High cholesterol
Conditions
By Mayo Clinic Staff
Overview
Cholesterol is a waxy substance found in the blood. The body needs cholesterol to build healthy cells. But high levels of cholesterol can raise the risk of heart disease.
With high cholesterol, fats and other substances can build up in blood vessels called arteries. This buildup is called plaque. As more plaque forms over time, the arteries can become narrowed or clogged. That makes it hard for enough blood to flow through the arteries. Sometimes a piece of plaque can break loose and form a blood clot. The clot may cause a heart attack or stroke.
High cholesterol can be inherited. That means it can pass from parents to children through genes. But high cholesterol often is the result of lifestyle choices such as not getting enough exercise, not eating a balanced diet or consuming large amounts of saturated fat. You can make changes to help prevent the condition. And if you have high cholesterol, you can help lower it with a healthy diet, regular exercise and sometimes medicine.
Cholesterol travels through the blood, attached to proteins. The mix of proteins and cholesterol is called a lipoprotein. Cholesterol is commonly described by the type of lipoprotein that carries it.
- Low-density lipoprotein (LDL) cholesterol. This is known as the "bad" cholesterol. LDL carries cholesterol particles throughout the body. "Bad" cholesterol builds up in the walls of arteries. This makes the arteries hard and narrow. When a gene change causes high cholesterol, the body may have trouble removing LDL cholesterol from the blood.
- High-density lipoprotein (HDL) cholesterol. This is known as the "good" cholesterol. HDL picks up extra cholesterol and takes it back to the liver.
Symptoms
High cholesterol has no symptoms. A blood test is the only way to find out if you have it. That's why it's important to get cholesterol checks as recommended, even if you feel well.
When to see a doctor
The American Heart Association recommends that children get checked, also called screened, for high cholesterol once between ages 9 and 11. Screening may start earlier if a child has a family history of high cholesterol, heart attack or stroke. Screening also may start earlier if a child has conditions such as diabetes or obesity.
The next cholesterol screening is often recommended for people between ages 17 and 21. After that, many adults get their cholesterol checked about every five years. People who have health conditions such as high blood pressure, obesity or diabetes may need to get screened more often. And those who take cholesterol-lowering medicine might need to be screened more often. Those who have a family history of high cholesterol or heart disease also may need screenings more often.
If your test results aren't within the standard range, your healthcare professional might recommend more-frequent testing as well.
Causes
Lifestyle factors that may be within your control are the most common causes of high cholesterol. These factors include eating a diet high in saturated fats and trans fats and not getting enough exercise.
Sometimes factors that aren't within your control can lead to high cholesterol. These include gene changes that pass from parents to children, some health conditions and some medicines.
Conditions linked to high cholesterol or higher heart disease risk include:
Common conditions and inherited factors
- Overweight and obesity.
- Diabetes.
- Hypothyroidism.
- Sleep apnea.
- Familial hypercholesterolemia.
Other health conditions
- Chronic kidney disease.
- Chronic liver disease.
- HIV/AIDS.
- Lupus.
Some types of medicines taken for other health conditions also can make cholesterol levels worse. These may include some medicines used for acne, high blood pressure, HIV/AIDS and organ transplants.
Risk factors
Risk factors for high cholesterol levels include:
- Eating habits. Too much saturated fat or trans fats can lead to high cholesterol. Saturated fats are found in fatty cuts of meat and full-fat dairy products. Sometimes trans fats are found in packaged or processed foods.
- Overweight or obesity. Excess body fat can raise LDL cholesterol and triglycerides.
- Lack of activity. Regular physical activity can help improve cholesterol levels, including the body's "good" HDL cholesterol.
- Smoking. Cigarette smoking may lower the level of HDL cholesterol.
- Alcohol. Too much alcohol can affect triglycerides and cholesterol levels. If you choose to drink alcohol, limit how often you drink and keep the amount small. For overall health, drink no more than one drink a day. Do not drink every day. The less you drink, the better.
- Age. High cholesterol can happen at any age, including in childhood. But cholesterol levels often rise as people get older.
Complications
High cholesterol can lead to other health conditions called complications. With high cholesterol, a dangerous amount of plaque can build up on the walls of arteries. This is called atherosclerosis. Over time, the plaque buildup can cause arteries to narrow and block blood flow.
Less blood flow through the arteries can cause complications such as:
- Chest pain, also called angina. If the arteries that supply the heart with blood narrow due to plaque buildup, that may cause chest pain. It also may cause other symptoms of a common type of heart disease called coronary artery disease.
- Heart attack. If plaque or a blood clot completely blocks blood flow to part of the heart, a heart attack can happen. A heart attack is an emergency that needs treatment right away.
- Stroke. If plaque or a blood clot blocks blood flow to the brain, a stroke can happen. A stroke is an emergency that needs treatment right away.
Prevention
The same heart-healthy lifestyle changes that can lower cholesterol also can help prevent high cholesterol. You can practice the following habits:
- Eat a diet that focuses on lean protein, fruits, vegetables and whole grains. Limit sodium and added sugar.
- Also limit the amount of saturated fats and trans fats you eat. Instead, eat foods with healthy fats such as fatty or oily fish, nuts, and olive or canola oil.
- Lose extra weight and keep it off.
- If you smoke, ask your care team to help you quit.
- Exercise on most days of the week. Aim for about 150 minutes of moderate-intensity activity each week.
- Do resistance training two times a week. This can help improve HDL cholesterol levels.
- Drink less alcohol, if at all. Limit alcohol to one or fewer drinks a day.
Diagnosis
Your healthcare professional can order blood tests to find out if you have high cholesterol. You might hear the blood test called a lipid panel or a lipid profile.
The results of the test usually show your:
- Total cholesterol. This is the overall amount of cholesterol in your blood. It includes LDL cholesterol, HDL cholesterol and cholesterol carried in other particles.
- Low-density lipoprotein (LDL) cholesterol. LDL carries cholesterol through the blood. High levels can lead to plaque buildup in the arteries.
- High-density lipoprotein (HDL) cholesterol. HDL carries extra cholesterol from the blood back to the liver.
- Non-HDL cholesterol. This measures all the potentially harmful cholesterol particles in the blood.
- Triglycerides. These are a type of fat in the blood. High levels can raise the risk of heart disease.
Many cholesterol tests don't require fasting. But sometimes you may need to avoid food and drinks other than water for 9 to 12 hours before the test. This is called fasting. Follow your healthcare professional's instructions.
Other blood tests
Your healthcare professional may recommend other blood tests to better understand your risk of heart and blood vessel disease.
These tests may include:
- Lipoprotein(a). Lipoprotein(a), also called Lp(a), is a type of lipoprotein that is mostly determined by genes. A high Lp(a) level can raise the risk of heart attack and stroke. Experts recommend that adults have Lp(a) measured at least once.
- Apolipoprotein B. Apolipoprotein B (ApoB) is a protein found in LDL cholesterol and other particles that can contribute to plaque buildup in the arteries. An ApoB test may help assess the risk of heart and blood vessel disease in some people, including those with high triglycerides or diabetes.
Assessing heart disease risk
Cholesterol numbers are only one part of your risk of heart and blood vessel disease. Your healthcare professional also may consider factors such as your age, blood pressure, smoking history and other health conditions.
Having a high triglyceride level also can raise the risk of heart disease. Lifestyle factors that you may be able to manage play a role in triglyceride levels.
For adults ages 30 to 79 who don't have cardiovascular disease, healthcare professionals may use a risk calculator called PREVENT to estimate the risk of having a heart attack or stroke in the future. The results can help guide decisions about whether cholesterol-lowering treatment may be helpful.
Interpreting the numbers
Your healthcare professional considers your overall risk of heart and blood vessel disease when deciding what LDL cholesterol level is healthy for you. People at higher risk generally have lower LDL cholesterol goals. For example, some people who have cardiovascular disease and are at very high risk of a heart attack or stroke may have an LDL cholesterol goal below 55 mg/dL.
In the United States, cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. In Canada and many European countries, cholesterol levels are measured in millimoles per liter (mmol/L). Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.
To understand your test results, use these general guidelines:
Total cholesterol levels
| U.S. and some other countries | Canada and most of Europe | What it means |
|---|---|---|
| Below 200 mg/dL | Below 5.2 mmol/L | Desirable |
| 200-239 mg/dL | 5.2-6.2 mmol/L | Borderline high |
| 240 mg/dL and above | Above 6.2 mmol/L | High |
LDL cholesterol levels
| U.S. and some other countries | Canada and most of Europe | What it means |
|---|---|---|
| Below 100 mg/dL | Below 2.6 mmol/L | Optimal |
| 100-129 mg/dL | 2.6-3.3 mmol/L | Near optimal |
| 130-159 mg/dL | 3.4-4.1 mmol/L | Borderline high |
| 160-189 mg/dL | 4.1-4.9 mmol/L | High |
| 190 mg/dL and above | Above 4.9 mmol/L | Very high |
HDL cholesterol levels
| U.S. and some other countries | Canada and most of Europe | What it means |
|---|---|---|
| Below 40 mg/dL for men | Below 1.0 mmol/L for men | Low |
| Below 50 mg/dL for women | Below 1.3 mmol/L for women | Low |
| 40-59 mg/dL for men | 1-1.5 mmol/L for men | Better |
| 50-59 mg/dL for women | 1.3-1.5 mmol/L for women | Better |
| 60 mg/dL and above | Above 1.5 mmol/L | Optimal |
Note: Low HDL cholesterol levels may be associated with a higher risk of heart disease. Better HDL cholesterol levels are generally linked to lower cardiovascular risk than low HDL cholesterol levels. But very high HDL cholesterol levels may not be protective against heart disease.
Triglyceride levels
| U.S. and some other countries | Canada and most of Europe | What it means |
|---|---|---|
| Below 150 mg/dL | Below 1.7 mmol/L | Desirable |
| 150-199 mg/dL | 1.7-2.2 mmol/L | Borderline high |
| 200-499 mg/dL | 2.3-5.6 mmol/L | High |
| 500 mg/dL and above | Above 5.6 mmol/L | Very high |
Children and cholesterol testing
The American Heart Association recommends that children get checked, also called screened, for high cholesterol once between ages 9 and 11. Screening may start earlier if a child has a family history of high cholesterol, heart attack or stroke. Screening also may start earlier if a child has conditions such as diabetes or obesity. The next cholesterol screening is recommended between ages 17 and 21.
Treatment
Treatment choices to reach ideal cholesterol and triglyceride levels typically are tailored to meet your needs. Talk with your healthcare professional about what levels are best for you.
Treatment for high cholesterol can include medicine. Together with healthy lifestyle changes, medicine can lower the risk of heart attacks and strokes.
You may benefit from one or more medicines. It depends on things such as your risk factors, age, health and possible medicine side effects. Your healthcare professional helps choose the right treatments for you.
LDL cholesterol goals
LDL is the cholesterol number that is most closely tied to treatment targets. Your healthcare professional considers your overall risk of heart and blood vessel disease when deciding what LDL cholesterol level is best for you. People at higher risk generally have lower LDL cholesterol goals. For example, some people who have cardiovascular disease and are at very high risk of a heart attack or stroke may have an LDL cholesterol goal below 55 mg/dL.
The general targets for LDL cholesterol levels are:
- Below 55 mg/dL (1.4 mmol/L). This is the recommended goal for people who have cardiovascular disease and are at very high risk of a heart attack or stroke.
- Below 70 mg/dL (1.8 mmol/L). This is the recommended goal for many people with cardiovascular disease or for those at high risk of developing it.
- Below 100 mg/dL (2.5 mmol/L). This is the recommended goal for many people who have borderline or intermediate risk of cardiovascular disease.
Medicines
Medicines used to treat high cholesterol include:
Statins
Statins block a substance that the liver needs to make cholesterol. This causes the liver to make less cholesterol and to remove cholesterol from the blood.
Statin choices include:
- Rosuvastatin (Crestor).
- Atorvastatin (Lipitor).
- Fluvastatin (Lescol XL).
- Lovastatin.
- Pitavastatin (Livalo, Zypitamag).
- Pravastatin.
- Simvastatin (Zocor).
Cholesterol absorption inhibitors
The small intestine absorbs the cholesterol from food and releases it into the bloodstream. The medicine ezetimibe (Zetia) helps lower the amount of cholesterol absorbed from food. Your healthcare professional may prescribe ezetimibe with a statin.Bempedoic acid
Bempedoic acid (Nexletol) helps lower LDL cholesterol by reducing cholesterol production in the liver. Your healthcare professional may prescribe it with other cholesterol-lowering medicines, especially if you can’t take a statin or if a statin does not lower LDL cholesterol enough.Bile acid sequestrants
The liver uses cholesterol to make bile acids. The body needs these substances for digestion. Bile acid sequestrants bind to bile acids. This prompts the liver to use extra cholesterol to make more bile acids. In turn, that lowers the level of cholesterol in the blood. Bile acid sequestrants include cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid).PCSK9-targeted medicines
These medicines can help the liver absorb more LDL cholesterol. This lowers the amount of cholesterol in the blood. These medicines include:
- Alirocumab (Praluent).
- Evolocumab (Repatha).
- Inclisiran (Leqvio).
- Enlicitide (Lipfendra).
PCSK9-targeted medicines might be used for people who have a genetic condition that causes very high levels of LDL cholesterol. These medicines also may be used for people with a history of heart disease when statins or other cholesterol medicines don't do enough to lower cholesterol levels.
Several PCSK9-targeted medicines, including alirocumab, evolocumab and inclisiran, are given by injection under the skin. Enlicitide, a newer PCSK9 therapy, is available as an oral tablet you take once a day rather than an injection.
Medicines for high triglycerides
If you also have high triglycerides, your healthcare professional may prescribe:
- Fibrates. The medicines fenofibrate (Lipofen) and gemfibrozil (Lopid) speed the removal of triglycerides from the blood. They also help lower LDL cholesterol. Using a fibrate with a statin can raise the risk of statin side effects.
- Niacin. Niacin limits the liver's ability to make LDL cholesterol. But niacin doesn't provide more benefits than a statin. Niacin also has been linked to liver damage and strokes. Most healthcare professionals now recommend it only for people who can't take statins.
- Omega-3 fatty acids. Prescription omega-3 fatty acids can help lower high triglyceride levels. Omega-3 fatty acids are also available as dietary supplements without a prescription, but supplements aren't recommended to treat high cholesterol or high triglycerides. Talk with your healthcare professional first because taking an omega-3 supplement may interact with medicines you take.
- Olezarsen (Tryngolza). Olezarsen lowers very high triglyceride levels. It also can lower the risk of inflammation of the pancreas, called pancreatitis, in adults with very high triglycerides. It is given as a monthly shot under the skin.
Medicine side effects
Let your healthcare professional know if your cholesterol medicine causes side effects. For instance, side effects of statins can include:
- Muscle pains.
- Muscle damage, which is very rare.
- Increased blood sugar.
If you decide to take cholesterol medicine, your healthcare professional may recommend liver function tests. These tests help check the medicine's effect on your liver.
Children and cholesterol treatments
Most often, making changes to diet and exercise is the first treatment for children age 2 and older who have high cholesterol. Children age 10 and older who have very high cholesterol levels might be prescribed cholesterol-lowering drugs such as statins.
Self-care
Lifestyle changes are important if you have high cholesterol. Try to make the following healthy changes:
- Lose extra weight. Losing weight can help lower cholesterol.
- Eat a heart-healthy diet. Focus on heart-healthy foods. These include fruits, vegetables and whole grains. Limit added sugar and sodium. Also limit saturated fats and trans fats. Healthy fat, found in olive and canola oils, is a better option. Avocados, nuts and oily fish are other sources of healthy fat.
- Be active in your daily life and exercise regularly. Talk with your healthcare professional if you're not active already. Work up to at least 30 minutes of exercise five times a week.
- Don't smoke. If you smoke, you can ask your healthcare professional to help you quit.
- Limit alcohol or don't drink it. Limit alcohol to no more than one drink a day.
- Manage stress. Activities such as exercise and meditation can help.
- Get enough sleep. It's ideal for adults to get about 7 to 9 hours of sleep each night.
Preparing for your appointment
If you're an adult who hasn't had regular cholesterol level checks, make an appointment with your healthcare professional. Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, check with your healthcare team if there's anything you need to do in advance. Many cholesterol tests don't require fasting. But sometimes you may need to avoid food and drinks other than water for 9 to 12 hours before the test.
Make a list of:
- Your symptoms, if any.
- Key personal information, including a family history of high cholesterol, coronary artery disease, strokes, high blood pressure or diabetes.
- All medicines, vitamins or supplements you take, including doses.
- Questions to ask your healthcare professional.
For high cholesterol, some basic questions to ask your healthcare professional include:
- What tests do I need?
- What's the best treatment?
- How often do I need a cholesterol test?
- Are there brochures or other printed material that I can have? What websites do you recommend?
Feel free to ask other questions.
What to expect from your doctor
Your healthcare team is likely to ask you questions such as:
- What's your diet like?
- How much exercise do you get?
- How much alcohol do you drink?
- Do you smoke? Are you or were you around other smokers?
- When was your last cholesterol test? What were the results?
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