Cholesterol is something your body needs, but too much of it can be harmful. High cholesterol is a common health problem that often has no symptoms, but it can quietly increase your risk for heart disease and stroke. The good news is that it’s easy to test for and usually manageable with changes to your lifestyle or medications.
In this article, we’ll explain what high cholesterol is, what causes it, the different types of cholesterol, how it’s diagnosed, and what treatments can help you keep it under control.
What Is Cholesterol?
Cholesterol is a waxy, fat-like substance found in your blood. Your body needs some cholesterol to build cells and make vitamins and hormones. Most cholesterol is made by your liver, but you also get some from the food you eat.
There are two main types of cholesterol:
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Low-density lipoprotein (LDL): Often called “bad cholesterol.” Too much LDL can build up in the walls of your arteries, creating plaque. This can narrow or block blood flow, which raises your risk of heart attack and stroke.
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High-density lipoprotein (HDL): Known as “good cholesterol.” HDL helps remove LDL from your blood and takes it back to the liver, where it gets broken down.
You also have triglycerides, another type of fat in your blood that can increase heart risk when levels are high. When your total cholesterol is too high—especially when LDL is high and HDL is low—you’re said to have high cholesterol, also called hyperlipidemia or hypercholesterolemia.
What Causes High Cholesterol?
Many different things can lead to high cholesterol. Some you can control, and others you can’t. Common causes include:
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Unhealthy diet: Eating too much saturated fat (found in red meat, butter, cheese, fried foods, and processed snacks) can raise LDL levels.
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Lack of exercise: Not moving enough can lower your HDL and raise LDL and triglycerides.
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Smoking: Tobacco use lowers your good cholesterol and damages your blood vessels.
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Obesity: Being overweight is linked to higher LDL and triglyceride levels.
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Genetics: High cholesterol can run in families. Some people have a condition called familial hypercholesterolemia, which causes very high levels even at a young age.
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Age and sex: Cholesterol levels tend to rise as you get older. Women often see a rise after menopause.
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Medical conditions: Diabetes, kidney disease, and underactive thyroid (hypothyroidism) can also raise cholesterol.
Even young and otherwise healthy people can have high cholesterol, so it’s important to check your levels regularly.
Are There Symptoms?
One of the tricky things about high cholesterol is that it usually has no symptoms. Most people don’t know they have it until they get a blood test or experience a serious event like a heart attack or stroke.
In very rare cases, people with extremely high cholesterol (like those with familial hypercholesterolemia) may develop:
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Xanthomas: Fatty deposits under the skin or around the eyes
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Chest pain: From blocked arteries (angina)
But for most people, high cholesterol is a silent condition—another reason why regular screening is so important.
How Is High Cholesterol Diagnosed?
The only way to know if you have high cholesterol is with a blood test called a lipid panel or lipid profile. This test measures:
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Total cholesterol
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LDL (bad) cholesterol
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HDL (good) cholesterol
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Triglycerides
You may need to fast for 9–12 hours before the test, depending on your doctor’s instructions. Here are general target levels:
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Total cholesterol: Below 200 mg/dL
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LDL: Below 100 mg/dL (below 70 for those with heart disease or diabetes)
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HDL: 60 mg/dL or higher (above 40 for men and 50 for women)
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Triglycerides: Below 150 mg/dL
Doctors consider your cholesterol numbers along with other risk factors—like age, smoking, blood pressure, and family history—to determine your overall heart risk.
Treatment Options for High Cholesterol
If your cholesterol levels are too high, your doctor will recommend steps to lower them. Treatment usually begins with lifestyle changes. If that’s not enough, medications may be needed too.
Lifestyle Changes
Making healthy choices every day can have a big impact on your cholesterol levels:
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Eat a heart-healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats (like those in nuts, seeds, and olive oil). Avoid trans fats and limit saturated fats.
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Exercise regularly: Aim for at least 30 minutes of moderate activity, like brisk walking, five days a week.
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Lose extra weight: Losing even a few pounds can help lower LDL and raise HDL.
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Quit smoking: This improves HDL and protects your heart in many other ways.
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Limit alcohol: Too much alcohol can raise triglycerides.
These habits don’t just help your cholesterol—they also support your overall health.
Medications
If lifestyle changes aren’t enough, or if your cholesterol is very high, your doctor may prescribe medication. Common types include:
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Statins: These drugs reduce the amount of cholesterol made by the liver. They are the most common and well-studied cholesterol medications.
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Cholesterol absorption inhibitors: These help block cholesterol from being absorbed in the intestines.
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Bile acid sequestrants: These drugs help remove cholesterol through your digestive system.
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PCSK9 inhibitors: These are newer injectable medications for people with very high cholesterol or genetic conditions.
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Fibrates and fish oil supplements: These are used mainly to lower triglycerides.
It’s important to take medications as prescribed, even if you feel fine, and to follow up with your doctor for routine blood tests.
Living With High Cholesterol
Having high cholesterol doesn’t mean you’ll get heart disease—but it does mean you’re at a higher risk. The key is to manage it before it becomes a serious problem.
Here’s what you can do:
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Get tested regularly: Adults should have their cholesterol checked every 4–6 years, or more often if they have risk factors.
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Follow your treatment plan: Stick with lifestyle changes and take medications if needed.
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Ask questions: Talk to your doctor about your numbers and what they mean.
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Stay motivated: Set goals, track progress, and celebrate small victories.
With the right approach, many people are able to lower their cholesterol and reduce their risk of heart attack and stroke.
