High blood cholesterol levels

  • Definition
    • Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems.

      The medical term for high blood cholesterol is lipid disorder, hyperlipidemia, or hypercholesterolemia.

      Test Your Cholesterol Knowledge

      1. What does a lipid profile (also called a lipid panel) measure?

        1. A. Total cholesterol
        2. B. LDL cholesterol
        3. C. HDL cholesterol
        4. D. Triglycerides
        5. E. All of the above

        The correct answer is all of the above. The test measures the level of these fats, or lipids, in your blood. Cholesterol is found in all parts of the body. Your body needs a little bit of cholesterol. But too much cholesterol can clog your arteries and lead to heart disease and stroke. Some cholesterol is considered "good" (HDL) and some is considered "bad." (LDL)

      2. Having high LDL cholesterol is healthy.

        1. A. True
        2. B. False

        The correct answer is false. When you have too much LDL, or "bad," cholesterol in your blood, it can build up on artery walls, causing them to become hard and narrow. The lower your LDL, the lower your risk for heart disease. Ask your doctor what your LDL level should be.

      3. Which type of cholesterol is called "good" cholesterol?

        1. A. HDL cholesterol
        2. B. LDL cholesterol

        The correct answer is HDL. HDL helps remove LDL cholesterol from artery walls. HDL levels of 60 mg/dL or above helps protect you from heart disease. HDL below 40 mg/dL for men and below 50 mg/dL for women can increase your risk for heart disease.

      4. Having high cholesterol and triglyceride levels increases your risk for:

        1. A. The buildup of fat, cholesterol, and other substances on your artery walls that makes them narrower (atherosclerosis)
        2. B. Heart attack
        3. C. Stroke
        4. D. All of the above

        The correct answer is all of the above. When plaque builds up on your artery walls, blood clots can form that block blood flow to the heart or brain, causing a heart attack or stroke. Talk with your doctor about how you can lower your risk for heart disease.

      5. Medicine is the only treatment for high cholesterol and triglycerides.

        1. A. True
        2. B. False

        The correct answer is false. Improving your health habits can lower cholesterol and triglyceride levels. Sometimes, lifestyle changes alone aren't enough, so your doctor may prescribe medicine.

      6. Which habits can lead to high cholesterol levels?

        1. A. Smoking
        2. B. Obesity
        3. C. Eating foods high in fat and cholesterol
        4. D. Not getting enough exercise
        5. E. High alcohol use
        6. F. All of the above

        The correct answer is all of the above. Family history, diabetes, and other medical problems also increase your risk. Ask your doctor about healthy changes you can make to help lower high cholesterol.

      7. If you are overweight, losing 5 to 10 pounds can help lower cholesterol levels.

        1. A. True
        2. B. False

        The correct answer is true. To lose about one pound a week, eat about 500 fewer calories a day. You can lose weight by eating smaller portions. Also replace low-fiber, high-fat foods with lean meats and other proteins, whole grains, low-fat dairy products, and plenty of fruits and vegetables.

      8. Getting regular exercise can improve your cholesterol numbers.

        1. A. True
        2. B. False

        The correct answer is true. Exercising 30 minutes a day at least 5 days a week can increase HDL levels by about 5 percent. If you haven't been active, check with your doctor before starting to exercise. Start by walking just a few minutes several times a week. Build up to 30 minutes of brisk exercise 5 days a week.

      9. Heart-healthy fats include:

        1. A. Saturated fats and trans fats
        2. B. Monounsaturated and polyunsaturated fats

        The correct answer is monounsaturated and polyunsaturated fats. They are found in fish, nuts, seeds, avocados, and olive, canola, corn, soy, and sunflower oils. Replacing saturated and trans fats with these healthy fats helps lower LDL and increase HDL. Omega-3s from fish help lower high triglycerides.

      10. Quitting smoking can help you:

        1. A. Increase your HDL, or "good," cholesterol by 10%
        2. B. Decrease your risk of a heart attack 24 hours after quitting
        3. C. Lower your risk of heart disease by half one year after quitting
        4. D. All of the above

        The correct answer is all of the above. Quitting isn't easy, but keep in mind that the more times you attempt to quit, the more likely you are to be successful.

  • Alternative Names
    • Lipid disorders; Hyperlipoproteinemia; Hyperlipidemia; Dyslipidemia; Hypercholesterolemia

  • Causes
    • There are many types of cholesterol. The ones talked about most are:

      • Total cholesterol -- all the cholesterols combined
      • High density lipoprotein (HDL) cholesterol -- often called "good" cholesterol
      • Low density lipoprotein (LDL) cholesterol -- often called "bad" cholesterol

      For many people, abnormal cholesterol levels are partly due to an unhealthy lifestyle. This often includes eating a diet that is high in fat. Other lifestyle factors are:

      • Being overweight
      • Lack of exercise
      Cholesterol producers

      Some health conditions can also lead to abnormal cholesterol, including:

      • Diabetes
      • Kidney disease
      • Polycystic ovary syndrome
      • Pregnancy and other conditions that increase levels of female hormones
      • Underactive thyroid gland

      Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:

      • Familial combined hyperlipidemia
      • Familial dysbetalipoproteinemia
      • Familial hypercholesterolemia
      • Familial hypertriglyceridemia

      Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.

  • Exams and Tests
    • A cholesterol test is done to diagnose a lipid disorder. Different experts recommend different starting ages.

      • Recommended starting ages are between 20 to 35 for men and 20 to 45 for women.
      • Adults with normal cholesterol levels do not need to have the test repeated for 5 years.
      • Repeat testing sooner if changes occur in lifestyle (including weight gain and diet).
      • Adults with a history of elevated cholesterol, diabetes, kidney problems, heart disease, and other conditions require more frequent testing.

      It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer doctors away from targeting specific levels of cholesterol. Instead, it recommends different medicines and doses depending on a person's history and risk factor profile.

      General targets are:

      • LDL: 70 to 130 mg/dL (lower numbers are better)
      • HDL: More than 50 mg/dL (high numbers are better)
      • Total cholesterol: Less than 200 mg/dL (lower numbers are better)
      • Triglycerides: 10 to 150 mg/dL (lower numbers are better)

      If your cholesterol results are abnormal, you may also have other tests such as:

      • Blood sugar (glucose) test to look for diabetes
      • Kidney function tests
      • Thyroid function tests to look for an underactive thyroid gland
  • Treatment
    • Steps you can take to improve their cholesterol levels, and help prevent heart disease and a heart attack include:

      • Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke. Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
      • Use low-fat toppings, sauces, and dressings.
      • Avoid foods that are high in saturated fat.
      • Exercise regularly.
      • Lose weight if you are overweight.

      Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:

      • Your age
      • Whether or not you have heart disease, diabetes, or other blood flow problems
      • Whether you smoke or are overweight
      • Whether you have high blood pressure or diabetes

      You are more likely to need medicine to lower your cholesterol:

      • If you have heart disease or diabetes
      • If you are at risk for heart disease (even if you do not yet have any heart problems)

      Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190 mg/dL.

      There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease.

  • Outlook (Prognosis)
    • High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

      Developmental process of atherosclerosis

      Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.

      Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.

  • References
    • Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

      Haney EM, Huffman LH, Bougatsos C, et al. Screening for lipid disorders in children and adolescents. Rockville, MD: Agency for Healthcare Research and Quality (US); 2007 Jul. Report No.: 07-0598-EF-1. PMID: 20722144

      Helfand M, Carson S. Screening for lipid disorders in adults: selective update of 2001 US Preventive Services Task Force Review. Rockville, MD: Agency for Healthcare Research and Quality (US); 2008 Jun. Report No.: 08-05114-EF-1. PMID: 20722146

      Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 206.

      Siu AL; U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786. PMID: 26458123

      Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-S45. PMID: 24222016

      US Preventive Services Task Force. Draft Recommendation Statement Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. Updated December 2015. Accessed July 21, 2016.