High blood cholesterol levels

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Causes

There are many types of cholesterol. The ones talked about most are:

  • Total cholesterol -- all the cholesterols combined
  • High density lipoprotein (HDL) cholesterol -- often called good cholesterol
  • Low density lipoprotein (LDL) cholesterol -- often called bad cholesterol

For many people, abnormal cholesterol levels are partly due to lifestyle choices. This often includes eating a diet that is high in fat. Other lifestyle factors are:

Some health conditions can also lead to abnormal cholesterol, including:

Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:

  • Familial combined hyperlipidemia
  • Familial dysbetalipoproteinemia
  • Familial hypercholesterolemia
  • Familial hypertriglyceridemia

Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.

Definition

Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol in your blood can increase your chance of getting heart disease, stroke, and other problems.

Common medical terms for high blood cholesterol are lipid disorder, hyperlipidemia, or hypercholesterolemia, with the last being the most precise.

What does a lipid profile (also called a lipid panel) measure?The correct answer is all of the above. The test measures the level of these fats, or lipids, in your blood. Cholesterol is found in all parts of the body. Your body needs a little bit of cholesterol. But too much cholesterol can clog your arteries and lead to heart disease and stroke. Some cholesterol is considered "good" (HDL) and some is considered "bad" (LDL). Having high LDL cholesterol is healthy.The correct answer is false. When you have too much LDL, or "bad," cholesterol in your blood, it can build up on artery walls, causing them to become hard and narrow. The lower your LDL, the lower your risk for heart disease. Ask your doctor what your LDL level should be.Which type of cholesterol is called "good" cholesterol?The correct answer is HDL. HDL helps remove LDL cholesterol from artery walls. HDL levels of 60 mg/dL or above helps protect you from heart disease. HDL below 40 mg/dL for men and below 50 mg/dL for women can increase your risk for heart disease.Having high cholesterol and triglyceride levels increases your risk for:The correct answer is all of the above. When plaque builds up on your artery walls, blood clots can form that block blood flow to the heart or brain, causing a heart attack or stroke. Talk with your doctor about how you can lower your risk for heart disease.Medicine is the only treatment for high cholesterol and triglycerides.The correct answer is false. Improving your health habits can lower cholesterol and triglyceride levels. Sometimes, lifestyle changes alone aren't enough, so your doctor may prescribe medicine.Which habits can lead to high cholesterol levels?The correct answer is all of the above. Family history, diabetes, and other medical problems also increase your risk. Ask your doctor about healthy changes you can make to help lower high cholesterol. If you are overweight, losing just 10 pounds can help lower cholesterol levels.The correct answer is true. To lose about one pound a week, eat about 500 fewer calories a day. You can lose weight by eating smaller portions. Also replace low-fiber, high-fat foods with lean meats and other proteins, whole grains, low-fat dairy products, and plenty of fruits and vegetables. Getting regular exercise can improve your cholesterol numbers.The correct answer is true. Exercising 30 minutes a day at least 5 days a week can help increase HDL levels. If you haven't been active, check with your doctor before starting to exercise. Start by walking just a few minutes several times a week. Build up to 30 minutes of brisk exercise 5 days a week. Heart-healthy fats include:The correct answer is monounsaturated and polyunsaturated fats. They are found in fish, nuts, seeds, avocados, and olive, canola, corn, soy, and sunflower oils. Replacing saturated and trans fats with these healthy fats helps lower LDL and increase HDL. Omega-3s from fish help lower high triglycerides. Quitting smoking can help you:The correct answer is all of the above. Quitting isn't easy, but keep in mind that the more times you attempt to quit, the more likely you are to be successful.

Exams and Tests

A cholesterol test is done to diagnose a lipid disorder. Different experts recommend different starting ages for adults.

  • Recommended starting ages are between 20 to 35 for men and 20 to 45 for women.
  • Adults with normal cholesterol levels should have the test repeated every 5 years.
  • Repeat testing sooner if changes occur in lifestyle (including weight gain and diet).
  • Adults with a history of elevated cholesterol, diabetes, kidney problems, heart disease, and other conditions require more frequent testing.

It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer providers away from targeting specific levels of cholesterol. Instead, they recommend different treatments or medicines and doses depending on a person's history and risk factor profile. These guidelines change from time to time as more information from research studies becomes available.

General targets are:

  • LDL: Less than 100 mg/dL (2.59 mmol/L) - lower numbers are better
  • HDL: 60 mg/dL (1.55 mmol/L) or higher - higher numbers are better
  • Total cholesterol: Less than 200 mg/dL (5.18 mmol/L) - lower numbers are better
  • Triglycerides: Less than 150 mg/dL (1.69 mmol/L) - lower numbers are better

If your cholesterol results are abnormal, you may also have other tests such as:

Outlook (Prognosis)

High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.

Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.

References

American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: standards of care in diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S207-S238. PMID: 39651970 pubmed.ncbi.nlm.nih.gov/39651970/.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e563-e595. PMID: 30879339 pubmed.ncbi.nlm.nih.gov/30879339/.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

Robinson JG. Disorders of lipid metabolism. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 190.

US Preventive Services Task Force; Mangione CM, Barry MJ, et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(8):746-753. PMID: 35997723 pubmed.ncbi.nlm.nih.gov/35997723/.

US Preventive Services Task Force; Barry MJ, Nicholson WK, et al. Screening for lipid disorders in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2023;330(3):253-260. PMID: 37462699 pubmed.ncbi.nlm.nih.gov/37462699/.

Treatment

Steps you can take to improve your cholesterol levels and to help prevent heart disease and a heart attack include:

  • Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke.
  • Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
  • Use low-fat toppings, sauces, and dressings.
  • Avoid foods that are high in saturated fat.
  • Exercise regularly.
  • Lose weight if you are overweight.

Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:

  • Your age
  • Whether or not you have heart disease, diabetes, or other blood vessel problems
  • Whether you smoke or are overweight
  • Whether you have high blood pressure or diabetes

You are more likely to need medicine to lower your cholesterol:

  • If you have heart disease or diabetes
  • If you are at high risk for heart disease (even if you do not yet have any heart problems)
  • If your LDL cholesterol is 190 mg/dL (4.92 mmol/L) or higher

Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190 mg/dL (4.14 mmol/L to 4.92 mmol/L).

There are several types of medicines to help lower blood cholesterol levels. The medicines work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease. Other medicines are available if your risk is high and statins do not lower your cholesterol levels enough. These include ezetimibe and PCSK9 inhibitors.

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