What is high cholesterol?

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High cholesterol: Overview

Cholesterol is a type of fat in your blood. It is needed for many body functions, such as making new cells. Cholesterol is made by your body. It also comes from food you eat. High cholesterol means that you have too much of the fat in your blood. This raises your risk of a heart attack and stroke.

LDL and HDL are part of your total cholesterol. LDL is the "bad" cholesterol. High LDL can raise your risk for coronary artery disease, heart attack, and stroke. HDL is the "good" cholesterol. It helps clear bad cholesterol from the body. High HDL is linked with a lower risk of coronary artery disease, heart attack, and stroke.

Your cholesterol levels help your doctor find out your risk for having a heart attack or stroke. You and your doctor can talk about whether you need to lower your risk and what treatment is best for you.

Treatment options include a heart-healthy lifestyle and medicine. Both options can help lower your cholesterol and your risk. The way you choose to lower your risk will depend on how high your risk is for heart attack and stroke. It will also depend on how you feel about taking medicines.

High cholesterol

Cholesterol is a type of fat (lipid) in your blood. High cholesterol means that you have too much of the fat in your blood. Your body needs some cholesterol. But if you have too much, it can build up in your arteries and increase your risk of heart attack and stroke.

What happens when you have high cholesterol?

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

What are the symptoms of high cholesterol?

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

How is high cholesterol treated?

The goal of treatment is to reduce your chances of having a heart attack or stroke. The goal is not to lower your cholesterol numbers only.

  • Have a heart-healthy lifestyle. This includes eating healthy foods, not smoking, losing weight, and being more active.
  • You may choose to take medicine.

How can you help prevent high cholesterol?

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.

How is high cholesterol 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 are medicines used to treat high cholesterol?

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).

How can you care for yourself when you have high cholesterol?

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

To have a heart-healthy lifestyle:

  • Eat heart-healthy foods. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that aren't so good for your heart, like sodium, alcohol, and 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.
  • Don't smoke. If you need help quitting, ask your doctor about stop-smoking programs and medicines.
  • Manage other health problems. These include diabetes and high blood pressure. If you think you may have a problem with alcohol or drug use, talk to your doctor.

What puts you at risk for high cholesterol?

Many things can put you at risk for high cholesterol. One example is eating too much saturated fat. Other things that put you at risk include your age, your sex, and your family history.

What causes high cholesterol?

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.

Cholesterol: How It Raises Your Risk

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.

Cholesterol: Choosing a Heart-Healthy Life

What are the guidelines for treating high cholesterol?

The goal in treating cholesterol is to lower your chance of having a heart attack or a stroke. The goal is not to lower your cholesterol numbers alone.

The following guidelines are from the American College of Cardiology and the American Heart Association.

The two main types of treatment are:

  • Heart-healthy lifestyle.
  • Medicines called statins.

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 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.

Statins

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

Statins strongly recommended for these people

Your doctor is likely to strongly recommend statins if you:

  • Have coronary artery disease.
  • Have peripheral arterial disease.
  • Had a heart attack.
  • Had a stroke.

Statins recommended for these people

Your doctor is likely to recommend statins if:

  • Your LDL cholesterol is 190 mg/dL or above.
  • You have diabetes and you are age 40 to 75.
  • Your 10-year risk of heart attack or stroke is 7.5% or above and you are age 40 to 75.

Statins not as clearly recommended for these people

For some people, it's not as clear if they would benefit from a statin. To help you decide, you and your doctor can look at your overall health and any other risks you have for heart attack and stroke.

When deciding about medicines, you and your doctor may think about:

  • Your family history of early coronary artery disease. Early coronary artery disease means you have a male family member who was diagnosed before age 55 or a female family member who was diagnosed before age 65.
  • A high LDL cholesterol test result (160 mg/dL or higher).
  • Results of tests such as C-reactive protein, coronary calcium scan, or ankle-brachial index.
  • Your lifetime risk of heart attack and stroke.

Other medicines

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. These medicines may be taken along with a statin.

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).

High cholesterol: When to call

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You need help making lifestyle changes.
  • You have questions about your medicine.

High cholesterol: Making changes to lower your risk of heart attack or stroke

When you have high cholesterol, there's a lot you can do to lower your risk of having a heart attack or stroke. Eat heart-healthy foods. Be more active. Get to a healthy weight. And don't smoke.

Changing habits isn't easy. And those changes can feel like big ones to tackle. But you can do it. The key is to start small. By taking one small step after another, you can improve your habits and make a big difference in your risk. That's the power of small changes.

When you're ready, you can use this information to get started.

  • Identify why you want to change.

    An important part of successful change is having your own reasons. Think about making a change in your habits, and ask yourself:

    • What's one reason to change that means a lot to me?
  • Decide which habit you'll change.

    Now, think about a change you could make to move toward a lower risk of heart attack or stroke. Ask yourself:

    • What's an important healthy change I'd like to make?
  • Choose your first small step.

    Think about the small steps that would help you reach your larger goal. Make these steps specific and within your reach—things you know you can do. Ask yourself:

    • What are some small steps I could take?
    • Which step do I feel most confident that I can take?
  • Picture success.

    Imagine it's a month from now and you've made the healthy change you chose. How will you feel about your success?

Joe's story: Changing my lifestyle

Joe, 61
Read how Joe learned that success can come one change at a time.
"The walking was the easy part for me. I get out every evening for a walk. The food part took some thought. Each week, I added a food that was good for me and took something away that was bad for me."

When Joe turned 60 last year, he decided he was overdue for a good, old-fashioned physical. He had always been blessed with good health. But he knew that at his age he should be having regular checkups, especially since he was overweight.

His doctor gave him a full exam and found no serious health problems. She also scheduled Joe for a cholesterol test.

Joe, a real estate broker, was surprised when the doctor called to tell him about the test results. His cholesterol was too high.

"My first thought was that I would file this away for later," recalls Joe. "But then my doctor said, 'We really need to get on top of this. Your age and your cholesterol levels raise your risk of having a heart attack or a stroke.'"

That was the day Joe decided to take on a new project: to keep his heart healthy.

Joe's plan

Joe and his doctor talked about his risk. They decided that he could try lowering his risk with some heart-healthy changes. They made a plan. He would eat more heart-healthy foods. And he would take a half-hour brisk walk most days of the week.

"I didn't know if I could change my old habits. But it turned out to be pretty simple: Don't eat so much fatty food. And get some exercise."

One change at a time

Joe knew he'd have to ease into it. "I'm just not that type of person who can change everything at once."

So he planned ahead and wrote one food change a week on his calendar. "The walking was the easy part for me. I get out every evening for a walk. The food part took some thought," explains Joe. But as soon as he had it written down, his plan was pretty easy to follow. "Each week, I added a food that was good for me and took something away that was bad for me."

Challenges and successes

"Usually, I can fight it, but sometimes I give in. So I've learned to not beat myself up about that. Instead, I refocus on my plan and get right back to eating healthy food. What keeps me going is the results. I've lost weight, and I feel younger every day."

This story is based on information gathered from many people facing this health issue.

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The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.