Cholesterol is a waxy substance found in your blood. Your body needs cholesterol to build healthy cells, but high levels of cholesterol can increase your risk of heart disease.
With high cholesterol, you can develop fatty deposits in your blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through your arteries. Sometimes, these deposits can break suddenly and form a clot that causes a heart attack or stroke.
High cholesterol can be inherited, but it’s often the result of unhealthy lifestyle choices, which make it preventable and treatable. A healthy diet, regular exercise and sometimes medication can help reduce high cholesterol.
High cholesterol has no symptoms. A blood test is the only way to detect if you have it.
When to see a doctor
Ask your doctor if you should have a cholesterol test. Children and young adults with no risk factors for heart disease are usually tested once between the ages of 9 and 11 and again between the ages of 17 and 19. Retesting for adults with no risk factors for heart disease is usually done every five years.
If your test results aren’t within desirable ranges, your doctor might recommend more-frequent measurements. Your doctor might also suggest more-frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.
Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. There are different types of cholesterol, based on what the lipoprotein carries. They are:
- Low-density lipoprotein (LDL). LDL, or “bad” cholesterol, transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
- High-density lipoprotein (HDL). HDL, or “good” cholesterol, picks up excess cholesterol and takes it back to your liver.
A lipid profile also typically measures triglycerides, a type of fat in the blood. Having a high triglyceride level can also increase your risk of heart disease.
Factors you can control – such as inactivity, obesity and an unhealthy diet – contribute to high cholesterol and low HDL cholesterol. Factors beyond your control might play a role, too. For example, your genetic makeup might keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.
Factors that can increase your risk of bad cholesterol include:
- Poor diet. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers and microwave popcorn, can raise your cholesterol level. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will also increase your cholesterol.
- Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
- Lack of exercise. Exercise helps boost your body’s HDL, or “good” cholesterol while increasing the size of the particles that make up your LDL, or “bad” cholesterol, which makes it less harmful.
- Smoking. Cigarette smoking damages the walls of your blood vessels, making them more prone to accumulate fatty deposits. Smoking might also lower your level of HDL, or “good” cholesterol.
- Age. Because your body’s chemistry changes as you age, your risk of high cholesterol climbs. For instance, as you age, your liver becomes less able to remove LDL cholesterol.
- Diabetes. High blood sugar contributes to higher levels of a dangerous cholesterol called very-low-density lipoprotein (VLDL) and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
High cholesterol can cause a dangerous accumulation of cholesterol and other deposits on the walls of your arteries (atherosclerosis). These deposits (plaques) can reduce blood flow through your arteries, which can cause complications, such as:
- Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you might have chest pain (angina) and other symptoms of coronary artery disease.
- Heart attack. If plaques tear or rupture, a blood clot can form at the plaque-rupture site – blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you’ll have a heart attack.
- Stroke. Similar to a heart attack, a stroke occurs when a blood clot blocks blood flow to part of your brain.
The same heart-healthy lifestyle changes that can lower your cholesterol can help prevent you from having high cholesterol in the first place. To prevent high cholesterol, you can:
- Eat a low-salt diet that emphasizes fruits, vegetables and whole grains
- Limit the amount of animal fats and use good fats in moderation
- Lose extra pounds and maintain a healthy weight
- Quit smoking
- Exercise on most days of the week for at least 30 minutes
- Drink alcohol in moderation, if at all
- Manage stress
A blood test to check cholesterol levels – called a lipid panel or lipid profile – typically reports:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Triglycerides – a type of fat in the blood
For the most accurate measurements, don’t eat or drink anything (other than water) for 9-12 hours before the blood sample is taken.
Children and cholesterol testing
For most children, the National Heart, Lung, and Blood Institute recommends one cholesterol screening test between the ages of 9 and 11, and another cholesterol screening test between the ages of 17 and 21.
If your child had a family history of early-onset heart disease or a personal history of obesity or diabetes, your doctor might recommend earlier or more-frequent cholesterol testing.
Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you’ve made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication.
The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects. Common choices include:
Statins. Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Statins can also help your body reabsorb cholesterol from built-up deposits on your artery walls, potentially reversing coronary artery disease.
Choices include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the levels of cholesterol in your blood.
Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
Injectable medication. A newer class of drugs, known as PCSK9 inhibitors, can help the liver absorb more LDL cholesterol – which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.
Medications for high triglycerides
If you also have high triglycerides, your doctor might prescribe:
Fibrates. The medications fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid) reduce your liver’s production of very-low-density lipoprotein (VLDL) cholesterol and speed the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
Using fibrates with a statin can increase the risk of statin side effects.
Niacin. Niacin limits your liver’s ability to produce LDL and VLDL cholesterol. But niacin doesn’t provide additional benefits over statins. Niacin has also been linked to liver damage and strokes, so most doctors now recommend it only for people who can’t take statins.
Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower your triglycerides. They are available by prescription or over-the-counter.
If you choose to take over-the-counter supplements, get your doctors OK. Omega-3 fatty acid supplements could affect other medications you’re taking.
Tolerance of medications varies from person to person. The most common side effect of statins are muscle pains and muscle damage, reversible memory loss and confusion, and elevated blood sugar. If you decide to take cholesterol medication, your doctor might recommend liver function tests to monitor the medication’s effect on your liver.
Children and cholesterol treatment
Diet and exercise are the best initial treatment for children age 2 and older who have high cholesterol or who are obese. Children age 10 and older who have extremely high cholesterol levels might be prescribed cholesterol-lowering drugs, such as statins.
Lifestyle and home remedies
Lifestyle changes are essential to improve your cholesterol levels. To bring your numbers down, try the following:
- Lose extra pounds. Losing even 5 to 10 pounds can help lower cholesterol levels.
- Eat a heart-healthy diet. Focus on plant-based foods, including fruits, vegetables and whole grains. Limit saturated fats, found in red meat and full-fat dairy products, and trans fats, found in many processed foods. Monounsaturated fat – found in olive and canola oils – is a healthier option. Avocados, nuts and oily fish are other sources of healthy fat.
- Exercise regularly. With your doctors OK, work up to least 30 minutes of moderate intensity exercise five times a week or vigorous exercise five times a week.
- Don’t smoke. If you smoke, find a way to quit.
Few natural products have been proved to reduce cholesterol, but some might be helpful. With your doctor’s OK, consider these cholesterol-lowering supplements and products:
- Plant sterols and stanols, found in oral supplements, some fortified orange juices and some margarines, such as Promise Activ.
- Blond psyllium, found in seed husks and products such as Metamucil
- Oat bran, found in oatmeal and whole oats.
Another popular cholesterol-lowering supplement is red yeast rice. There is evidence that red yeast rice can help lower your LDL cholesterol. However, the Food and Drug Administration has said that red yeast rice products that contain monacolin K, a naturally occurring form of the prescription medication known as lovastatin, can’t be sold in the United States.
If you buy red yeast rice supplements in the United States, there’s no way to know whether you’re getting enough monacolin K to lower your LDL cholesterol. In other countries, lovastatin in red yeast rice products is potentially dangerous because there’s no way to know how much might be in a particular product or what the quality of the lovastatin is.
Even if you take cholesterol-lowering supplements, remember the importance of a healthy lifestyle, and take medication to reduce your cholesterol as directed. Tell your doctor which supplements you take.