What Is High Cholesterol? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Medically Reviewed

High cholesterol is a condition that occurs when levels of cholesterol in your blood are elevated enough to cause health problems, including heart disease and stroke.? Sometimes known as hyperlipidemia, high cholesterol is painless and doesn’t cause any symptoms until a person develops severe heart disease.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause.

Approximately 93 million Americans over 20 years old, or almost 40 percent of the U.S. population, have high cholesterol.

Slightly more than half of adults with high cholesterol are getting treatment to lower it, the CDC notes.

Produced by your liver, cholesterol is a dense, fatty substance that’s found in every cell of your body, and it is considered essential to many life-sustaining functions. It helps your body make hormones and vitamin D, and it's also found in compounds that your body creates to help you digest food, such as bile.

Circulating in the bloodstream in small bundles of fat and protein called lipoproteins, cholesterol comes in two primary types: low-density lipoprotein (LDL), which contributes to the buildup of fatty plaques, and high-density lipoprotein (HDL), which is thought to protect from heart disease and stroke.? A blood test known as a lipid panel can measure both LDL and HDL cholesterol, as well as triglycerides, the most common type of fat in the blood.

Although scientists have long focused on measuring LDL cholesterol through a blood test, new research suggests that this narrow focus on LDL cholesterol levels does not necessarily lead to overall improved health outcomes for patients.

Some people with healthy LDL levels may still develop heart disease.
Currently, the American Heart Association (AHA)

and the CDC

both recommend that healthy adults over 20 get their cholesterol levels measured every four to six years. People who already have high cholesterol, cardiovascular disease, or other risk factors may need to check their cholesterol levels more often.

Chickpea ‘Tuna’ Salad

Who knew that chickpeas made such a delightful replacement for tuna??You won't even come close to missing the fish?in this delicious vegan rendition of the classic lunchtime favorite. In place of the familiar crunch of celery or raw red onion (feel free to throw those in there if you so desire), this incorporates?shallots, garlic, green onion, fresh tomatoes, cornichon pickles, and dill. Slather this mixture on some lovely pieces of toast and you've got your new favorite lunch!

contains? Wheat
4.6 out of 32 reviews

SERVES

2

CALORIES PER SERVING

306

AUTHOR

Alex Santos

PREP TIME

5 min

TOTAL TIME

5 min

Ingredients

1 16 oz can chickpeas
1 tbsp vegan mayonnaise
1 tbsp mustard
1 shallot, finely diced
3 green onions, finely sliced
2 cloves garlic, finely minced
1/4 cup tomatoes, finely chopped
1/4 cup cornichons or pickles, finely chopped
1/4 cup fresh dill, finely chopped, plus more for serving
Kosher salt, to taste
Freshly cracked black pepper, to taste
2 pieces toast

Directions

1

In a large bowl, add chickpeas and mash them down using a fork or potato masher. Then add mayonnaise, mustard, shallot, green onion, garlic, tomatoes, pickles, fresh dill, salt, and pepper. Mix until combined.

2

Divide the mixture onto?two pieces of toast. Enjoy!

Nutrition Facts

Amount per serving

calories

306

total fat

6g

saturated fat

0.7g

protein

14g

carbohydrates

53g

fiber

10.2g

sugar

9.5g

added sugar

0.9g

sodium

846mg

TAGS:

Wheat, Mediterranean, Vegetarian, Vegan, High-Fiber, Cholesterol-Conscious, Quick & Easy, Lunch

Signs and Symptoms of High Cholesterol

Typically, high cholesterol doesn’t cause any symptoms until it causes a medical emergency, like a heart attack or stroke. These heart-disease-related events don’t occur until high cholesterol levels have led to fatty plaque building up in the arteries. In turn, this leads to a narrowing of the arteries and a change in the makeup of the arterial lining,?also known as heart disease.

Causes and Risk Factors of High Cholesterol

According to the CDC, both hereditary and lifestyle-related factors contribute to high cholesterol, including the following.

Heredity

Having a family history of high cholesterol or heart disease also means you are more likely to have high cholesterol.

Although it is relatively rare, some people also carry a genetic condition called familial hypercholesterolemia, which causes extremely high LDL levels at a young age and, if left untreated, can lead to early-onset coronary artery disease and heart attacks. The CDC estimates that 1 million Americans, or a third of a percent of the U.S. population, have familial hypercholesterolemia.

Age

Due to age-related metabolic changes, including how the liver removes LDL cholesterol from the blood, everyone’s risk of high cholesterol increases as they get older.

Gender

Women over 55 or who have completed menopause tend to have lower LDL cholesterol levels than men. In general, men tend to have higher HDL cholesterol levels than women.

Diet

Eating a diet high in cholesterol, saturated fat, and trans fats is known to contribute to high cholesterol levels. Most animal and full-fat dairy products, and certain oils that are solid at room temperature, contain high levels of saturated fat. In recent years, the AHA?has stopped explicitly recommending against dietary cholesterol, after finding that it did not significantly correlate with heart disease risk.

Reducing the amount of saturated and trans fat in your diet is considered the best dietary change to lower your cholesterol.

Level of Physical Activity

According to the AHA, getting little to no physical activity in your everyday life can lower HDL cholesterol, which can make it difficult for your body to clear LDL cholesterol in the arteries.

Moderate to intense levels of exercise can increase HDL cholesterol levels and decrease the size of LDL cholesterol particles, making it less harmful.

Tobacco Use

Tobacco use is known to damage blood vessels and lower HDL cholesterol, which at normal levels protects against heart disease, particularly in women.

No conclusive evidence shows that smoking tobacco increases LDL cholesterol, but it does create an arterial environment that promotes fatty plaque buildup.

Obesity

According to the CDC, obesity — defined as a body mass index (BMI) over 30 — is linked to higher levels of triglycerides, HDL cholesterol, and LDL cholesterol. Although people considered overweight or obese using the BMI scale have an increased risk for high cholesterol, people with a lower BMI can be affected by high cholesterol as well.

Diabetes

Type 2 diabetes — another chronic condition sensitive to lifestyle factors, body weight, and metabolism — is also associated with lower HDL cholesterol and elevated LDL cholesterol. According to a study, the reasons for this relationship are only partially understood, but the changes in insulin metabolism and overall inflammation may be contributing factors.

People with type 1 diabetes are also more likely to have lipid profiles that contribute to heart disease, even if their levels are normal overall.

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How Is High Cholesterol Diagnosed?

Since high cholesterol alone typically has no signs or symptoms, the only way to find out if you have it is to get a simple blood test known as a lipid profile, or lipid panel. This blood test might require you to fast (not eat or drink) for 8 to 12 hours before your blood is drawn.

From this blood sample, your doctor can measure your LDL cholesterol, HDL cholesterol, and triglycerides, which at high levels can combine with low HDL or high LDL to increase your risk of heart disease. A lipid panel can also tell you your total cholesterol, which is based on all three components.

According to the CDC, the desirable levels for each component for adults are as follows:

  • LDL cholesterol of less than 100 milligrams per deciliter (mg/dL)
  • HDL cholesterol that's greater than or equal to 60 mg/dL
  • Triglycerides of less than 150 mg/dL
  • Total cholesterol of less than 200 mg/dL

However, more and more cardiologists are focusing less on specific numbers and more on overall risk of heart disease, according to Peter Schulman, MD, an attending cardiologist and professor of medicine at UConn Health in Farmington, Connecticut. Your age and overall health can help you determine whether you should talk to your doctor about improving your cholesterol levels if they’re not in the desirable range.

Duration of High Cholesterol

Although people can have high cholesterol for years, medication and lifestyle changes can reduce cholesterol levels to desirable levels within a few months, with some studies finding levels can improve in as little as four weeks with a plant-based diet. In a meta-analysis of 49 studies on the effect of plant-based dietary interventions lasting under four weeks, researchers found that plant-based diets correlated with decreased LDL cholesterol and total cholesterol.

Treatment and Medication Options for High Cholesterol

Although having high cholesterol numbers can contribute to the long-term risk of heart attack and stroke, you can lower your cholesterol through changes in your lifestyle habits, including adopting a heart-healthy diet, increasing your physical activity level, and quitting smoking. These long-term lifestyle changes can also prevent your cholesterol levels from changing in the first place.

Learn More About Prevention of High Cholesterol

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.

According to the Food and Drug Administration, 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 directly lower LDL and total cholesterol, 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.

Learn More About Treatment for High Cholesterol: Medication, Lifestyle Changes, and More

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 published in 2020 reviewed the effects of alcohol on high cholesterol and heart disease and found that the effects of alcohol in 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.

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Research and Statistics: How Many People Have High Cholesterol?

The CDC estimates that 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 National Health and Nutrition Examination Survey from 2015 to 2016, 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 known to be associated with certain groups. For example, people of Japanese descent might be more sensitive to statins, according to the AHA, 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 national 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 associated with other medical conditions:

  • High Blood Pressure High cholesterol is linked to high blood pressure because cholesterol-filled plaques can narrow arteries, forcing the heart to pump harder.

  • Heart Disease Without management, high cholesterol contributes to the development of heart conditions like heart attack and peripheral arterial disease.
  • Stroke If left untreated over the long term, high cholesterol contributes to the risk of stroke, a type of severe blood clot or blockage of blood flow to the brain.
  • Type 2 Diabetes People with diabetes tend to have high LDL and low HDL cholesterol levels, as well as higher levels of triglycerides.

Editorial Sources and Fact-Checking

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