High Cholesterol

Condition Basics

What is high cholesterol?

High cholesterol means that you have too much cholesterol in your blood. Cholesterol is a type of fat. It's needed for many body functions, such as making new cells. It's made by your body. It also comes from food you eat (meat and dairy products).

Having high cholesterol can lead to the buildup of fatty deposits called plaque (say "plak") in artery walls. This can increase your risk of heart attack and stroke.

What causes it?

Doctors can't usually say for sure what may have caused high cholesterol. But many things can make it more likely. These things include eating too much food that contains saturated fat and having family who have or had high cholesterol.

What are the symptoms?

High cholesterol doesn't cause symptoms in most people. It's usually found during a blood test that measures cholesterol levels.

How is it diagnosed?

High cholesterol is diagnosed with a blood test. The test measures the level of total cholesterol plus the level of different types of cholesterol and fats in your blood. These include LDL, HDL, and triglycerides. High cholesterol levels don't cause symptoms. A blood test is the only way to know your cholesterol levels.

How is high cholesterol treated?

The two types of treatment for high cholesterol are lifestyle changes and medicines called statins. The goal of treatment is to reduce your chances of having a heart attack or stroke. It's not to lower your cholesterol numbers alone.

Lifestyle changes include:

• Eating heart-healthy foods.
• Losing weight if you need to, and staying at a healthy weight.
• Being active on most, if not all, days of the week.
• Not smoking.

Some people also take medicines called statins, along with lifestyle changes, to reduce their risk.

The way you choose to lower your risk will depend on how high your risk for heart attack and stroke is. It will also depend on how you feel about taking medicines. Your doctor can help you know your risk and balance the benefits and risks of your treatment options.

What Increases Your Risk

Many things can put you at risk for high cholesterol. These include:

• Eating too much saturated fat. Saturated fat is in foods that come from animals. These foods include meats, whole milk, butter, and cheese.
• Your age and sex. After you reach age 20, your cholesterol naturally starts to rise. In men, cholesterol often levels off after age 50. In women, it stays fairly low until menopause. Then it rises to about the same level as in men.
• Some diseases, such as hypothyroidism and chronic kidney disease.
• Your family history. If family members have or had high cholesterol, you may also have it.

Other things that can affect your cholesterol levels include:

• Being overweight.
• Not getting much physical activity.
• Smoking.
• Some medicines. Some examples are thiazide diuretics, beta-blockers, estrogen, and steroids.

Prevention

A heart-healthy lifestyle can help you prevent high cholesterol and lower your risk for a heart attack and stroke.

• Eat heart-healthy foods.
  • Eat fruits, vegetables, whole grains, beans, and other high-fiber foods.
  • Eat lean proteins, such as seafood, lean meats, beans, nuts, and soy products.
  • Eat healthy fats, such as canola and olive oil.
  • Choose foods that are low in saturated fat.
  • Limit sodium and alcohol.
  • Limit drinks and foods with added sugar.
• Be active. Try to do moderate activity at least 2½ hours a week. Or try vigorous activity at least 1¼ hours a week. You may want to walk or try other activities, such as running, swimming, cycling, or playing tennis or team sports.
• Stay at a healthy weight. Lose weight if you need to.
• Don't smoke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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What Happens

Having high cholesterol can lead to the buildup of plaque in artery walls. This is called atherosclerosis. It can lead to coronary artery disease, heart attack, stroke or transient ischemic attack, and peripheral arterial disease.

Atherosclerosis can cause these problems because it may:

• Narrow your arteries. As plaque forms, it may narrow your arteries. This happens over many years. In time, plaque may limit blood flow throughout your body, including the heart and brain.
• Harden your arteries. A healthy artery can widen so that more blood can flow through when needed, such as during activity. When hard plaque forms in the walls of an artery, the artery may become too stiff to widen. "Hardening" of your arteries can also limit blood flow in your body.
• Block your arteries. If a blood clot forms around a crack or rupture in the plaque, it can block the artery. This can cause a heart attack or stroke.

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When to Call a Doctor

High cholesterol usually has no symptoms. Sometimes the first sign that you have high cholesterol or other risk factors for heart disease is a heart attack, a stroke, or a transient ischemic attack (TIA). If you have any symptoms of these, call 911 or other emergency services.

Heart attack symptoms include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

Symptoms can vary. The most common symptom is chest pain or pressure. But females are somewhat more likely than males to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Stroke and TIA symptoms include:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

Exams and Tests

A blood test is used to check cholesterol levels. The test measures the level of total cholesterol plus the level of different types of cholesterol and fats in your blood. These include LDL cholesterol, HDL cholesterol, and triglycerides.

When to have a cholesterol test

Doctors use different guidelines to decide when a person should have a cholesterol test.

A cholesterol test can be one of the things doctors use to check on your risk of heart attack and stroke. Some health organizations recommend cholesterol screening every 4 to 6 years for everyone ages 20 to 39 and more often for people ages 40 to 75.^{footnote 1} Other organizations recommend cholesterol tests based on age and risk factors for heart disease. ^{footnote 2}

How often you should get a cholesterol test depends on your cholesterol level, your other health problems, and your overall chance of heart disease.

Children and teens

Your child's doctor may suggest a cholesterol test based on your child's age or family history or a physical exam.

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Treatment Overview

The two main types of treatment for high cholesterol are a heart-healthy lifestyle and medicines called statins. The goal of treatment is to reduce your chances of having a heart attack or stroke. It's not to lower your cholesterol numbers alone.

The way you choose to lower your risk will depend on how high your risk for heart attack and stroke is. It will also depend on how you feel about taking medicines. Your doctor can help you know your risk. Your doctor can also help you balance the benefits and risks of your treatment options.

Heart-healthy lifestyle

A heart-healthy lifestyle is always important, even if you take medicines to lower your risk.

To be heart-healthy:

• Eat heart-healthy foods.
• Lose weight if you need to, and stay at a healthy weight.
• Be active on most, if not all, days of the week.
• Don't smoke.
• Manage other health problems.

Medicines

If your chance of having a heart attack or stroke is high, you may decide to start taking medicines called statins along with having a healthy lifestyle. Statins can reduce the risk of having a heart attack or stroke.

You may not be sure whether or not you would benefit from a statin. To help you decide, you and your doctor can look at your overall health and at any other risks you have for heart attack and stroke.

Sometimes other medicines are also used.

Plant products and supplements

Some people use plant products or supplements like psyllium or red yeast rice to lower their cholesterol. These should not replace treatment recommended by your doctor. That's because research has not proved that they lower the risk of heart attacks and strokes.

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Self-Care

Taking your medicine correctly and having a heart-healthy lifestyle can help you stay healthy and lower your risk of a heart attack or a stroke. A healthy lifestyle is always important, even if you also take medicines for high cholesterol.

To care for yourself:

• Eat heart-healthy foods.
  • Eat fruits, vegetables, whole grains, beans, and other high-fiber foods.
  • Eat lean proteins, such as seafood, lean meats, beans, nuts, and soy products.
  • Eat healthy fats, such as canola and olive oil.
  • Choose foods that are low in saturated fat.
  • Limit sodium and alcohol.
  • Limit drinks and foods with added sugar.
• Be active.

  Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.

• Stay at a healthy weight.

  Lose weight if you need to. Making a plan for change, managing stress, seeing a dietitian, and tracking your food and activity can help.

• Don't smoke.

  If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

• Manage other health problems.

  Managing other health conditions, such as diabetes and high blood pressure, can help keep your heart and body as healthy as possible. If you think you may have a problem with alcohol or drug use, talk to your doctor.

• If you take medicine, take it exactly as prescribed.

  Talk with your doctor if you think you are having a problem with your medicine.

• Talk with your doctor before using plant products or supplements to lower cholesterol.

  This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects. Some plant products can help lower cholesterol. These include psyllium and red yeast rice. But don't use these products to replace your doctor's treatment. Research has not proved that they lower the risk of heart attacks and strokes.

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Medicines

If you have high cholesterol, you may choose to take medicines called statins. They reduce your risk of a heart attack or stroke.

You and your doctor can work together to decide what treatment is best for you. Your doctor may recommend that you take statins if the benefits outweigh the risks.

Statins are always used along with a plan for a heart-healthy lifestyle, not instead of it.

Your doctor may talk with you about also taking a cholesterol absorption inhibitor or a PCSK9-inhibitor. These medicines can also reduce the risk of heart attack and stroke for some people.

Other medicines can improve cholesterol and triglyceride levels, but they have not been proven to lower the risk of a heart attack or a stroke. These medicines include bempedoic acid, bile acid sequestrants, fibric acid derivatives, and nicotinic acid (niacin).

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