Cholesterol is a waxy, fat-like substance that your body needs for good health, but in the right amounts. Unhealthy levels of cholesterol can lead to a condition called high blood cholesterol.
Cholesterol in your blood is carried on lipoproteins:
- Low-density lipoprotein (LDL), sometimes called “bad” cholesterol
- High-density lipoprotein (HDL), sometimes called “good” cholesterol.
High levels of “bad” LDL cholesterol cause plaque (fatty deposits) to build up in your blood vessels. This may lead to heart attack, stroke, or other health problems High levels of “good” HDL cholesterol may actually lower your risk for health problems. HDL cholesterol carries cholesterol and plaque buildup from your arteries to the liver, so it can be flushed out of the body.
Unhealthy cholesterol levels are often caused by lifestyle habits, such as unhealthy eating patterns, in combination with the genes that you inherit from your parents.
Routine blood tests can show whether your cholesterol levels are healthy. To help get your cholesterol levels into the healthy range, you may need heart-healthy lifestyle changes or medicines.
What raises the risk for unhealthy blood cholesterol levels?
Unhealthy lifestyle habits:
- Eating a lot of foods high in saturated fats raises “bad” LDL cholesterol levels. Saturated fats are found in fatty cuts of meat and dairy products. No more than 10% of your daily calories should come from saturated fats.
- Lack of physical activity
- Smoking lowers HDL cholesterol, particularly in women, and raises LDL cholesterol.
- Stress may raise levels of certain hormone, such as Corticosteroids. These can cause your body to make more cholesterol.
- Drinking too much alcohol (more than two drinks a day for men or one drink a day for women) can raise your total cholesterol level.
Family history: Family members usually have similar cholesterol levels. This suggests that your genes can raise your risk of having unhealthy cholesterol levels.
Mutation, or changes, in your genes can be passed from parent to child, which can cause familial hypercholesterolemia. If you have a family history of high blood cholesterol, it may be more difficult for your body to remove LDL cholesterol from your blood or break it down in the liver.
Other medical conditions: Many health problems that raise your risk of high blood cholesterol are caused by unhealthy lifestyle habits. For example, a lack of physical activity and poor eating habits can lead to overweight and obesity, which are linked to diabetes and sleep apnea. For people with conditions such as lupus and HIV, the condition itself and the medicine used to treat it may lead to unhealthy cholesterol levels.
Talk to your doctor about your risk of high cholesterol if you have any of the following:
- Chronic kidney disease
- HIV infection
- Lupus erythematosus
- Overweight and obesity
- Polycystic ovary syndrome (PCOS)
- Sleep apnea
Medicines: Some medicines that you take for other health problems can raise your level of “bad” LDL cholesterol or lower your level of “good” HDL cholesterol.
- Arrhythmia medicines, such as amiodarone
- Beta-blockers for relieving angina chest pain or treating high blood pressure
- Chemotherapy medicines used to treat cancer
- Diuretics such as thiazide to treat high blood pressure
- Immunosuppressive medicines, such as cyclosporine, to treat inflammatory diseases or to prevent rejection after organ transplant
- Retinoids to treat acne
- Steroids, such as prednisone, to treat inflammatory diseases such as lupus, rheumatoid arthritis, and psoriasis
Age: Unhealthy levels of cholesterol can affect people of all ages, even young children. However, high cholesterol is most commonly diagnosed in people between ages 40 and 59. As you get older, your body’s metabolism changes. Your liver does not remove “bad” LDL cholesterol as well as it did when you were young. These normal changes may increase your risk for developing high blood cholesterol as you age.
Race or ethnicity: Your race or ethnicity may affect your risk of high blood cholesterol.
- Overall, non-Hispanic white people are more likely than other groups to have high levels of total cholesterol.
- Asian Americans, including those of Indian, Filipino, Japanese, and Vietnamese descent, are more likely to have high levels of “bad” LDL cholesterol than other groups.
- Hispanic Americans are more likely to have lower levels of “good” HDL cholesterol than other groups.
- African Americans are more likely than other groups to have high levels of “good” HDL cholesterol. However, they are more likely to have other risk factors, such as high blood pressure, obesity, or diabetes, that may overcome the health benefit of higher HDL levels.
Sex: Between ages 20 and 39, men have a greater risk for high total cholesterol than women.
A woman’s risk goes up after menopause. Menopause lowers levels of female hormones that may protect against high blood cholesterol. After menopause, women’s levels of total and “bad” LDL cholesterol usually go up, while their levels of “good” HDL cholesterol go down.
High levels of low-density lipoprotein (LDL) cholesterol usually do not cause symptoms. Most people do not know they have high blood cholesterol until they have a blood test during a routine doctor’s visit.
If your levels are very high, you may notice the following symptoms:
- Fatty bumps (xanthomas) on your skin, especially on the elbows, joints, knees, hands, feet, or buttocks
- Grayish-white rings (corneal arcus) that appear around the corneas in your eye
These symptoms mostly develop in people who have high cholesterol that runs in families (familial hypercholesterolemia).
Undiagnosed or untreated high blood cholesterol can lead to serious problems, such as heart attack and stroke. Talk to your doctor about your risk and steps you can take to keep your cholesterol levels in a healthy range.
Your doctor will ask about your eating habits, physical activity, family history, medicines you are taking, and risk factors for heart or blood vessel diseases.
During your physical exam, your doctor will check for signs of very high blood cholesterol, such as xanthomas, or signs of other health conditions that can cause high blood cholesterol.
Screening for high cholesterol: Your doctor may order a blood test called a lipid panel to screen for unhealthy cholesterol levels.
Lipoprotein (lipid) panel: A lipoprotein panel, also called a lipid panel or lipid profile, measures the levels of LDL and HDL cholesterol and triglycerides in your blood. Cholesterol and triglyceride levels that are higher or lower than normal may be signs of higher risk of coronary heart disease.
A lipoprotein panel gives information about your:
- Total cholesterol
- LDL (“bad”) cholesterol, which is the main source of cholesterol buildup and blockages in the arteries
- HDL (“good”) cholesterol, which helps decrease cholesterol blockages in the arteries
- Triglycerides, which are a type of fat in your blood
Most people will need to fast for 9 to 12 hours before a lipoprotein panel.
How often you get a lipid panel done depends on your age, risk factors, and family history of high blood cholesterol or cardiovascular diseases, such as atherosclerosis, heart attack or stroke.
Here is a general guide:
- Age 19 or younger: Screening begins at ages 9 to 11 and should be repeated every 5 years. Screening may be performed as early as age 2 if there is a family history of high blood cholesterol, heart attack, or stroke.
- Age 20 to 65: Younger adults should be screened every 5 years. Men ages 45 to 65 and women ages 55 to 65 should be screened every 1 to 2 years.
- Older than 65: Older adults should be screened every year.
If your blood cholesterol levels are not within the healthy range for your age and sex, your doctor may order a repeat lipid profile test, especially if you were not fasting before your first lipid panel. Also, it is important to know that your risk of coronary heart disease and stroke is based on several other factors, not just your cholesterol levels. These factors include things like your age, race, and lifestyle habits.
Lipoprotein-a: A lipoprotein-a, or Lp(a), test is not usually part of a routine lipid panel. High levels of Lp(a) may mean you are at high risk of heart or blood vessel diseases, even if your other cholesterol levels are healthy. The genes you inherit from your parents determine how much Lp(a) you have. Your Lp(a) level is unlikely to change much from childhood to old age.
Your doctor may order an Lp(a) test if you have a family history of early heart disease, such as a heart attack, or do not know your family medical history. If you have a high Lp(a) level, your doctor may prescribe a statin, a medicine to help prevent heart disease, even if your other cholesterol levels are in the healthy range.
To treat unhealthy blood cholesterol levels, your doctor may recommend heart-healthy lifestyle changes and prescribe medicines. If a medical condition or medicine is causing your blood cholesterol problem, your doctor may treat that condition or change your medicine or its dose.
Talk with your doctor about your cholesterol levels, your risk of developing heart disease, other medical conditions you have, and your lifestyle. You can learn about the benefits and side effects of medicines for lowering your blood cholesterol. Together, you can set up a treatment plan that will work for you.
Healthy lifestyle changes: To help you lower your LDL cholesterol level, your doctor may talk to you about adopting a healthy lifestyle.
- Choose heart-healthy foods. The Therapeutic Lifestyle Changes and DASH eating plans can help you lower your “bad” LDL cholesterol. These plans also encourage limiting saturated fats found in fatty cuts of meets, dairy products, and desserts; and eating whole grains, fruits, and vegetables rather than refined carbohydrates such as sugar.
- Get regular physical activity. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your “good” HDL cholesterol. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
- Aim for a healthy weight. Research has shown that adults with overweight and obesity can lower “bad” LDL cholesterol and raise “good” HDL cholesterol by losing only 3% to 5% of their weight.
- Manage stress. Research has shown that chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels.
- Quit smoking.
- Get enough good quality sleep. Sleep helps heal and repair your heart and blood vessels. The recommended amount for adults is 7 to 9 hours of sleep a day.
- Limit alcohol.
Medicines: Your doctor may prescribe one of these medicines to help lower high blood cholesterol.
- Statins are the most common medicine used to treat high blood cholesterol. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. Statins usually don’t cause side effects, but they may raise the risk of diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who have prediabetes, overweight or obesity, or metabolic syndrome. Statins may also cause abnormal results on liver enzymes tests, but actual liver damage is extremely rare. Other rare side effects include muscle damage.
- Medicine to treat familial hypercholesterolemia. These include mipomersen, eetimibed, and lomitapide. Ezetimibe may also be used if statins cause side effects, or if statin treatment and lifestyle changes do not lower your “bad” LDL level enough. In rare cases, these medicines can cause liver injury. Your doctor will check your liver enzymes regularly and may recommend that you take vitamin E.
- Bile acid sequestrants may be prescribed if you cannot take statins or if you need to lower your cholesterol even more than a statin taken alone. Bile acid sequestrants help bile acids, which help you digest fats and oils, stay in the intestines instead of being reabsorbed. This medicine may cause diarrhea, make some other medicines less effective, or raise your blood triglyceride level.
- PCSK9 inhibitors are a type of medicine that you inject under your skin every 2 to 4 weeks. Your doctor may prescribe a PCSK9 inhibitor and a statin if you are at high risk of complications like heart attack or stroke, or if you have familial hypercholesterolemia. The most common side effects are itching, pain, or swelling at the place where you injected it.
If your doctor prescribes medicines as part of your treatment plan, be sure to continue your healthy lifestyle changes. The combination of the medicines and heart-healthy lifestyle changes can help lower and control your blood cholesterol levels.
Lipoprotein apheresis: Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis uses a filtering machine to remove unwanted substances from the body. The machine removes “bad” LDL cholesterol from the blood, then returns the remainder of the blood to your body.