(Tiny Tips) – High cholesterol is a condition that occurs when blood cholesterol levels rise high enough to cause health problems, including heart disease and stroke. High cholesterol (sometimes called hyperlipidemia) is painless and causes no symptoms until serious heart disease occurs.
Heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause of death.
Approximately 93 million Americans over 20, or nearly 40% of the U.S. population, have high cholesterol. More than half of adults with high cholesterol receive cholesterol-lowering treatment.
Produced by the liver, cholesterol is a dense fatty substance found in every cell in the body and is considered essential for many life-supporting functions. It helps your body produce hormones and vitamin D and is also found in compounds your body makes to help you digest food, such as bile.
Cholesterol circulates in the blood in small bundles of fats and proteins called lipoproteins. There are two main types of cholesterol: low-density lipoprotein (LDL), which helps build fatty plaques, and high-density lipoprotein (HDL), which is thought to protect against heart disease and stroke. A blood test called a lipid panel measures LDL and HDL cholesterol, as well as triglycerides (the most common type of fat in the blood).
While scientists have long focused on measuring LDL cholesterol through blood tests, new research suggests this narrow focus on LDL cholesterol levels doesn’t necessarily lead to improvements in patients’ overall health. Some people with healthy LDL levels may still develop heart disease.
Currently, both the American Heart Association (AHA) and the CDC recommend that healthy adults over the age of 20 have their cholesterol levels checked every four to six years. People who already have high cholesterol, cardiovascular disease, or other risk factors may need to have their cholesterol levels checked more frequently.
Signs and symptoms of high cholesterol
Typically, high cholesterol does not cause symptoms until a medical emergency occurs (such as a heart attack or stroke). These heart disease-related events only occur when high cholesterol levels cause fatty plaque to form in the arteries. This in turn can lead to the narrowing of the arteries and changes in the consistency of the inner walls of the arteries, also known as heart disease.
Causes and risk factors of high cholesterol
Genetic and lifestyle factors can contribute to high cholesterol, including the following.
Heritage
This also means you are more likely to have high cholesterol if you have a family history of high cholesterol or heart disease.
Although the condition is relatively rare, some people also suffer from a genetic disorder called familial hypercholesterolemia, which causes extremely high LDL levels at a young age and can lead to severe disease if left untreated. Leads to premature coronary artery disease and heart attacks. Approximately 1 million Americans, or one-third of the U.S. population, have familial hypercholesterolemia.
Age
The risk of high cholesterol increases with age due to age-related metabolic changes, including how the liver clears LDL cholesterol from the blood.
Gender
Women who are over 55 or who have gone through menopause tend to have lower LDL cholesterol levels than men. In general, men tend to have higher HDL cholesterol levels than women.
Diet
It is known that a diet high in cholesterol, saturated fat, and trans fat can lead to high cholesterol. Most animal and full-fat dairy products and some oils that are solid at room temperature contain high levels of saturated fatty acids. In recent years, the American Heart Association has stopped specifically recommending against dietary cholesterol after determining that it is not significantly associated with heart disease risk. Reducing the amount of saturated fat and trans fat in your diet is considered the best dietary change for lowering cholesterol levels.
Physical activity level
Little or no physical activity in your daily life can lower HDL cholesterol, which can make it difficult for your body to clear LDL cholesterol from your arteries. Moderate to vigorous exercise can increase HDL cholesterol levels and reduce the size of LDL cholesterol particles, making them less harmful.
Tobacco use
Smoking is known to damage blood vessels and lower HDL cholesterol, and normal levels of HDL cholesterol protect against heart disease, especially in women. There is no conclusive evidence that smoking increases LDL cholesterol levels, but it creates an arterial environment that promotes the formation of fatty plaque.
Obesity
Obesity—defined as a body mass index (BMI) above 30—is associated with higher levels of triglycerides, HDL, and LDL cholesterol. While people who are considered overweight or obese according to the BMI scale are at increased risk for high cholesterol, high cholesterol can also affect people with a lower BMI.
Diabetes
Type 2 diabetes is another chronic disease related to lifestyle factors, weight, and metabolism, and is also associated with reduced levels of HDL cholesterol and increased levels of LDL cholesterol. The cause of this link is unclear, but changes in insulin metabolism and general inflammation may contribute, according to one study. People with type 1 diabetes also have blood lipid levels that are more likely to contribute to heart disease, even if their levels are generally normal.
How is high cholesterol diagnosed?
Because high cholesterol itself often doesn’t have any signs or symptoms, the only way to find out if it’s present is to do a simple blood test called a lipid profile or lipid panel. This blood test may require you to fast (no food or water) for 8 to 12 hours before the blood is drawn.
From this blood sample, your doctor can measure your LDL cholesterol, HDL cholesterol, and triglycerides. If these cholesterols are too high, plus LDL cholesterol or high LDL cholesterol, it can cause Increase your risk of heart disease. A lipid test also shows your total cholesterol level, which is based on all three components.
The ideal values for each adult component are as follows:
- LDL cholesterol less than 100 milligrams per deciliter (mg/dL)
- HDL cholesterol greater than or equal to 60 mg/dL
- Triglycerides less than 150 mg/dL
- Total cholesterol less than 200 mg/dL
According to Dr. However, more cardiologists are focusing less on specific numbers and more on the overall picture of heart disease, said Dr. Peter Schulman, a cardiologist and professor of medicine at UConn Health in Farmington, Conn. risk. Depending on your age and overall health, you can decide whether you should talk to your doctor about improving your cholesterol levels if they are not within the desired range.
Duration of high cholesterol
Although people may have low cholesterol levels for many years, medications and lifestyle changes can lower cholesterol to the desired levels within a few months. Some studies have found that a plant-based diet can improve cholesterol levels in as little as four weeks. In a meta-analysis of 49 studies of the effects of plant-based dietary interventions that lasted less than four weeks, researchers found that plant-based diets were associated with reductions in LDL cholesterol and total cholesterol.
High Cholesterol Treatment and Medication Options
While high cholesterol levels increase your long-term risk of heart attack and stroke, you can lower your cholesterol levels by making lifestyle changes, including eating a heart-healthy diet, increasing physical activity, and quitting smoking. These long-term lifestyle changes can also prevent fundamental changes in cholesterol levels.
If these behavioral changes alone don’t impact your cholesterol levels, your doctor might prescribe you medications to lower your cholesterol. The Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator can help your doctor determine if you need medication. Generally, if your risk is 7.5 percent or higher on the ASCVD Risk Calculator, your doctor will recommend cholesterol-lowering drugs, according to Dr. Schulman.
Medications to Treat High Cholesterol
For most people who need medication to manage high cholesterol, doctors will prescribe statins. Statins, also known as HMG CoA reductase inhibitors, are a class of drugs that prevent cholesterol from forming in the liver, where both LDL and HDL cholesterol are made. This lowers the amount of cholesterol circulating in the blood. They are most effective at lowering LDL cholesterol but can also lower triglycerides and HDL cholesterol.
Statins typically don’t cause severe side effects. Most side effects are mild and disappear if you continue to use them. However, statin use carries a small risk of increasing muscle pains and type 2 diabetes, and people who are pregnant or who have certain types of liver disease should not take statins.
If you have certain conditions, or if statins aren’t working to decrease your high cholesterol sufficiently, your doctor may prescribe one of these other cholesterol-lowering medications:
- PCSK9 Inhibitors A newer type of medicine, PCSK9 inhibitors bind to and inactivate a protein on certain liver cells, which then lowers LDL cholesterol. Administered by injection, they are often used in patients with high cholesterol that doesn’t respond to statins or people with familial hypercholesterolemia.
- Selective Cholesterol Absorption Inhibitors The most commonly used nonstatin agent, according to the AHA, selective cholesterol absorption inhibitors prevent cholesterol from being absorbed in the intestine. This means less cholesterol is delivered to the liver and, ultimately, the blood.
- Bile Acid Sequestrants Also known as bile-acid-binding agents, these drugs work by removing bile acids from the liver. Since LDL cholesterol is needed to make bile acids, the body then breaks down more LDL cholesterol particles.
Although the data doesn’t support the ability of these drugs to lower LDL and total cholesterol directly, your doctor may prescribe the following drugs to manage your triglyceride levels:
- Fibrates These medications reduce overall triglyceride levels by reducing the liver’s production of very low-density lipoproteins, which are made up mostly of triglycerides.
- Niacin Also known as nicotinic acid, niacin is a B vitamin that can raise HDL cholesterol while lowering levels of total cholesterol, LDL cholesterol, and triglycerides.
- Omega-3 Fatty Acid Supplements In large doses, omega-3 fatty acids can help lower triglyceride levels. The most common supplement is OTC fish oil, but they are also available by prescription.
Prevention of High Cholesterol
Regardless of family history or any previous history of heart disease, you can prevent high cholesterol by eating a healthy diet, getting regular physical activity, and quitting smoking. Maintaining a normal weight and limiting alcohol intake can also help.
Regularly monitoring your cholesterol levels can also help prevent your numbers from getting too high or low. In general, healthy adults should check their cholesterol every four to six years, but your doctor may ask to check your cholesterol more often depending on your age, overall health, and other risk factors. There are other ways to prevent high cholesterol, too
Eat a Healthy Diet
Eating a diet low in saturated and trans fat and high in fiber and unsaturated fats can help prevent high cholesterol. Foods like oatmeal, beans, avocados, and vegetable oils can lower LDL cholesterol and increase HDL cholesterol levels.
Although the AHA once recommended against consuming dietary cholesterol, which is found in foods like eggs, it has recently stopped explicitly recommending this because of a lack of robust data.
Get Regular Physical Activity
The latest physical activity guidelines for Americans recommend that adults get at least 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes if engaging in more vigorous physical activity, like jogging or running. Doing weight or resistance-based strength training on two or more days a week adds additional health benefits.
Quit Smoking
Quitting smoking, or not starting, is one of the major recommendations by the AHA to prevent high cholesterol and heart disease. After 15 years of not smoking, a former smoker’s risk of heart disease is similar to someone who has never smoked.
For cholesterol levels specifically, tobacco use is known to damage blood vessels and lower HDL cholesterol, which at normal levels protects against heart disease, particularly in women.
Maintain a Normal Weight
Having a BMI in the overweight or obese range highly correlates with having excess body fat, which in turn can affect how your body processes cholesterol. Excess body fat also slows down the ability to remove LDL cholesterol from the blood, raising your levels and increasing your risk of heart attack and stroke.
Limit Alcohol Intake
Excess alcohol intake, defined as more than two drinks a day for men and one drink for women, can raise cholesterol and triglyceride levels. A study reviewed the effects of alcohol on high cholesterol and heart disease and found that the effects of alcohol on overall health vary widely, depending on amount and consumption pattern.
Complications of High Cholesterol
Since high cholesterol alone typically doesn’t cause any symptoms, people only experience complications when their high cholesterol contributes to the development of severe heart disease, often in the form of heart attack or stroke. Over the long term, high cholesterol can cause plaque to form in your arteries, which can then narrow and lead to a cardiovascular emergency.
Research and Statistics: How Many People Have High Cholesterol?
Approximately 93 million Americans over 20, or close to 40 percent of the U.S. population, have high cholesterol, which puts them at increased risk of heart disease and stroke.
Heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause.
BIPOC and High Cholesterol
The prevalence of high cholesterol among Black, Indigenous, and People of Color (BIPOC) in the United States is well-studied. In a survey, the CDC found that there were no statistically significant differences in the prevalence of total high cholesterol among men. However, Americans of Hispanic origin had a significantly higher prevalence of low HDL cholesterol compared with Black, white, and Asian Americans. The study also made the following findings:
- Overall, HDL cholesterol levels were lowest in Black Americans and highest in people identifying as of Hispanic origin, a category that includes many who identify as Chicano or Latinx.
- Across all racial and ethnic groups, women had a lower prevalence of low HDL cholesterol than men.
Although the prevalence of high cholesterol numbers may not always vary widely among U.S. racial and ethnic groups, Black Americans are disproportionately more likely to suffer from heart disease, in which high cholesterol plays a role. Other risk factors related to high cholesterol and heart disease — like obesity, diabetes, and high blood pressure — are also higher in women of Hispanic origin. In recent years, American Indians and Alaskan Natives have also seen increasing rates of heart disease.
In 2019, the AHA and others updated national cholesterol guidelines for medical providers to include a specific section on risk factors related to race and ethnicity beyond the standard ASCVD risk calculator. These factors may relate to lifestyle or genetic differences associated with certain groups. For example, people of Japanese descent might be more sensitive to statins and thus require lower dosing.
Among Asian Americans, South Asians have a higher risk of heart disease compared with the general population, and they tend to have lower levels of HDL cholesterol. According to an ongoing study on South Asian Americans, the subgroup tends to develop abnormal cholesterol and other risk factors for heart disease at lower body weights compared with people in other racial and ethnic groups.
Related Conditions
High cholesterol is linked to other diseases:
- High blood pressure High cholesterol is associated with high blood pressure because cholesterol-filled plaque narrows the arteries, forcing the heart to beat harder.
- Heart Disease If left untreated, high cholesterol can lead to heart disease such as heart disease and peripheral artery disease.
- Stroke If left untreated for a long time, high cholesterol can increase the risk of stroke, a serious type of blood clot, or blockage of blood flow to the brain.
- Type 2 Diabetes People with diabetes have higher levels of LDL cholesterol, lower levels of HDL cholesterol, and higher levels of triglycerides.
Editorial Sources and Fact-Checking
- What Is Blood Cholesterol? National Heart, Lung, and Blood Institute. March 24, 2022.
- High Cholesterol: Symptoms and Causes. Mayo Clinic. January 11, 2023.
- HDL (Good), LDL (Bad) Cholesterol and Triglycerides. American Heart Association. November 6, 2020.
- Triglycerides: Why Do They Matter? Mayo Clinic. September 3, 2022.
- High Cholesterol Facts. Centers for Disease Control and Prevention. May 15, 2023.
- Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics — 2020 Update: A Report From the American Heart Association. Circulation. March 3, 2020.
- DuBroff R, Malhotra A, de Lorgeril M. Hit or Miss: The New Cholesterol Targets. BMJ Evidence-Based Medicine. December 2021.
- How to Get Your Cholesterol Tested. American Heart Association. November 9, 2020.
- Get a Cholesterol Test. Centers for Disease Control and Prevention. May 15, 2023.
- Know Your Risk for High Cholesterol. Centers for Disease Control and Prevention. May 15, 2023.
- Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation. January 21, 2020.
- Prevention and Treatment of High Cholesterol (Hyperlipidemia). American Heart Association. November 11, 2020.
- High Cholesterol: Symptoms and Causes. Mayo Clinic. January 11, 2023.
- He BM, Zhao SP, Peng ZY. Effects of Cigarette Smoking on HDL Quantity and Function: Implications for Atherosclerosis. Journal of Cellular Biochemistry. November 2013.
- Common Misconceptions About Cholesterol. American Heart Association. November 9, 2020.
- Wu L, Parhofer KG. Diabetic Dyslipidemia. Metabolism: Clinical and Experimental. December 2014.
- Schofield J, Ho J, Soran H. Cardiovascular Risk in Type 1 Diabetes Mellitus. Diabetes Therapy. June 2019.
- Yokoyama Y, Levin SM, Barnard ND. Association Between Plant-Based Diets and Plasma Lipids: A Systematic Review and Meta-Analysis. Nutrition Reviews. September 2017.
- ASCVD Risk Estimator Plus. American College of Cardiology.
- Controlling Cholesterol With Statins. U.S. Food and Drug Administration. February 16, 2017.
- PCSK9 Inhibition: A Game Changer in Cholesterol Management. Mayo Clinic. November 20, 2015.
- Sizar O, Nassereddin A, Talati R. Ezetimibe. StatPearls. February 5, 2023.
- Prevent High Cholesterol. Centers for Disease Control and Prevention. May 16, 2023.
- Physical Activity Guidelines for Americans, 2nd Edition [PDF]. U.S. Department of Health and Human Services. 2018.
- How Much Physical Activity Do Adults Need? Centers for Disease Control and Prevention. June 2, 2022.
- The Benefits of Quitting Smoking Now. American Heart Association. January 9, 2017.
- He BM, Zhao SP, Peng ZY. Effects of Cigarette Smoking on HDL Quantity and Function: Implications for Atherosclerosis. Journal of Cellular Biochemistry. November 2013.
- Minzer S, Losno RA, Casas R. The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information? Nutrients. April 2020.
- Total and High-Density Lipoprotein Cholesterol in Adults: United States, 2015–2016 [PDF]. National Center for Health Statistics. October 2017.
- The State of Health Disparities in the United States. Communities in Action: Pathways to Health Equity. January 11, 2017.
- Hispanic Health. Centers for Disease Control and Prevention. May 5, 2015.
- Ethnicity a “Risk-Enhancing” Factor Under New Cholesterol Guidelines. American Heart Association. January 11, 2019.
- Investigating Heart Disease in the South Asian Community: Publications. The Masala Study Coordinating Center.
- Why Do South Asians Have Such High Rates of Heart Disease? The New York Times. February 12, 2019.
- Ferrara LA, Guida L, Iannuzzi R, et al. Serum Cholesterol Affects Blood Pressure Regulation. Journal of Human Hypertension. May 1, 2002.
- Schofield JD, Liu Y, Rao-Balakrishna P, et al. Diabetes Dyslipidemia. Diabetes Therapy. June 2016.