Overview

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:

• High cholesterol is 240 or above.
• Borderline-high is 200 to 239.
• Best is less than 200.

What are the different kinds of cholesterol?

• LDL is the "bad" cholesterol, the kind that can clog your arteries if you have too much of it. This is the cholesterol you need to lower, if you have high cholesterol.
• HDL is the "good" cholesterol. HDL helps clear fat from your blood. A high level of HDL can help protect you from a heart attack.
• Triglycerides are another type of fat in your blood. If you have high triglycerides and high LDL, your chances of having a heart attack are higher.

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 clogging 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:

• The foods you eat. Eating too much saturated fat, trans fat, and cholesterol can raise your cholesterol.
• Being overweight.
• Being inactive.
• Age. Cholesterol starts to rise after age 20.
• Family history. If family members have or had high cholesterol, you may also have it.
• Overall health. Diseases such as hypothyroidism can raise cholesterol.

How is high cholesterol diagnosed?

You need a blood test to check your cholesterol. There are several kinds of tests:

• A fasting cholesterol test is the most complete test because it measures all of the fats in your blood, including LDL and HDL cholesterol and triglycerides.
• A direct LDL test measures your LDL level only.
• A simple cholesterol test can measure total cholesterol and HDL.

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:

• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and healthy fats like olive oil.
• Lose weight, if you need to. 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.
• Get regular exercise on most, if not all, days of the week. Walking is great exercise that most people can do. A good goal is 30 minutes or more a day.
• Don't smoke. Quitting can help raise your HDL and improve your heart health.

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?

Frequently Asked Questions

Cause

High cholesterol can be caused by:

• What you eat. Eating too much saturated fat, trans fat, and cholesterol can cause high cholesterol.
  • Saturated fat and cholesterol are in foods that come from animals, such as meats, whole milk, egg yolks, butter, and cheese.
  • Trans fat is found in fried foods and packaged foods, such as cookies, crackers, and chips.
• Your weight. Being overweight may increase triglycerides and decrease HDL (good cholesterol).
• Your activity level. Lack of physical activity can lower your HDL.
• Your age and gender. After you reach age 20, your cholesterol naturally begins to rise.
  • In men, cholesterol generally 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. Certain diseases may raise your risk of high cholesterol. These include hypothyroidism, chronic kidney disease, and some types of liver disease.
• Your family history. High cholesterol may run in your family. If family members have or had high cholesterol, you may also have it.
• Cigarette smoking. Smoking can lower your HDL cholesterol.
• Certain medicines. Some medicines can raise triglyceride levels and lower HDL (good) cholesterol levels. These medicines include thiazide diuretics, beta-blockers, estrogen, and corticosteroids.

Symptoms

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.

What Happens

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:

• Narrows your arteries. When enough plaque builds up, it starts to narrow your arteries. This happens slowly over many years. In time, the plaque can limit blood flow throughout your body, including the heart and brain.
• Hardens your arteries. A healthy artery can widen (dilate) so that more blood can flow through when needed, such as during activity. When hard plaque forms in the walls of an artery, it can make the artery too stiff to widen. This "hardening" of your arteries can also limit blood flow in your body.
• Blocks your arteries. When 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.

For more information, see the topic:

• Coronary Artery Disease.
• Stroke and Transient Ischemic Attack (TIA).
• Peripheral Arterial Disease of the Legs.

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:

• Eating foods high in saturated fat, trans fat, and cholesterol.
• Being overweight.
• Not being active every day.
• Smoking.

Each of these things can raise your LDL, lower your HDL, or both.

Things you cannot change include:

• Family history. If high cholesterol runs in your family, you may have it, and it may be harder to treat.
• Age and gender.

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.

Symptoms of a heart attack 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 one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or uneven heartbeat.

Symptoms of a stroke or TIA include:

• Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
• New problems with walking or balance.
• Sudden vision changes.
• Drooling or slurred speech.
• New problems speaking or understanding simple statements, or feeling confused.
• A sudden, severe headache that is different from past headaches.

Who to see

Any of the following doctors, nurses, or specialists can order a cholesterol test and treat high cholesterol:

• Nurse practitioner (NP)
• Physician assistant (PA)
• Family medicine doctor
• Internal medicine doctor
• Cardiologist
• Endocrinologist

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.

• A simple cholesterol test can measure total cholesterol. You can eat before this test. Sometimes doctors do this test first.
• A fasting cholesterol test is a more thorough test. It measures your total cholesterol plus your LDL, HDL, and triglyceride levels. It is called a fasting test because you don't eat for 9 to 12 hours before the test.
• A direct LDL test measures your LDL level only. You can have this test done at any time, no matter when you last ate.

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.

Total cholesterol

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. For more information, see Treatment Overview.

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:

• Smoking.
• Diabetes.
• High blood pressure.
• A family history of high cholesterol and heart attack.

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?

Other tests

• You may need other tests to find out if another health problem, such as hypothyroidism, is causing your high cholesterol.
• A C-reactive protein (CRP) test may be done for some people who are at risk for getting coronary artery disease. A special type of CRP test, the high-sensitivity CRP test, can help find out your chance of having a sudden heart problem, such as a heart attack. This test may be done even if you have a normal or low level of LDL cholesterol.

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.

For more information, see:

• When to Have a Cholesterol Test.
• Cholesterol in Children and Teens.

Treatment Overview

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:

1. Lifestyle changes.
2. Daily medicines.

Lifestyle changes

Your doctor may suggest that you make one or more of the following changes:

• Build good eating habits.
• Lose weight.
• Get more active.
• Stop smoking.

For more information, see Making Lifestyle Changes.

Medicines

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.

Interactive Tool: Are You at Risk for a Heart Attack?

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.

For more information, see Medications.

Prevention

You can help prevent high cholesterol by:

• Eating a diet low in saturated fat, trans fat, and cholesterol.
• Getting plenty of exercise.
• Managing your weight.
• Not smoking.

For more information, see Heart-Healthy Lifestyle.

Heart-healthy diets include the Mediterranean diet and the American Heart Association diet recommendations. This chart compares several heart-healthy diets(What is a PDF document?).

Because cholesterol levels tend to increase with age, paying attention to diet and exercise is even more important as you get older.

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

Lifestyle changes are important to help control high cholesterol, especially if you have other risk factors for heart disease and stroke.

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?

One Man's Story: Joe, 61 "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."—Joe Read more about how Joe is improving his cholesterol by making one change at a time.

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.

High Cholesterol: Using the TLC Diet

If you have questions about which diet to follow, talk to your doctor.

For more information about food and high cholesterol, see:

• Healthy Food Choices to Lower Cholesterol.
• Foods and Their Effect on Cholesterol.
• Fish, Fish Oil, and Cholesterol.
• Antioxidants.
• Foods to Avoid for High Cholesterol.

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:

Healthy Eating: Starting a Plan for Change.

Weight Management: Using Positive Thinking.

Get active

Regular physical activity raises "good" HDL cholesterol. Getting active has many other benefits too. It can help you lose weight. And it can lower your blood pressure.

For tips, see:

High Cholesterol: Raising Your HDL Level

Fitness: Adding More Activity to Your Life

Activity Ideas

Quick Tips: Getting Active at Home

Don't smoke

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:

Quitting Smoking.

Quitting Smoking: Getting Support.

Quitting Smoking: Coping With Cravings and Withdrawal.

Quitting Smoking: Preventing Slips or Relapses.

One Woman's Story: Linda, 56 "Terri’s heart attack scared me to death. I decided that this time, I’m doing the whole package. I’m quitting smoking for good."—Linda Read more about Linda and how quitting smoking improved her cholesterol.

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?

One Man's Story: Joe, 61 "I’m just not that type of person who can change everything at once."—Joe Read more about Joe and how using the TLC plan helped him take charge of his cholesterol.

You can learn simple steps to help you make lifestyle changes, like setting goals. 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. For help, see:

Healthy Eating: Overcoming Barriers to Change.

Fitness: Getting Around Barriers to Exercise.

One Man's Story: Joe, 61 "I've learned to not beat myself up [when I slip up]. 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, my cholesterol's getting better, and I feel younger every day."—Joe Read more about how Joe is controlling his cholesterol.

Medications

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.

• Some people can try diet and exercise for at least 3 months before they decide if they need medicines.
• People who have coronary artery disease (CAD) should start taking medicines right away.
• You may also need to start on medicine right away if your cholesterol is very high or you have:
  • A family history of early CAD.
  • An inherited form of high cholesterol.
  • Peripheral arterial disease.
  • Diabetes.
  • High blood pressure.
  • Had a heart attack or stroke before.

You and your doctor will decide if you will take medicine for high cholesterol.

For more information, see:

High Cholesterol: Should I Take Statins?

One Man's Story: Tony, 57 "I don’t mind taking a pill a day. As long as it’s doing me some good. And I no longer have any doubts about that."—Tony Read more about Tony and how medicine helps him keep his cholesterol low.

Medication Choices

The following medicines can be used to lower LDL and triglyceride levels in the blood and to raise HDL.

• Statins
• Bile acid sequestrants
• Cholesterol absorption inhibitors
• Nicotinic acid
• Fibric acid derivatives

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:

• Taking Medicines as Prescribed.
• Dealing With Medicine Side Effects and Interactions.

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.

Other Treatment

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

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.

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 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

• Garlic. Eating lots of garlic or taking garlic supplements does not effectively lower cholesterol. And eating too much garlic can have side effects, including allergic reaction, gas, heartburn, garlic odor from the skin, interference with some drugs, and longer blood-clotting time.
• Very low-fat diets. Although very low-fat diets may indeed lower cholesterol levels, they are not recommended. Very low-fat diets usually allow less than 15% of total calories from fat. In comparison, a cholesterol-reducing diet allows 25% to 35% of calories to come from total fat, with 7% from saturated fat. A diet with less than 25% of its calories from fat can increase triglycerides and decrease HDL (good) cholesterol. Such a diet may deplete your body of other important nutrients and vitamins.
• Policosanol. Policosanol, which is made from sugar cane, has not been shown to lower cholesterol.