High Cholesterol (Hyperlipidemia)

What Is High Cholesterol?

High cholesterol, also called hyperlipidemia, means there’s too much cholesterol, [LINK to What is Cholesterol page] especially LDL (“bad”) cholesterol, circulating in your blood. Over time, this excess cholesterol can build up on artery walls, forming plaques that narrow or block blood flow, leading to heart disease, heart attack, and stroke.

There are two main types of cholesterol:

• LDL (Low-Density Lipoprotein): “Bad” cholesterol that contributes to artery-clogging plaque.
• HDL (High-Density Lipoprotein): “Good” cholesterol that helps remove LDL from the bloodstream.
  
  

Who Is Affected?

High cholesterol affects millions of adults and even children in the U.S. It often develops with no symptoms, which is why regular screening is essential, even for people who feel healthy.

What Causes High Cholesterol?

High cholesterol is caused by a combination of genetic factors and lifestyle choices. Some people inherit a condition called familial hypercholesterolemia, while others develop it through poor diet or lack of physical activity.

Risk Factors

Not Controllable

• Genetics: Family history of high cholesterol or early heart disease
  
• Age: Risk increases after age 45 for men and 55 for women
  
• Sex: Men are more likely to have higher LDL earlier in life
  
• Medical conditions: Diabetes, hypothyroidism, kidney or liver disease
  
  

Controllable

• Unhealthy diet: High in saturated fats, trans fats, and cholesterol
• Physical inactivity
• Obesity or being overweight
• Smoking
• Excessive alcohol intake
  
  

Who Is Most at Risk?

You may be at higher risk if you:

• Have a family history of high cholesterol or heart disease
• Are overweight or sedentary
• Smoke or drink excessively
• Eat a diet high in processed or fried foods
  
  

How to Reduce Your Risk

• Eat a heart-healthy diet: More fruits, vegetables, whole grains, and lean proteins
• Exercise regularly (at least 150 minutes per week)
• Maintain a healthy weight
• Avoid smoking and limit alcohol
• Manage underlying health conditions like diabetes and hypertension

What Are the Symptoms of High Cholesterol?

Most people with high cholesterol do not experience symptoms. It is often discovered through routine blood work. However, extremely high cholesterol levels may cause visible signs such as:

• Xanthomas: Yellowish deposits around the eyes or on tendons
• Chest pain or angina if atherosclerosis develops
• Leg pain when walking (peripheral artery disease)

How Is High Cholesterol Diagnosed?

High cholesterol is diagnosed with a simple blood test called a lipid panel. This test measures:

• Total cholesterol
• LDL (bad) cholesterol
• HDL (good) cholesterol
• Triglycerides
  
  

You may be asked to fast for 9–12 hours before the test for accurate results.

Other Diagnostic Tools

• Coronary calcium scan or carotid ultrasound if there’s concern about blocked arteries
• Genetic testing for familial hypercholesterolemia

How Is High Cholesterol Treated?

Treatment depends on your cholesterol levels, risk factors, and overall health.

Lifestyle Changes

• Adopt the DASH or Mediterranean diet
• Increase physical activity
• Lose weight if overweight
• Quit smoking
• Limit processed foods, red meat, and sugary drinks
  
  

Medical Treatment

If lifestyle changes aren’t enough, your doctor may prescribe medications such as:

• Statins (e.g., atorvastatin, simvastatin)
• Ezetimibe (lowers cholesterol absorption)
• PCSK9 inhibitors (for people with familial hypercholesterolemia)
• Bile acid sequestrants
• Fibrates or omega-3 fatty acids for high triglycerides
  
  

Devices

There are currently no implantable devices for treating cholesterol, but wearable fitness trackers can help support physical activity goals.

Surgical Treatment

Surgery is not used to treat high cholesterol itself but may be needed if high cholesterol has led to severe arterial blockages, requiring stents or bypass surgery.

When to Seek Care

Signs to Look For

Because high cholesterol is often silent, the first sign may be a heart attack or stroke. However, you should see your doctor if:

• You have a family history of high cholesterol or early heart disease
• You are over age 20 and haven’t had a cholesterol screening
• You’re experiencing unexplained fatigue, chest pain, or leg cramps with activity
  
  

When to Seek Emergency Medical Care

Call 911 immediately if you experience:

• Chest pain or pressure
• Shortness of breath
• Sudden weakness or numbness
• Difficulty speaking or seeing
  
  

These could be signs of a heart attack or stroke caused by blocked arteries from high cholesterol.

What Should You Do Next?

• Get a cholesterol test if you haven’t had one in the past 5 years (or more frequently if at risk)
• Make lifestyle changes now, even if your numbers are borderline
• Work with your healthcare provider to develop a personalized treatment plan
• If prescribed medications, take them as directed and follow up regularly
• Encourage family members to get tested—especially if high cholesterol runs in your family