Everything You Need To Know About High Cholesterol

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High cholesterol, or hyperlipidemia, refers to an above-normal level of cholesterol circulating in the blood. Cholesterol is a fatty substance that your liver and intestines produce to build cells and help with functions such as hormone production and digestion. You only need the amount your body produces, but factors such as diet and genes can cause your body to make more cholesterol than it needs.

Nearly 40% of adults in the U.S. have high cholesterol. Among U.S. children ages 6-19, almost 7% have high cholesterol.

Having high cholesterol increases your risk of developing serious health problems over time. Fortunately, you can take steps to prevent too much cholesterol from flowing through your blood. If you already have high cholesterol, making certain lifestyle changes or taking medication may help lower it. 

High Cholesterol Symptoms

High cholesterol itself usually doesn't have any symptoms. Instead, you may eventually experience symptoms from complications of the condition.

Over time, excess cholesterol joins with other substances to form thick deposits called plaque on the inside of arteries. This build-up is a condition called atherosclerosis. The build-up in the arteries can form clots, which may block blood flow to the heart, brain, and tissues in the arms and legs.

Your exact symptoms will depend on the location of the artery that's blocked, but in general a blocked artery may cause:

In rare instances, people with high cholesterol may develop soft, yellowish cholesterol deposits on the skin called xanthomas. Another sign of high cholesterol may be found in your eye. Some children with high cholesterol may have arcus juvenilis, which is a light gray or blueish ring made of mostly cholesterol around their iris.

How Is High Cholesterol Diagnosed?

The only way to diagnose high cholesterol is through a blood test called a lipid panel. A healthcare provider will draw a sample of blood from your arm or finger. This test may require fasting beforehand for up to 12 hours. 

The blood test measures several aspects of your blood, including your blood's levels of two types of lipoproteins, which are proteins that carry cholesterol throughout the body. A lipid panel will reveal the following numbers relating to your cholesterol:

  • Low-density lipoprotein (LDL): This is often called the “bad” cholesterol because it’s the type that forms plaque inside the arteries. Levels should be below 100 milligrams per deciliter (mg/dL).
  • High-density lipoprotein (HDL): Referred to as the “good” cholesterol, this type moves extra cholesterol to your liver so that it can rid your body of it. Optimal levels are at least 40mg/dL for men and at least 50mg/dL for women.
  • Triglycerides: Theses are another type of fat in the blood that can thicken artery walls. Your triglycerides should be below 150mg/dL.
  • Total cholesterol: This is the amount of cholesterol circulating in your blood. The level is determined by the following formula: HDL+LDL+20% of your triglycerides.

Healthcare providers will generally diagnose you with high cholesterol if your total cholesterol number is above 240mg/dL. A level of 200mg/dL to 239mg/dL is considered borderline high.

What Causes High Cholesterol?

High cholesterol occurs when too much cholesterol circulates in the blood. This can happen for reasons within your control, such as lifestyle choices, or outside of your control, like family history.

Lifestyle choices include smoking, which can lower HDL, and not exercising, which can lead to weight gain and, in turn, a subsequent rise in LDL.

Eating foods high in trans fats and saturated fats also contributes to high cholesterol by increasing the liver's production of LDL. Examples of foods high in trans fats include:

  • Fried foods
  • Some meats, such as bacon and sausage
  • Dairy products, such as cheese and ice cream
  • Butter
  • Baked goods

Sometimes the development of high cholesterol is out of your control. Some people have an inherited condition called familial hypercholesterolemia, which impacts the body’s ability to get rid of cholesterol. These people have high cholesterol at birth. Other people aren’t born with high cholesterol but are at higher risk for developing it because it runs in their family.

Additional risk factors of high cholesterol include:

  • Aging
  • Being a woman who's gone through menopause
  • Having certain conditions like type 2 diabetes or kidney disease
  • Taking certain medications, such as beta blockers and certain birth control pills

Treatments for High Cholesterol

High cholesterol treatments aim to lower levels of LDL and triglycerides in your blood. A healthcare provider will likely discuss two options: making lifestyle changes and taking medication.

Lifestyle Changes

Because some lifestyle decisions often contribute to high cholesterol, combating the condition often means reversing those habits and creating new ones. A healthcare provider may suggest:

  • Reducing your intake of foods containing trans and saturated fats (and replacing them with healthful choices such as fruits and veggies)
  • Exercising 
  • Quitting smoking
  • Losing weight if you are overweight

Prescription Medications

On top of lifestyle changes, your healthcare provider may recommend medication. This is more likely if you:

  • Have had a heart attack or stroke
  • Have an LDL level of at least 190mg/dL
  • Are 40–75 years old, have an LDL cholesterol level of at least 70mg/dL, and have diabetes or a high risk of heart disease or stroke

The most commonly prescribed and effective cholesterol-lowering drugs are statins, which slow down the liver's production of cholesterol and increase the organ's ability to remove cholesterol from blood. It's rare for people to have side effects from statins, but the medications carry a risk of developing muscle aches, diabetes, or stroke.

If you and a healthcare provider decide against statins or opt for another medication to take in addition to a statin, you may be prescribed:

  • Zetia (ezetimibe), which prevents the intestine from absorbing cholesterol
  • Bile acid sequestrants, which help the intestine get rid of more cholesterol
  • PCSK9 inhibitors, which work in the liver to lower the amount of LDL
  • Adenosine triphosphate-citrate lyase (ACL) inhibitors, which work in the liver to block cholesterol

Your healthcare provider may also prescribe medications to reduce triglyceride levels, such as fibrates and the B vitamin niacin.

How to Prevent High Cholesterol

You might be able to prevent high cholesterol by making decisions that won’t increase cholesterol production in the body. Limiting foods with saturated and trans fats is one way to keep cholesterol levels low, as is eating foods high in fiber, which may help to control LDL while boosting HDL. Avocados, nuts, and olive oil are examples of fiber-rich foods.

Other lifestyle choices that can prevent high cholesterol include:

  • Keeping your weight at an optimal level
  • Exercising regularly
  • Not smoking
  • Limiting alcohol

You can also prevent high cholesterol by getting regular lipid panels, which can alert you to take steps to lower cholesterol before it jumps to a concerning level. It's recommended that most adults check cholesterol every four to six years but that people who have heart disease, diabetes, or a family history of high cholesterol have it tested more often. Children should have their cholesterol checked between the ages of 9 and 11 and again between ages 17 and 21.

For some people, cholesterol-friendly lifestyle choices still won’t prevent cholesterol from rising. If numbers increase despite preventative measures, a healthcare provider can determine next steps, such as taking cholesterol-lowering medication.

Related Conditions

High cholesterol can lead to plaque build-up in arteries, blocking crucial blood flow to organs and tissues. This raises the risk of developing the following serious medical conditions over time:

  • Coronary artery disease: This is when the blockage occurs in the coronary arteries, which supply blood to the heart. The disease can be chronic or acute, which is when it comes on suddenly in the form of a heart attack.
  • Carotid artery disease: In this condition, there's a blockage of blood flow through the carotid artery, which runs to the brain and head. This can cause a stroke.
  • Peripheral artery disease: This happens when there’s decreased blood flow through the peripheral articles, which move blood to the arms and legs.

Living With High Cholesterol

If left untreated, high cholesterol can continue to cause plaque buildup inside your arteries. As you live with untreated high cholesterol, your risk of developing a life-threatening condition increases with time.

Researchers have found that people at age 55 who had borderline high cholesterol for 11 to 20 years doubled their risk of heart disease compared to people who had a maximum of 10 years of high cholesterol.

The good news is that changing your habits and taking cholesterol-lowering medication can effectively lower cholesterol levels, reducing your risk of developing life-threatening conditions. You can't completely reverse plaque buildup caused by high cholesterol, but with treatment it's possible to shrink it and prevent more plaque from accumulating.

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