High Blood Cholesterol

Overview

Your body needs cholesterol for good health. Cholesterol helps make hormones, vitamin D, and substances that help you digest food. However, having too much of the “wrong” kind of cholesterol can cause serious harm.

Cholesterol travels through the bloodstream in tiny particles called lipoproteins. There are different types of lipoproteins that have different effects:

• Low-density lipoproteins (LDL), or “bad cholesterol,” can lead to cholesterol deposits, called plaque, inside blood vessels. This can cause arteries to narrow or become blocked over time.
• High-density lipoproteins (HDL), or “good cholesterol,” carry cholesterol and plaque to the liver to be flushed out of the body.

Triglycerides are another type of fat in your blood that your body uses for energy. They are the most common types of fat in your body. Triglycerides come from foods such as butter, oils, and other fats, and from extra calories your body does not need right away. Unused calories are stored as triglycerides in fat cells. Some triglycerides are important for good health. However, high triglyceride levels in your blood can raise your risk of heart disease and stroke.

Unhealthy cholesterol levels and/or high blood triglycerides usually cause no symptoms. As a result, many people do not know they have one of these conditions until a healthcare provider does a routine blood test.

Related Health Effects

Over time, unhealthy blood cholesterol can lead to:

• Carotid artery disease
• Coronary heart disease, which may cause chest pain (called angina)
• Heart attack
• Peripheral artery disease
• Stroke

In addition, very high blood triglycerides (more than 500 mg/dL) can raise the risk of acute pancreatitis, a sudden swelling of the pancreas. It can also cause changes in the eye’s blood vessels (lipemia retinalis) and damage skin on the back, chest, arms, and legs.

Extremely high blood triglyceride levels (greater than 1,500 mg/dL) may cause the body to stop breaking down fats (called multifactorial chylomicronemia syndrome). Symptoms include short-term memory loss, swelling of the liver and spleen, stomach pain, and skin flushing with alcohol use.

If your levels are very high, you may notice the following signs:

• Fatty bumps (xanthomas) on your skin, especially on the elbows, joints, knees, hands, ankles, or buttocks
• Grayish-white rings (corneal arcus) that appear around the cornea in your eye

Causes and Risk Factors

An unhealthy lifestyle is the most common cause of high LDL or low HDL cholesterol. However, genes, other medical conditions, and some medicines may also affect cholesterol levels.

Unhealthy Lifestyle Habits

• Eating a lot of foods high in saturated fats raises LDL levels. Saturated fats are found in fatty cuts of red meat and dairy products. No more than 10% of your daily calories should come from saturated fats.
• Lack of physical activity is linked to a higher risk of unhealthy blood cholesterol levels.
• Smoking lowers HDL, particularly in women, and raises LDL.
• Stress may raise levels of certain hormones, such as corticosteroids, which can cause your body to make more cholesterol.
• Drinking too much alcohol can raise your total cholesterol level.
• Getting little or low-quality sleep has been linked to lower cardiovascular health.

Family History

Family members usually have similar cholesterol levels, which suggests genes can raise your risk. Mutations, or changes, in genes that control cholesterol levels can cause familial hypercholesterolemia, making it more difficult for your body to remove LDL from your blood or break it down in the liver. Even if you have a family history of high blood cholesterol, you can still help prevent unhealthy blood cholesterol levels with a heart-healthy lifestyle.

Medicines

Some medicines taken for other health problems can raise LDL or lower HDL, including:

• Arrhythmia medicines, such as amiodarone
• Beta-blockers for angina or high blood pressure
• Chemotherapy medicines
• Diuretics, such as thiazide
• Immunosuppressive medicines, such as cyclosporine
• Retinoids to treat acne
• Steroids, such as prednisone

Age

Unhealthy levels of cholesterol can affect people of all ages, but it is most commonly diagnosed in people between ages 40 and 59. As you age, the body’s metabolism changes and the liver does not remove “bad” LDL cholesterol as well as it did when you were young. These normal changes may increase your risk for developing high blood cholesterol as you age. Younger people, including children and teens, can have high LDL, but it is less common.

Race and Ethnicity

Your race and ethnicity may affect your risk:

• Non-Hispanic White people are more likely than other groups to have high total cholesterol.
• Asian Americans, including those of Indian, Filipino, Japanese, and Vietnamese descent, are more likely to have high "bad" LDL than other groups.
• Hispanic Americans are more likely to have lower "good" HDL than other groups.
• Black Americans are more likely to have high HDL levels. 

A study found that higher levels of HDL may not be as beneficial in some Black and White adults as was once believed. Having other risk factors, such as high blood pressure, obesity, or diabetes may outweigh the health benefits of higher HDL levels.

Sex

Between ages 20 and 39, men have a greater risk for high total cholesterol than women. A woman’s risk goes up after menopause, when levels of female hormones that may protect against high blood cholesterol drop. After menopause, women’s total and "bad" LDL cholesterol levels usually go up, while HDL levels go down. Being pregnant may also alter cholesterol levels.

Prevention Guidance

Heart-healthy habits that start in childhood and continue throughout your life can help prevent unhealthy blood cholesterol and heart and blood vessel diseases. Key lifestyle changes include:

• Being physically active
• Eating a heart-healthy diet
• Aiming for a healthy weight
• Quitting smoking or vaping
• Limiting alcohol
• Reducing stress
• Getting enough good-quality sleep

Heart-Healthy Eating Tips

The Therapeutic Lifestyle Changes diet recommends:

• Decreasing saturated fat and cholesterol
• Adding plant stanols and sterols found in whole grains, nuts, legumes, and oils like olive and avocado oil
• Increasing soluble fiber found in fruits, beans, and oats

Soluble fiber blocks cholesterol and fats from being absorbed through intestinal walls into the bloodstream. Fiber also helps push out extra cholesterol from the body. Meanwhile, plant stanols and sterols help block the absorption of cholesterol from the digestive tract, which helps lower LDL.

The Physicians Committee for Responsible Medicine recommends focusing on four plant-based food groups: fruits, vegetables, whole grains, and legumes. Plant-based foods are low in fat, free of cholesterol, and high in fiber. Eating fish high in omega-3 fatty acids, nuts, and certain vegetable oils such as olive oil is also encouraged.

Diagnosis

Because high cholesterol typically has no symptoms, testing is the only way to know your levels. A blood test can show whether your cholesterol levels are healthy or unhealthy.

The main blood test is called a lipid panel. It measures:

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

You may need to fast for 9 to 12 hours before the test. Many places that provide cholesterol testing measure only total cholesterol, so follow up with a healthcare provider for a complete lipid profile.

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. LDL causes clogged arteries, so lower levels are better. Since HDL protects against heart disease, higher numbers are better.

Desirable cholesterol numbers for adults include:

• Total cholesterol less than 200 mg/dL
• LDL cholesterol less than 100 mg/dL
• HDL cholesterol greater than or equal to 60 mg/dL — an HDL level less than 40 mg/dL for men and 50 mg/dL for women increases your risk of developing heart disease
• Triglycerides less than 150 mg/dL for adults or lower than 90 mg/dL for children and teens

Your provider may also order an apolipoprotein B blood test if your triglyceride levels are borderline high.

How Often You Should You Tested

When and how often you should get tested depends on your age, risk factors, and family history.

For people age 19 or younger:

• First test: between ages 9 and 11
• Second test: between ages 19 and 21
• Retest: every 5 years
• Starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

For people age 20 or older:

• Younger adults: every 5 years
• Men ages 45–65: every 1–2 years
• Women ages 55–65: every 1–2 years
• People over age 65: every year

You may need more frequent testing if you have heart disease, diabetes, or a family history of high cholesterol. Talk with your doctor to find out what is best for you.

Your provider may also use a risk calculator — such as the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equation or Atherosclerotic Cardiovascular Disease (ASCVD) Estimator — to estimate your chances of having a heart attack or stroke in the next 10 years. These tools consider your cholesterol levels, age, sex, race, and blood pressure, as well as whether you smoke or take medicines for high blood pressure or cholesterol.

Treatment and Management

The main goal in treating high cholesterol is to lower LDL levels. Studies show that lowering LDL can slow, stop, or even reverse the buildup of plaque in your arteries. Limiting plaque can help prevent heart attacks, strokes, and death from heart and blood vessel diseases.

To treat unhealthy blood cholesterol, your healthcare provider may recommend heart-healthy lifestyle changes and prescribe medicines. If a medical condition or medicine is causing your blood cholesterol problem, your provider may treat that condition or change your medicine or its dose.

Lifestyle Changes

The same lifestyle habits that can prevent unhealthy cholesterol and triglyceride levels are typically part of a treatment plan for these conditions:

• Being physically active
• Eating a heart-healthy diet
• Aiming for a healthy weight
• Quitting smoking or vaping
• Limiting alcohol
• Reducing stress
• Getting enough quality sleep

Medicines for High Cholesterol

If lifestyle changes are not enough, your healthcare provider may prescribe medicine. Common medicines include:

• Statins are the most common medicine used to treat high blood cholesterol. They reduce the amount of cholesterol made in the liver. Studies show that statins lower the risk of heart attack and stroke in people with high LDL.
• Medicines to treat familial hypercholesterolemia including mipomersen, ezetimibe, bempedoic acid, and lomitapide. Ezetimibe works by blocking how cholesterol is absorbed into the body.
• Bile acid sequestrants may be prescribed if you cannot take statins or if statins alone are not lowering your cholesterol enough. They keep bile acids from being absorbed into the body.
• PCSK9 inhibitors including alirocumab and inclisiran. These are injected under the skin and stop the PCSK9 protein, which allows LDL cholesterol to be absorbed by the liver.

Medicines for High Triglycerides

Your healthcare provider may prescribe medicines to control or lower triglyceride levels, including:

• Statins
• Ezetimibe, which can remove triglycerides from the blood when paired with a healthy diet
• Fibrates
• Concentrated omega-3 fatty acids or omega-3 dietary supplements, although these are not FDA-approved to treat people with high triglyceride levels

Living With High Blood Cholesterol

Follow up with your healthcare provider regularly to see how well your treatment is working:

• Take all medicines regularly, as prescribed. Do not change the amount of your medicine or skip a dose unless your provider tells you to.
• Talk with your provider about how often you should schedule office visits and blood tests. If you start taking a statin, your provider may order a lipid panel one to three months later to see whether the drug is working. Repeat tests may be done every three to twelve months after that.
• Call your healthcare provider if you have any symptoms of complications or problems with your blood pressure or blood sugar.

Tips if You're Taking Statins

Statins are the most common medicine used to treat high blood cholesterol. They reduce the amount of cholesterol made in the liver. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. Statins usually don't cause side effects, but they may raise the risk of diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who have prediabetes, overweight or obesity, or metabolic syndrome.

• Do not stop taking statins on your own. That can lead to a serious problem or even death. Ask your provider if you have any concerns.
• Ask your provider what medicines, nutritional supplements, or foods you should avoid. For example, grapefruit (fresh or as juice) affects how your liver breaks down some statins.
• Tell your provider about any symptoms or side effects. If you start having muscle pain, your provider may order a blood test to look for muscle damage.
• If you plan to become pregnant, talk to your provider. You should stop taking statins about three months before getting pregnant. You should not take statins if you are breastfeeding.

Track your progress

Record any lifestyle changes you make. Write in a journal or use an app to record:

• The number of servings of fruits and vegetables you eat
• Time spent on moderate to vigorous physical activity
• Your weight
• Hours of good-quality sleep you get each night
• Your blood pressure and cholesterol

Small changes can make a big difference for your cholesterol levels and your overall health. Social support makes it easier to live a heart-healthy lifestyle, so ask a family member or friend to join you on your journey.

Questions to Ask Your Healthcare Provider

• What are my cholesterol levels? What should they be?
• How often should I have my levels checked?
• What other lifestyle factors should I consider to improve my cholesterol and overall heart health?
• Do I need cholesterol medicine? Will it have side effects?
• Are there any foods, other medicines, vitamins, or herbal supplements that may change how well my cholesterol medicine works?

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on cholesterol.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH leads and sponsors many studies on blood cholesterol and related conditions, as well as high blood triglycerides.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.  

Multimedia

Video: Cholesterol Good and Bad