What Is High Cholesterol? Symptoms, Causes, and Treatments
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Cholesterol is a waxy substance that circulates in your blood stream. You need a small amount of cholesterol to keep your cells healthy. But high cholesterol — especially the wrong kind — can cause health problems.
There are two types of cholesterol:
LDL (low-density lipoprotein) cholesterol: This is often called “bad” cholesterol. Too much LDL raises your risk for heart attack and stroke.
HDL (high-density lipoprotein) cholesterol: This is known as “good” cholesterol. HDL can help remove excess cholesterol from the blood.
High HDL may protect you against heart attack and stroke. However, HDL is complicated. And a high number doesn’t always mean that you’re protected. We used to think that a high HDL “cancelled out” a high LDL. Now we know that isn’t the case.
LDL is the cholesterol number we usually worry about. That’s because too much LDL cholesterol in the blood can cause buildup in the walls of your arteries. This is known as atherosclerosis or plaque. Cholesterol plaque puts you at risk for serious problems like heart attack, stroke, and even dementia.
High cholesterol doesn’t usually cause symptoms, but there are a few exceptions. When your cholesterol is extremely high, the following signs and symptoms can happen:
Xanthomas are small yellow nodules that can appear on the knees, elbows, and other joints and tendons.
Xanthelasmas are small yellow bumps near the inner corner of your eyes.
Corneal arcus is a thin white line around the iris of your eye.
Most of the time, these conditions don’t cause pain or interfere with normal function.
These signs are unusual. So, if you don’t have them, your cholesterol levels could still be high. For most people with high cholesterol, symptoms begin when an artery is blocked by cholesterol plaque. That’s when angina (heart pain), heart attack, or stroke happens.
There are many different causes and risk factors that contribute to high cholesterol. Some of these are things you can control, while others are things you can’t. You may be more likely to have high cholesterol if you:
Eat a diet high in saturated fat and/or cholesterol
Have increased body fat or obesity
Don’t exercise
Have diabetes
Live with liver or kidney disease
Have an underactive thyroid (hypothyroid)
Are over the age of 50
Have gone through menopause
Take certain medications
Even with a nutritious diet and lifestyle, you may have high cholesterol because of your family history. This is called familial hypercholesterolemia.
Compare prices and information on the most popular High Cholesterol medications.
Cholesterol is measured with a blood test. The CDC recommends screening for high cholesterol at the following ages and intervals:
A first test as early as age 9
A second test between the ages of 17 and 21
Every 4 to 6 years after the second test
Every 1 to 2 years for men in their 40s and up and women in their 50s
Yearly testing after age 65
If you have risk factors, or if your numbers are high, more frequent testing is usually needed. Screening tests are usually ordered by your primary healthcare professional.
In general, an LDL over 160 is considered high, even if you have no other risk factors. About 11% of people in the U.S. fall into this category.
If your LDL number isn't technically in the “high” range, it may still be higher than the recommended range. Your ideal LDL number depends on your other health conditions, such as:
If you have no other health problems, then your LDL goal should be under 100.
If you have heart disease, stroke, peripheral arterial disease, or diabetes, your ideal LDL is below 70.
For some especially high risk individuals, research suggests that an LDL under 55 may become the new goal.
After your blood test, your primary healthcare professional will review your cholesterol levels with you to determine the next best steps.
Small changes in your daily lifestyle can make a big difference in your cholesterol levels. You can improve your cholesterol by:
Optimizing your nutrition by limiting unhealthy fats, cholesterol, and sugars
Increasing the fiber in your diet
Getting at least 150 minutes (2.5 hours) per week of aerobic exercise
Asking your healthcare team for help if you smoke or use other forms of tobacco
Limiting alcohol
Sometimes, these changes may be enough to get your LDL number down. But for some people, genetics or other medical conditions will keep your numbers high.
If your LDL cholesterol is too high, there are medications that can safely bring it down. People between ages 40 and 75 are most likely to need cholesterol medication.
Here are the types of medications most commonly used to help manage cholesterol. Some of these can be combined, when needed:
Statins are first-choice medications for treating high cholesterol. Examples of statins include atorvastatin (Lipitor), fluvastatin (Lescol), rosuvastatin calcium (Crestor), and simvastatin (Zocor).
Selective cholesterol absorption inhibitors are fairly weak on their own. So they work best when combined with a statin or other cholesterol medication. Ezetimibe (Zetia) is the only available drug in this class.
PCSK9 inhibitors are injected under the skin. Examples include alirocumab (Praluent) and evolocumab (Repatha). They’re often combined with a statin. But they may be used on their own for people who can’t take statins.
Adenosine triphosphate-citrate lyase inhibitors are another good choice for people who can’t take statins. Bempedoic acid (Nexletol) is the only available drug in this class. A combination pill with ezetimibe is available (Nexlizet).
Bile acid sequestrants (resins) are the oldest and safest cholesterol medications. However, they aren’t as effective as other drugs for preventing heart attacks or stroke. Examples include cholestyramine (Questran, Prevalite, LoCholest) and colestipol (Colestid).
Normal cholesterol levels vary by age and gender:
Total cholesterol: In general, a total cholesterol level of less than 200 mg/dL is considered ideal for most adults. It’s important to remember that your total cholesterol number doesn’t tell you whether your LDL is high. That’s why this number is less useful.
LDL: For most people, optimal LDL cholesterol is less than 100 mg/dL.
HDL: HDL cholesterol should be at least 40 mg/dL for men and 50 mg/dL for women.
These targets can be different for some people. For example, people with cardiovascular disease or certain risk factors, including diabetes, often need to keep their LDL under 70 mg/dL.
Normal cholesterol levels vary by age and gender:
Total cholesterol: In general, a total cholesterol level of less than 200 mg/dL is considered ideal for most adults. It’s important to remember that your total cholesterol number doesn’t tell you whether your LDL is high. That’s why this number is less useful.
LDL: For most people, optimal LDL cholesterol is less than 100 mg/dL.
HDL: HDL cholesterol should be at least 40 mg/dL for men and 50 mg/dL for women.
These targets can be different for some people. For example, people with cardiovascular disease or certain risk factors, including diabetes, often need to keep their LDL under 70 mg/dL.
High cholesterol can lead to fatty deposits in the blood vessels. This can lead to many health problems, including:
Coronary artery disease (blockages in blood vessels to the heart) and heart attacks
Carotid artery disease (blockages of blood vessels to the brain) and strokes
Peripheral artery disease (blockages in the legs)
Aortic aneurysm
Yes. Total cholesterol includes both LDL and HDL cholesterol levels. Even if your total cholesterol is in the “healthy” range, your LDL (bad) may be too high and your HDL (good) too low.
High cholesterol usually doesn’t have any symptoms. Most people with high cholesterol feel just fine. In fact, some people only find out that they have high cholesterol after they have a heart attack or stroke. This is why it’s important to get your levels checked regularly. Only a blood test can tell whether you have high cholesterol.
If you have Type 2 diabetes, you should have your cholesterol checked regularly. Diabetes can raise LDL (bad) cholesterol and lower HDL (good) cholesterol. And simply having diabetes doubles your risk for heart disease. That’s why your LDL goal with diabetes is usually below 70.
It depends. Unfiltered coffee (French press, espresso, and pre-packaged pods) contains a molecule called cafestol that can make your cholesterol levels go up. But filtered coffee has the cafestol removed. And it might even be beneficial for your heart health. If you have high cholesterol and drink coffee, a filtered option is your best choice.
American Heart Association. (n.d.). Cholesterol score.
American Heart Association. (2024). American Heart Association recommendations for physical activity in adults and kids.
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