High Cholesterol: Symptoms, Diagnosis and Treatment

Nearly 94 million adults over the age of 20 and 7% of children and adolescents in the U.S. have high cholesterol levels.

High cholesterol increases your risk for heart disease, the leading cause of death in the United States.

According to the American Heart Association (AHA) and the American College of Cardiology (ACC), implementing certain lifestyle strategies can help to prevent high cholesterol and heart disease and ultimately promote a healthy lifestyle. 

In this article, I’ll explain the symptoms and causes of high cholesterol and how it’s diagnosed.

I’ll also cover which preventive methods may help you to keep your cholesterol levels in the healthy range.

If you’ve never had your cholesterol levels tested, it’s a good idea to reach out to your healthcare provider for more information.

What is Cholesterol?

Cholesterol is an organic, waxy, fat-like molecule made and found throughout the body.

Surprisingly, most of the cholesterol stored in the body is made by the body.

But humans also eat, store, and excrete cholesterol, which helps the body build cells and produce vitamins and hormones.

It is essential for living.

However, high cholesterol levels can increase the risk of several health conditions. 

Within a medical context, high cholesterol refers to the levels of cholesterol in the blood.

Having high cholesterol can lead to the development of fatty deposits in blood vessels, which can eventually make it difficult for sufficient blood to flow through the arteries.

In serious cases, these deposits can break to form a clot that causes a heart attack or stroke.

There are two types of cholesterol that make up the measure of total cholesterol in the blood.

These types are referred to as HDL and LDL cholesterols. 

LDL cholesterol

Low-density lipoprotein (LDL) is often called “bad cholesterol” because it is the main source of fatty deposit (plaque) build up in the blood vessels, which can increase the risk of heart attack, stroke, and other heart health conditions. 

LDL cholesterol buildup can also combine with other substances to form arterial plaque, leading to a condition called atherosclerosis, when arteries become hardened, narrow, and less flexible.

Additional factors required for the development of atherosclerosis include inflammation and endothelial dysfunction (damage to the blood vessel walls).

HDL cholesterol

High-density lipoprotein (HDL) is often called “good cholesterol” because it helps to remove buildup from the arteries and return it to the liver.

Once cholesterol is in the liver, it can be removed from the body.

Otherwise healthy people with high levels of HDL cholesterol may have lowered risk of heart attack, stroke, and other health problems.

Triglycerides

Triglycerides are the most common type of fat in the body.

Blood triglycerides are made from the body and also come from certain foods, including butter, oils, and other fats.

Causes of High Cholesterol 

Unfortunately, there are several possible causes of high cholesterol.

Any combination of factors can cause high cholesterol in a single individual:

• Genetics: Having a family history of high cholesterol, heart disease, diabetes, or any combination of the three.

• Medications or other medical conditions: Certain medications (including some HIV and blood pressure medications) and medical conditions (like diabetes or hypothyroidism) can also cause high cholesterol.

• Diet: What you eat can also have an impact on your cholesterol levels, including your intake of saturated fats or trans fats and carbohydrates.

• Exercise: Lack of physical activity has been linked to lower levels of HDL cholesterol. 

• Smoking: Smoking can lower HDL levels, especially in people born female, and raise LDL levels, or “bad” cholesterol, in everyone. 

• Stress: High levels of stress can increase the level of certain hormones that can cause your body to make more cholesterol.

• Alcohol consumption: Drinking too much alcohol, including binge drinking, can raise your total cholesterol levels.

Cholesterol levels chart

Healthy cholesterol levels for adults ages 20 and older are defined by the following ranges:

Normal triglyceride levels for both children and adults is defined as below 150 mg/dL.

Symptoms

Unfortunately, there are usually no symptoms of high cholesterol, which is why many people with high cholesterol will not know they have it until they get their levels checked.

However, very high levels of LDL cholesterol can cause symptoms like:

• Xanthomas, fatty bumps on the skin
• Corneal arcus, grayish-white rings around the corneas of the eyes

People with high LDL cholesterol who develop these symptoms usually have familial hypercholesterolemia (FH), a common genetic disorder that affects 1 in 250 people in the U.S. and causes high levels of LDL, leading to premature coronary heart disease.

Diagnosis

Thankfully, a simple blood test called a lipid panel can screen for high cholesterol levels.

A lipid panel can test the levels of LDL and HDL cholesterol and may also include a test for triglyceride levels.

How often you get screened for high cholesterol will vary depending on several factors, including your age, medical history, and family history of high cholesterol, diabetes, and heart disease.

In some cases, your provider may recommend advanced lipid testing (ALT) to determine the particle count and size of your lipoproteins (rather than just the concentration) and improve your risk prediction.

Risk Factors

There are several factors that can increase your risk of high cholesterol.

Some of these factors are preventable, while others are not.

Non-preventable risk factors include:

• Genetics: People with a family history of high cholesterol are more at risk of developing the condition themselves.

• Sex and race: Data from the Centers for Disease Control and Prevention (CDC) suggest that high cholesterol may be more prevalent in white women and hispanic men. Men are more likely overall to have high cholesterol when they are between the ages of 20 and 39, while women are more likely to have high cholesterol at all other ages. This is likely due to the changes in hormones experienced during menopause, pregnancy, and when on birth control pills.

• Age: People of any age can have high cholesterol, but it is most commonly diagnosed in people between the ages of 40 and 59.

Preventable risk factors that can increase your risk of high cholesterol include:

• Eating an unhealthy diet 
• Not getting enough consistent physical exercise
• Smoking tobacco 
• Drinking excessive amounts of alcohol 

Complications

Undiagnosed and/or untreated high cholesterol can lead to serious health problems, including:

• Atherosclerosis: A condition in which plaque builds up in the blood vessels throughout the body. Over time, atherosclerosis can lead to heart attack, stroke, and death.

• Carotid artery disease: A condition in which plaque builds up inside the carotid arteries. Carotid arteries supply oxygen-rich blood to the brain, face, scalp, and neck. Carotid artery disease is a major cause of stroke in the U.S.

• Coronary artery disease: Also referred to as heart disease, coronary heart disease is the leading cause of death in the U.S.

• Heart attack: Also known as a myocardial infarction, a heart attack occurs when the flow of oxygen-rich blood to a section of the heart muscle becomes blocked. Heart attacks can lead to serious health problems, including heart failure and life-threatening arrhythmias.

• Peripheral artery disease (PAD): PAD is caused by atherosclerosis and is marked by reduced flow of blood in the peripheral arteries. In the U.S., more than 8 million people over the age of 40 have PAD.

• Stroke: A stroke is a medical emergency in which blood flow to the brain is blocked. Unfortunately, stroke can cause lasting brain damage, long-term disability, or even death.

• Sudden cardiac arrest: A sudden cardiac arrest occurs when the heart unexpectedly stops beating. If not treated within minutes, it can be fatal.

How to Lower Cholesterol

There are several ways to help lower your cholesterol, including medications and heart-healthy lifestyle changes.

If you’re diagnosed with high cholesterol, here are some of the treatment options your provider may recommend:

Home remedies

There are several things you can do at home to help lower your cholesterol, including incorporating regular exercise into your daily routine, getting enough quality sleep every night, limiting your alcohol intake, and quitting smoking.

There are also some natural supplements marketed to help lower cholesterol.

But keep in mind that no supplements have yet been proven to be as effective as medications when it comes to lowering and managing cholesterol levels.

Medications

Your provider may recommend medication to treat your high cholesterol depending on your risk factors for complications and your body’s response to lifestyle changes.

There are several medications that can help to lower and control blood cholesterol levels, including:

• Statins
• Ezetimibe
• Bile acid sequestrants
• PCSK9 inhibitors
• Lomitapide
• Mipomersen

Diet

Making some healthy changes to your diet can have a beneficial impact on your cholesterol.

These changes can include eating:

• More fiber
• More fruits and vegetables
• Less trans fats
• Healthy proteins
• More fish, less red meat

Prevention

Depending on your risk factors, high cholesterol cannot always be prevented.

However, there are some preventive strategies that can help to reduce the risk of developing high cholesterol in some people.

Healthy diet

Eating a healthy diet rich in vegetables, fruit, and fiber can help to prevent high cholesterol in some people.

It should be noted that there is some debate on what constitutes a healthy diet for managing cholesterol.

Until recently, the emphasis has largely been placed on reducing your cholesterol intake (primarily from saturated fats). 

However, recent evidence suggests that consuming cholesterol from foods high in saturated fats doesn’t significantly raise blood cholesterol levels in the body.

This is mostly due to the fact that when cholesterol is consumed from foods in large quantities, most of this cholesterol isn’t actually absorbed by the body.

Instead, limiting your trans fat intake may be more beneficial when it comes to preventing high cholesterol.

Additionally, reducing carbohydrate intake may also be beneficial for some people looking to reduce their risk of high cholesterol and heart disease.

Quit smoking

If you currently smoke tobacco, quitting smoking can help to significantly reduce your risk of high cholesterol and heart disease.

Limit alcohol

Limiting alcohol intake to one alcoholic drink a day for people born female and two drinks a day for people born male may also help to reduce your risk.

Maintain a healthy weight

Maintaining a healthy weight may help to reduce your risk of high cholesterol, but keep in mind that determining a healthy weight for your body may require help from a healthcare provider.

Simple metrics like the Body-Mass Index (BMI) don’t actually give a reliable indicator of health.

In fact, some people with obesity are metabolically healthy.

To determine your healthy weight, you’ll need to identify several health indicators, including the amount of excess visceral fat (fat stored deep inside the belly) you have, which can lead to poor health outcomes, versus exclusively cutaneous adipose tissue (a layer of fat cells in the skin).  

Physical activity

Regular physical activity can help to prevent high cholesterol. 

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