High Cholesterol

Cholesterol is an essential building block for many cellular processes in the body. Too much cholesterol in the blood, however, can lead to heart problems. Medication and diet changes can help.

High Cholesterol Overview

Reviewed: August 25, 2014

Cholesterol is used by the body in several biochemical reactions necessary for life, including making new cells, and making hormones. Too much cholesterol can cause plaque to build up in blood vessels, putting patients at risk for heart attack and stroke.

High blood cholesterol does not cause symptoms. Some people with rare genetic diseases that cause extremely high cholesterol may experience yellowish patches underneath the skin around the eyelids (xanthelasma palpebrarum).

Blood levels of cholesterol can be controlled partially by limiting foods high in cholesterol and eating foods high in fiber, which can help remove cholesterol from the blood. Factors such as heredity, age and gender may predispose certain groups to high cholesterol.

Medications to control cholesterol include statins (HMG-CoA reductase inhibitors) which have been directly associated with reduced risk for heart attack and stroke. Examples of statins include atorvastatin, lovastatin, rosuvastatin, and simvastatin. Other medications used to lower blood cholesterol levels include bile acid sequestrants, fibrates, and cholesterol absorption inhibitors.

High Cholesterol Symptoms

High cholesterol does not cause symptoms.

High Cholesterol Causes

Many factors can affect the cholesterol levels in your blood.

The factors you can control include:

  • Limiting foods with cholesterol (egg yolks, some meats, and cheese)
  • Limiting foods with saturated fat (meats, dairy, chocolate, cakes and cookies, deep-fried foods, processed foods)
  • Limiting foods with trans fats (some fried and processed foods)
  • being physically active for weight loss and to lower LDL cholesterol

The factors you can't control include:

  • Heredity. High cholesterol can run in families.
  • Age and gender. Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men.

High Cholesterol Diagnosis

The best way to know your cholesterol level is to have a fasting blood test. You must "fast" (not eat or drink anything) for at least 8 hours before the blood test. You can drink water during the "fast" before the test. The fasting cholesterol test measures your total cholesterol plus your LDL, HDL, triglyceride levels.

The fasting cholesterol test measures your total cholesterol plus your LDL (low-density lipoproteins), HDL (high-density lipoproteins), triglyceride levels.

High levels of LDL (also called "bad" cholesterol) increase your chances of heart disease as it delivers cholesterol to the body.

High levels of HDL ("good" cholesterol) decrease your chances of heart disease as it removes cholesterol from the bloodstream.

Your test report will show your cholesterol levels in milligrams per deciliter of blood (mg/dL).

  • High cholesterol is 240 mg/dL or above.
  • Borderline-high is 200 to 239 mg/dL.
  • Best is less than 200 mg/dL.

Your total cholesterol score is calculated using the following equation: HDL + LDL + 20 percent of your triglyceride level. A total cholesterol score of less than 180 mg/dL is considered optimal.

When you change your lifestyle to improve your cholesterol levels, you want to lower LDL, raise HDL and lower triglycerides.

Living With High Cholesterol

To prevent and control high cholesterol, follow a healthy eating plan, participate in physical exercise to raise your heart rate, and maintain a healthy weight.

Know your cholesterol numbers are and write them down. Discuss these numbers with your healthcare provider.

You should have your cholesterol regularly checked if:

You are a man 35 years or older; or

You are a woman of any age or a younger man and have risk factors for heart disease or stroke such as:

  • Smoking
  • Diabetes
  • High blood pressure
  • Overweight
  • A family history of heart attacks or strokes before age 50 in male relatives or before age 60 in female relatives. 

If your healthcare provider prescribes medications to lower your blood cholesterol, take your medicine every day, or as directed.

If your cholesterol levels decrease and your medicine is working, don’t stop it or take a lower dose unless your healthcare provider advises you to do so.


High Cholesterol Treatments

If you have high cholesterol, lifestyle changes may be necessary.

Quitting smoking, exercising regularly, and weight loss can improve cholesterol levels. Eat a diet rich in fruits, vegetables, fish and whole grains. Avoid saturated and trans fats, and limit cholesterol intake.

Depending on your risk factors, if these lifestyle changes are not enough to lower your cholesterol level, your doctor may suggest medicine.


There are different kinds of medicines to control cholesterol. Statins (also known as HMG-CoA reductase inhibitors) are recommended for most patients because they are the only cholesterol-lowering drug class that has been directly associated with reduced risk for heart attack and stroke. Examples of statins include atorvastatin, lovastatin, rosuvastatin, and simvastatin.

Other medications used to lower blood cholesterol levels include:

  • Bile Acid Sequestrants (examples include colestipol and cholestyramine)
  • Fibrates (examples include fenofibrate and gemfibrozil)
  • Niacin (a B vitamin found in foods and multivitamin supplements)
  • Cholesterol Absorption Inhibitors (ezetimibe)
  • Omega-3 Fatty Acids (fats found in avocados and oily fish such as mackerel, salmon and tuna)
  • Combination Medicines

High Cholesterol Other Treatments

If necessary, your healthcare provider may prescribe medicines for other medical conditions. Take all medicines exactly as prescribed. The combination of medicines may lower your risk for heart disease and heart attack.