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Learn about high cholesterol

Cholesterol is a fatty, waxy substance that serves multiple functions within the human body. It serves a purpose in building certain hormones, cell membranes, and bile production.

It’s a common misconception that cholesterol is bad for the body. Cholesterol is actually crucial as a building block for many bodily functions. Too much of a good thing, though, can be harmful -- high cholesterol levels can cause multiple heart health-related issues, such as heart attacks and heart disease. It can build up along blood vessel walls, causing them to harden and become clogged.

Generally speaking, an ideal total cholesterol level should be lower than 200. However, the values of HDL and LDL are even more important. These abbreviations refer to lipoproteins, which are packages of cholesterol and protein that travel through the blood on their way to parts of the body that need them. High-density lipoprotein (HDL) removes excess cholesterol from the body in a process called reverse cholesterol transport. Consider it a clean-up crew that ensures that cholesterol in the blood stays at a healthy level. Low-density lipoprotein (LDL) is made up mostly of cholesterol and is responsible for transporting it to parts of the body in need. Too much of this, however, can lead to clogged arteries (atherosclerosis).

Ideally, men & those with male gender at birth should maintain an HDL of at least 40mg/dL, while women & those with female gender at birth should maintain a level of at least 50mg/dL. LDL levels less than 100mg/dL are ideal for most adults, while those with a history of heart disease are most protected if they keep it less than 70mg/dL.

High cholesterol causes

High cholesterol is caused by many factors. Genetics, lifestyle choices, and health conditions can all contribute to high cholesterol.

Unhealthy diet: A diet high in saturated and trans fats can lead to high cholesterol. Saturated fats are found in animal products such as red meat, butter, and cheese. Trans fats are found in processed foods such as crackers, cookies, and margarine. Dietary cholesterol, like that found in eggs, is generally no longer considered harmful.
Lack of exercise: Physical inactivity can lead to high bad cholesterol (LDL) as well as low good cholesterol (HDL). Exercise is, in fact, the best way to increase your HDL. A sedentary lifestyle combined with an unhealthy diet, on the other hand, can be a recipe for disaster.
Smoking: Smoking damages and hardens the lining of your arteries, leading to a much higher chance of cholesterol-induced plaque buildup (atherosclerosis).
Age and gender: Your cholesterol levels rise as you age. Men are also more likely than women to have high cholesterol.
Being overweight: Excess weight can raise your cholesterol levels.
Family history: Genetics can play a large role in determining how much cholesterol your body makes. Sometimes, family lineages can even pass on Familial Hypercholesterolemia (FH), a condition in which the body produces a huge excess of it. FH isn’t curable, but it can be well managed with your doctor to get levels back into a normal range.

Symptoms of high cholesterol

Often, high cholesterol doesn't cause symptoms, so it's important to get your cholesterol checked regularly. If you have high cholesterol, you may eventually develop hardening of the arteries (atherosclerosis). This condition can lead to heart disease, heart attack, or stroke.

If you have atherosclerosis, you may experience:

Chest pain or discomfort (angina)
Pain in your legs when walking (intermittent claudication)
Heart attack
Stroke

How to treat high cholesterol

If you have high cholesterol, there are lifestyle changes and medications you can take to lower your cholesterol and reduce your risk of heart disease, heart attack, and stroke.

Lifestyle Changes

Making healthy lifestyle choices is the first step in treating high cholesterol. These include:

Eating a healthy diet
Exercising regularly
Quitting smoking
Reducing stress

Dietary Changes

Eating a healthy diet is one of the most important things you can do to lower your cholesterol. A healthy diet includes:

Plenty of fruits, vegetables, and whole grains
Lean protein, such as fish, chicken, and tofu
Low-fat or non-fat dairy products
Healthy fats, such as olive oil, nuts, and avocados

Exercise

Regular exercise can help lower cholesterol, increase the percentage of HDL, and reduce heart disease risk. Exercise has many other benefits as well, including:

Weight loss
Lower blood pressure
Improved circulation
Reduced stress levels

Medications

If lifestyle changes alone aren't enough to lower your cholesterol, your doctor may prescribe cholesterol medication. One common medication is a medicine called statins. Other common cholesterol-lowering medications include:

Niacin
Fibrates
Bile acid sequestrants
Cholesterol absorption inhibitors
Probucol (rarely used)
PCSK9 inhibitors (newer class of drugs)

High cholesterol medications

Statins

Statins are the most common type of cholesterol-lowering medication. They work by inhibiting an enzyme in your liver that is needed to produce cholesterol. Statins can be very effective in lowering LDL ("bad") cholesterol and may also help raise HDL ("good") cholesterol. Common statins include:

Lipitor (Atorvastatin)

Fluvastatin (Lescol)

Zocor (simvastatin) Rosuvastatin (Crestor)

Niacin

Niacin is a vitamin that can also be used to lower cholesterol. It works by inhibiting the liver's ability to make cholesterol. Niacin is available in an over-the-counter (OTC) supplement and in prescription form. Common prescription niacin products include:

Niaspan

Advicor

Simcor

TriCor

Fibrates

Fibrates are a type of medication that lowers triglycerides and can also raise HDL cholesterol. Common fibrates include:

TriCor

Gemfibrozil (Lopid)

Clofibrate (Atromid-S)

Bile acid sequestrants

Bile acid sequestrants are a type of medication that binds to bile acids in the intestines, preventing them from reabsorbing. This causes the liver to make more bile acids, which lowers cholesterol levels. Common bile acid sequestrants include:

Cholestyramine (Prevalite)

Colestipol (Colestid)

Cholesterol absorption inhibitors

Cholesterol absorption inhibitors are a type of medication that inhibits cholesterol absorption from the intestines. Common cholesterol absorption inhibitors include:

Ezetimibe (Zetia)

Probucol

Probucol is a medication that was once commonly used to lower cholesterol. Probucol works by inhibiting the liver's ability to make cholesterol and increasing cholesterol excretion from the body.

PCSK9 Inhibitors

PCSK9 Inhibitors are a new class of drugs that work by inhibiting a protein that causes LDL cholesterol to be reabsorbed into the bloodstream. PCSK9 inhibitors are injectable medications used in addition to statins in people who cannot get their LDL cholesterol levels low enough with statins alone. Common PCSK9 inhibitors include:

Evolocumab (Repatha)

Alirocumab (Praluent)

When to see a doctor for high cholesterol

You should generally have your cholesterol checked via lab tests every 4 to 6 years starting at age 20. You may need to be checked more often if you have a family history of high cholesterol or heart disease. You may also need to be checked more often if you have other risk factors for heart disease, such as diabetes, high blood pressure, or obesity.

Your doctor will help you understand what is known as your 10-year ASCVD (atherosclerotic cardiovascular disease) risk, which combines possible risk factors into an estimate of heart attack or stroke risk within 10 years. It can serve as a guide as to what types and to what intensity cholesterol treatment may be needed.

High cholesterol treatment FAQs

What are the symptoms of high cholesterol?

There are no symptoms of high cholesterol. Only a blood test called a lipid panel can reveal whether you have elevated cholesterol levels. According to the American Heart Association, people aged 20 years or older should have their cholesterol levels checked every four to six years.

Can an online doctor treat high cholesterol?

Yes, an online doctor may refer you to lipid testing and afterward discuss your lab test results with you. If you have elevated cholesterol levels or have previously been diagnosed with high cholesterol, the clinician will work with you to establish a treatment strategy. This may include changes to your diet and lifestyle, and potentially may include cholesterol-lowering medication.

How is high cholesterol treated?

Short of or alongside medications, high cholesterol is usually treated with a combination of lifestyle modifications and medication. Dietary changes include: reducing saturated fats while increasing fiber intake, fruits, and vegetables.

Exercise for at least 30 minutes daily, don't smoke or drink alcohol excessively, and reduce stress as much as possible. Physicians can also prescribe medications such as statins to help lower cholesterol. In some cases, other drugs may be necessary.

What medications are used to treat high cholesterol?

Crestor, Rosuvastatin, Lipitor, TriCor, and Lovastatin are examples of common high cholesterol medications that our medical team prescribes.

Step 1

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Step 2

Talk to your medical provider regarding your high cholesterol symptoms.

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Step 3

If prescribed, pick up prescription for high cholesterol treatment.

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Related conditions to high cholesterol

High cholesterol can cause several related conditions, including:

Atherosclerosis

Coronary heart disease

Heart attack

Stroke

If you have any of these conditions, it is important to talk to your medical team about ways to lower your risk of developing them.

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