What is high cholesterol?
Cholesterol is a type of fat (lipid) in your blood. Your cells need cholesterol , and your body makes all it needs. But you also get cholesterol from the food you eat.
If you have too much cholesterol, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis . It is usually a slow process that gets worse as you get older.
To understand what happens, think about how a clog forms in the pipe under a kitchen sink. Like the buildup of grease in the pipe, the buildup of cholesterol narrows your arteries and makes it harder for blood to flow through them. It reduces the amount of blood that gets to your body tissues, including your heart. This can lead to serious problems, including heart attack and stroke .
Your cholesterol is measured by a blood test:
What are the different kinds of cholesterol?
What are the symptoms?
High cholesterol doesn't make you feel sick. By the time you find out you have it, it may already be narrowing your arteries. So it is very important to start treatment even though you may feel fine.
What causes high cholesterol?
Many things can cause high cholesterol, including:
How is high cholesterol diagnosed?
You need a blood test to check your cholesterol. There are several kinds of tests:
How is it treated?
If you have high cholesterol, you need treatment to lower your risk of heart attack and stroke. The two main treatments are lifestyle changes and medicine.
Some lifestyle changes are important for everyone with high cholesterol. Your doctor will probably want you to:
Changing old habits may not be easy, but it is very important to help you live a healthier and longer life. Having a plan can help. Start with small steps. For example, commit to adding one fruit or one vegetable a day for a week. Instead of having dessert, take a short walk.
If these lifestyle changes don't lower your cholesterol enough, or if your risk of heart attack is high, you may also need to take a cholesterol-lowering medicine, such as a statin. Knowing your heart attack risk is important, because it helps you and your doctor decide how to treat your cholesterol.
To find out your risk, use the Interactive Tool: Are You at Risk for a Heart Attack?
Health Tools help you make wise health decisions or take action to improve your health.
Frequently Asked Questions
High cholesterol can be caused by:
High cholesterol does not cause symptoms. It is usually found during a blood test that measures cholesterol levels.
Some people with rare lipid disorders may have symptoms such as bumps in the skin, hands, or feet, which are caused by deposits of extra cholesterol and other types of fat.
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 or transient ischemic attack (TIA) , and peripheral arterial disease .
Atherosclerosis can cause these problems because it:
For more information, see:
What Increases Your Risk
Some things that increase your risk for high cholesterol are things you can change, but some are not. It's important to lower your risk as much as possible.
Things you can change include:
Each of these things can raise your LDL, lower your HDL, or both.
Things you cannot change include:
For more information, see Cause.
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:
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.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Stroke and TIA symptoms include:
Who to see
Any of the following doctors, nurses, or specialists can order a cholesterol test and treat high cholesterol:
A registered dietitian can help you with a diet to lower your cholesterol.
People who have rare lipid disorders , which can be hard to treat, may need to see a specialist, such as a lipidologist or an endocrinologist.
Exams and Tests
A blood test tells you if you have high cholesterol.
What do your cholesterol numbers mean?
Your numbers help your doctor know your risk of getting heart disease or having a heart attack or stroke.
Your total cholesterol level is important. But your levels of LDL, HDL, and triglycerides help your doctor decide if you need treatment for high cholesterol. Your doctor will also consider your overall health and your risk of heart attack. For more information, see the topic High Cholesterol Treatment Guidelines Based on Heart Attack Risk.
To learn about the results and numbers for cholesterol tests, see the topic Cholesterol and Triglyceride Tests.
Your total cholesterol number shows if your cholesterol is too high.
If you have high cholesterol, your doctor will want to know your LDL and HDL levels before deciding whether you need treatment and what sort of treatment you need.
LDL (bad) cholesterol
You want your LDL level to be low. But how low your LDL should be depends on your risk of heart attack.
Your doctor will help decide what your LDL goal is. The higher your risk of heart attack, the lower your LDL goal.
HDL (good) cholesterol
You want your HDL level to be high. An HDL level of 60 or higher is linked to a lower risk of heart disease. A high HDL number also can help offset a high LDL number.
Your risk level
When you visit your doctor to talk about your cholesterol test, you will talk about other things that increase your risk for heart problems. These include:
If your risk is high, or if you already have heart problems, your doctor will be more likely to prescribe medicine along with lifestyle changes.
To find out your risk for a heart attack, see the Interactive Tool: Are You at Risk for a Heart Attack?
When to have a cholesterol test
Most doctors recommend that everyone older than 20 be checked for high cholesterol. How often you need to be checked depends on whether you have other health problems and your overall chance of heart disease.
Your child's doctor may suggest a cholesterol test based on your child's age, family history, or a physical exam. A cholesterol test can help a doctor find out early if your child has a cholesterol level that could affect his or her health.
For more information, see:
The goal in treating high cholesterol is to reduce your chances of having a heart attack or stroke.
The two types of treatment for high cholesterol are:
Your doctor may suggest that you make one or more of the following changes:
For more information, see Making Lifestyle Changes.
Many people try lifestyle changes first. But if lifestyle changes aren't enough to reach your cholesterol goal, you will need to take medicine too. Even if you take medicine for high cholesterol, keeping healthy lifestyle habits is still important.
Some people need to start taking medicine right away because their risk of heart attack is higher than average. Your doctor will base your need for medicine on your risk level.
Once you know your risk for heart attack, you can learn more about treatment for your risk level.
You may also need treatment for other health problems, such as high blood pressure.
A heart-healthy lifestyle can help you prevent high cholesterol. This includes:
Some people may not be able to prevent high cholesterol with lifestyle changes. Family history or certain conditions that cause the body to make too much cholesterol can raise levels even with lifestyle changes. In these cases, medicine can help.
Remember that high cholesterol is just one of the things that increase your risk for heart attack and stroke. Controlling other health problems, such as high blood pressure and diabetes , can also help reduce your overall risk.
Making Lifestyle Changes
Even if your doctor has prescribed medicine for you, you may still need to make changes at home to lower your cholesterol and reduce your risk. Some people can even take less medicine after making these changes.
What changes do you need to make?
Make these lifestyle changes to help lower your cholesterol:
Eat healthy foods
Making healthy eating habits a part of your daily life is one of the best things you can do to lower your cholesterol. Your doctor may recommend that you follow the Therapeutic Lifestyle Changes (TLC) diet . The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat raises your cholesterol.
If you have questions about which diet to follow, talk to your doctor.
For more information about food and high cholesterol, see:
Lose extra weight
Losing just 5 lb to 10 lb (2.3 kg to 4.5 kg) can lower your cholesterol. Losing weight can also help lower your blood pressure.
For help, see:
For tips, see:
Quitting can help raise your HDL and improve your heart health. "Good" HDL levels often go up soon after a person quits smoking.
For more information, see:
If high cholesterol runs in your family, these lifestyle changes may not be enough. You may need to take medicine too. But no matter what treatment you use, you can lower your high cholesterol.
How do you make lifestyle changes?
You can learn simple steps to help you make lifestyle changes, like setting goals. Work on one small goal at a time. Expect slip-ups. Get support from others. Reward yourself for each success. To find out more about making healthy lifestyle changes, see Change a Habit by Setting Goals.
When changing a lifestyle habit, barriers can sometimes get in your way. Figuring out what those barriers are and how you can get around them can help you reach your healthy eating goals.
For help, see:
Statins are the medicines used the most often to treat high cholesterol, and they often work the best. They can reduce the risk for heart attack, stroke, and early death in people who are at high risk for a heart attack or stroke. Other medicines also lower cholesterol, and some may be used to lower triglycerides or raise HDL .
Doctors may also prescribe aspirin therapy if you have had a heart attack or a stroke, or you have a high risk for heart attack or stroke.
Do you need to take medicine? That depends. The decision to use medicine to treat high cholesterol is usually based on your cholesterol goal, LDL level, and your risk for heart attack and stroke.
Medicine is always used along with a diet and exercise plan, not instead of it.
You and your doctor will decide if you will take medicine for high cholesterol.
For more information, see:
The following medicines can be used to lower LDL and triglyceride levels in the blood and to raise HDL.
Take your medicines properly
Some people find it hard to take their medicines properly. If you do take medicine, it is important to use it the right way.
Some people don't see why they should take medicines every day when they don't feel sick. High cholesterol doesn't make you feel sick. But it's important to treat it, because it damages your blood vessels and eventually your heart, even though you don't have symptoms.
Some side effects are more likely and may be worse when you use higher doses of statins. If you're having side effects, tell your doctor. You may be able to take a different medicine or a different dose.
For more information, see:
Be sure to tell your doctor everything you take for high cholesterol, even herbs or other supplements or treatments. Sometimes they can interact with other medicines and cause problems.
If you have trouble taking your medicine for any reason, talk to your doctor.
Some plant products can help lower high cholesterol. But don't use them to replace your doctor's treatment. Whether or not you use such products, be sure to continue your diet, exercise, and prescription medicines.
As with any new form of treatment, make sure to talk with your doctor first. This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects.
Psyllium is an ingredient in some dietary supplements—Metamucil, for example. It's a fiber from fleawort and plantago seeds.
Doctors aren't sure how it helps cholesterol levels. It may make the small intestine absorb less cholesterol, so less of it enters your blood.
Psyllium is approved by the U.S. Food and Drug Administration (FDA). The main side effect is increased bowel movements. Products containing psyllium aren't recommended to replace foods as a source of fiber.
Sterol or stanol esters
Sterol and stanol esters are used in cholesterol-lowering margarine spreads.
Sterol esters might limit how much cholesterol the small intestine can absorb. Cholesterol-lowering margarines can help lower cholesterol levels, particularly in people who have high cholesterol levels or who consume too much fat in their diets. These margarines are used along with a healthy diet to lower cholesterol.
Red yeast rice
Red yeast rice contains a natural form of lovastatin, a statin medicine. This supplement may keep your body from producing too much cholesterol. But this supplement can cause dangerous side effects.
Talk to your doctor before you try red yeast rice. Serious side effects include rhabdomyolysis and hepatitis. Red yeast rice is not regulated by the U.S. Food and Drug Administration (FDA), so you cannot be sure of the amount of red yeast in a supplement. This means you cannot be sure of its dose and safety.
If you take red yeast rice, call your doctor right away if you have a bad reaction to it such as severe muscle pain or symptoms of hepatitis .
Do not take red yeast supplements if you are taking statins. Combining them can cause dangerous side effects.
Not recommended for lowering cholesterol
Other Places To Get Help
Last Revised: June 29, 2012
Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
Berthold HK, et al. (2006). Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia. JAMA, 295(19): 2262–2269.
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