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What You Need to Know About High Cholesterol

High cholesterol is just one of many heart disease risk factors.

A man in a kitchen prepares a heart-healthy meal. Diet is an important part of managing high cholesterol.

Medically reviewed in November 2022

Cholesterol is one of the major markers of heart health. More than 73 million Americans have too much LDL cholesterol, which can lead to hardening of the arteries, raising the risk of heart attack and stroke.

What is cholesterol?
Cholesterol is a waxy, fat-like substance that’s in every cell. There are three elements that make up total cholesterol: LDL (“bad” cholesterol), HDL (“good” cholesterol) and a fat called triglycerides.

If you have too much LDL cholesterol and triglycerides, they can stick to the walls of your arteries in the form of plaque, a condition called atherosclerosis. This restricts blood flow to the arteries. If a piece of plaque breaks off the walls and blood cells clot around it, the clot can partially or completely block blood flow to the heart or brain, leading to heart attack or stroke.

More than the numbers
The rule of thumb is to keep your total cholesterol less than 200, your LDL less than 100, your HDL more than 60 and your triglycerides less than 150. But the absolute numbers are less important these days, says Scott Joy, MD, an internist at Presbyterian/St. Luke’s Medical Center in Denver and a professor of clinical practice at the University of Colorado.

“What’s more important is using your cholesterol values to calculate your 10-year risk of heart disease. That’s the big paradigm shift,” says Dr. Joy. “You can be a person with cholesterol numbers that look normal, but if you have other risk factors, cholesterol becomes a factor to calculate your risk.”

The 10-year risk
The 10-year risk is a calculation of your chance of developing heart disease—heart attack, stroke, peripheral artery disease and heart failure, among others—within the next 10 years. It takes cholesterol into account, but also age, blood pressure and treatment for high blood pressure, diabetes and smoking.

High cholesterol symptoms and diagnosis
High cholesterol usually has no symptoms, but chest pain is a common symptom of severe atherosclerosis. “High cholesterol is not something you usually feel,” says Joy. “The only symptom of very high cholesterol is xanthomas, little plaques of cholesterol that develop on the skin. But routine patients won’t develop those.”

Cholesterol is checked by a blood test in your healthcare provider’s office. Ask your healthcare provider at what age you should start getting tested, as recommendations vary. The U.S. Preventive Services Task Force (USPSTF) strongly recommends men older than 35 and women older than 45 with increased risk of heart disease have their cholesterol levels checked. Repeat tests are typically performed every five years. Anyone older than 20 who is in good health should have their cholesterol checked every four to six years, according to the American Heart Association. Those at risk for heart disease should have it checked more frequently.

Medication and lifestyle
You may be at risk for high cholesterol if you’re a man older than 45 or a woman older than 55, if you consume high levels of saturated fat, if you don’t exercise regularly or you’re overweight or have a family history of high cholesterol. Statins, which reduce the liver’s ability to produce cholesterol, are the standard treatment for high cholesterol, according to Joy. “They’ve been shown to reduce the risk of heart attack or stroke by 20 to 35 percent,” Joy says. Statins are generally considered safe, but muscle soreness and aches can be a problem for some people. 

Medication can help control your cholesterol, but it shouldn’t be your only line of defense. “Lifestyle changes are always included in treatment,” says Joy. You can reduce your risk by doing at least 150 minutes of moderate exercise a week (the more you move, the better), keeping your weight down and your body mass index (BMI) under 25 kg/m2 and eating a diet low in saturated fat.

“There’s no side effects to a healthy lifestyle,” Joy adds.

Article sources open article sources

Updated on April 6, 2022 to include revised HDL threshold and updated federal physical activitty guidelines.

American Heart Association. HDL (Good), LDL (Bad) Cholesterol and Triglycerides. Nov 6, 2020.
Centers for Disease Control and Prevention. Getting Your Cholesterol Checked. Sep 8, 2020.
How much physical activity do adults need? Mar 17, 2022.

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