High Cholesterol
Too much cholesterol in the blood, raising heart and stroke risk
Quick Facts
- Type: Metabolic / cardiovascular risk factor
- Often has: No symptoms (found on a blood test)
- Main risk: Heart attack, stroke, artery disease
- Managed by: Diet, exercise, and medication if needed
Overview
Cholesterol is a waxy, fatty substance that the body needs in small amounts to build cells and make certain hormones. It travels in the blood attached to particles called lipoproteins. "Bad" cholesterol (LDL) can build up in the walls of the arteries, while "good" cholesterol (HDL) helps remove cholesterol from the blood. High cholesterol means there is too much cholesterol, particularly the harmful kind, in the blood.
Over time, excess cholesterol contributes to atherosclerosis, the buildup of fatty deposits that narrow and stiffen the arteries. This raises the risk of serious problems such as heart attack and stroke. High cholesterol usually causes no symptoms, so it is often discovered through a routine blood test. The good news is that it can usually be improved with lifestyle changes and, when needed, medication.
Symptoms
High cholesterol itself usually causes no symptoms. Most people feel completely well and only learn they have it through a blood test. This is why it is sometimes called a "silent" risk factor.
- No symptoms in most cases
- In some inherited forms, fatty deposits may appear under the skin, around the eyes, or in tendons
- Symptoms usually appear only once cholesterol has caused complications, such as chest pain from narrowed heart arteries or symptoms of a heart attack or stroke
Because high cholesterol is silent, regular screening is important, especially for people with risk factors or a family history of heart disease.
Causes
Cholesterol levels are influenced by a mix of lifestyle and inherited factors:
- Diet: Eating a lot of saturated and trans fats can raise harmful cholesterol.
- Being overweight and inactive: These tend to raise bad cholesterol and lower good cholesterol.
- Genetics: Some people inherit conditions, such as familial hypercholesterolemia, that cause very high cholesterol regardless of lifestyle.
- Other health conditions: Diabetes, an underactive thyroid, kidney disease, and some others can affect cholesterol.
- Smoking: Lowers good cholesterol and damages blood vessels.
- Certain medications can also raise cholesterol.
Often several factors combine. Age and family history matter too, since cholesterol tends to rise with age.
Risk Factors
- A diet high in saturated and trans fats
- Being overweight or obese
- Physical inactivity
- Smoking
- A family history of high cholesterol or early heart disease
- Diabetes, high blood pressure, or kidney disease
- Increasing age
Diagnosis
High cholesterol is diagnosed with a simple blood test, sometimes called a lipid panel or lipid profile.
- Lipid panel: Measures total cholesterol, LDL ("bad") cholesterol, HDL ("good") cholesterol, and triglycerides, another type of blood fat.
- Risk assessment: Doctors interpret the results alongside other factors such as age, blood pressure, smoking, diabetes, and family history to estimate overall heart and stroke risk.
Screening is recommended periodically for adults, and earlier or more often for those with risk factors or a strong family history. Some tests may ask you to fast beforehand.
Treatment
Treatment focuses on lowering harmful cholesterol and reducing the overall risk of heart attack and stroke. The plan is tailored to your cholesterol levels and your overall risk.
- Healthy eating: Reducing saturated and trans fats, eating more fiber, fruits, vegetables, whole grains, and healthy fats.
- Physical activity: Regular exercise can raise good cholesterol and improve overall heart health.
- Weight management and stopping smoking: Both improve cholesterol and lower risk.
- Medications: Statins are the most common cholesterol-lowering medicines and are very effective; other medicines may be added or used if statins are not suitable.
- Managing related conditions: Such as diabetes and high blood pressure.
For most people, a combination of lifestyle changes and, where needed, medication can bring cholesterol to a healthier level and substantially lower cardiovascular risk.
Prevention
- Eat a balanced diet low in saturated and trans fats and rich in fiber, fruits, and vegetables
- Stay physically active most days of the week
- Maintain a healthy weight
- Do not smoke, and limit alcohol
- Have your cholesterol checked as recommended
- Manage related conditions such as diabetes and high blood pressure
When to See a Doctor
Talk to your doctor about having your cholesterol checked, especially if you have risk factors or a family history of high cholesterol or early heart disease. Seek emergency care immediately for warning signs of a heart attack or stroke, which can result from the artery damage high cholesterol causes:
- Chest pain, pressure, or tightness, possibly spreading to the arm, jaw, or back
- Sudden shortness of breath, cold sweat, nausea, or lightheadedness
- Sudden weakness or numbness on one side of the body, facial drooping, slurred speech, or trouble seeing or speaking
Frequently Asked Questions
Does high cholesterol cause symptoms?
Usually not. High cholesterol typically causes no symptoms and is found through a blood test. Symptoms tend to appear only after it has led to complications such as narrowed arteries, a heart attack, or a stroke, which is why regular screening is important.
What is the difference between good and bad cholesterol?
LDL is often called "bad" cholesterol because it can build up in artery walls and raise the risk of heart attack and stroke. HDL is called "good" cholesterol because it helps remove cholesterol from the blood. Treatment aims to lower LDL and support overall heart health.
Can I lower my cholesterol without medication?
Many people can improve their cholesterol with lifestyle changes such as eating less saturated and trans fat, being more active, losing excess weight, and stopping smoking. Some people, especially those with very high cholesterol or high overall risk, also need medication such as statins.
What are statins and are they safe?
Statins are the most common cholesterol-lowering medicines and are very effective at reducing heart attack and stroke risk. They are generally safe and well tolerated, though some people have side effects such as muscle aches. Your doctor can discuss the benefits and any concerns for your situation.
When should I get my cholesterol checked?
Adults should have their cholesterol checked periodically, and earlier or more often if they have risk factors such as diabetes, high blood pressure, smoking, or a family history of high cholesterol or early heart disease. Your doctor can advise how often is right for you.
References
- Centers for Disease Control and Prevention (CDC). Cholesterol.
- National Heart, Lung, and Blood Institute (NHLBI). Blood Cholesterol.
- Mayo Clinic. High cholesterol — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Cholesterol.