests are essential for diagnosis and effective treatment.

Treatment options for hypercholesterolemia include lifestyle approaches and medication.

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Medical Reviewer: Megan Soliman, MD
Last Review Date: 2024 Jul 8
View All Cholesterol Articles
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