High Cholesterol

Condition Basics

What is high cholesterol?

High cholesterol means that you have too much cholesterol in your blood. Cholesterol is a type of fat (lipid). It's needed for many body functions. It's made by your body. It also comes from food you eat (meat and dairy products).

Having high cholesterol can lead to the buildup of fatty deposits called plaque (say "plak") in artery walls. This can increase your risk of coronary artery disease (CAD), heart attack, and stroke.

What causes it?

Doctors can't usually say for sure what may have caused high cholesterol. But many things can make it more likely. These things include eating too much food that contains saturated fat and having family who have or had high cholesterol.

What are the symptoms?

High cholesterol doesn't cause symptoms in most people. It's usually found during a blood test that measures cholesterol levels.

How is it diagnosed?

High cholesterol is diagnosed with a blood test. The test measures the level of total cholesterol plus the level of different types of cholesterol and fats in your blood. These include LDL, HDL, and triglycerides. High cholesterol levels don't cause symptoms. A blood test is the only way to know your cholesterol levels.

How is high cholesterol treated?

The two main types of treatment for high cholesterol are a heart-healthy lifestyle and medicines. The goal of treatment is to reduce your risk of having a heart attack or stroke.

Your doctor can help you know your risk. The doctor can also help you weigh the benefits and risks of your treatment options.

Heart-healthy lifestyle

A heart-healthy lifestyle includes:

• Eating heart-healthy foods.
• Staying at a weight that's healthy for you. Talk to your doctor if you need help losing weight.
• Being active on most days of the week.
• Not smoking or vaping.
• Managing other health problems.

Medicines

Some people decide to take medicines called statins along with having a healthy lifestyle. Statins can reduce the risk of having a heart attack or stroke. Sometimes other medicines are also used.

Plant products and supplements

Talk with your doctor before using plant products or supplements to lower cholesterol. Some plant products, such as fiber (psyllium) or red yeast rice, may help lower cholesterol. Research has not proven that these products lower the risk of heart attack and stroke. Taking some plant products or supplements together with medicines can cause problems.

What Increases Your Risk

Many things can put you at risk for high cholesterol. These include:

• Eating too much saturated fat. Saturated fat is in foods that come from animals. These foods include meats, whole milk, butter, and cheese.
• Your age and sex. After you reach age 20, your cholesterol naturally starts to rise.
• Some health conditions, such as hypothyroidism and chronic kidney disease.
• Your family history. If family members have or had high cholesterol, you may also have it.

Other things that can affect your cholesterol levels include:

• Being at a higher weight.
• Not getting much physical activity.
• Tobacco use (smoking or vaping).
• Some medicines. Some examples are thiazide diuretics, beta-blockers, estrogen, and steroids.

Prevention

A heart-healthy lifestyle can help you prevent high cholesterol and lower your risk for a heart attack and stroke.

• Eat heart-healthy foods.
  • Eat fruits, vegetables, whole grains (like oatmeal), nuts, beans, and other high-fiber foods.
  • Eat lean proteins, such as seafood, lean meats, and soy products (like tofu).
  • Eat healthy fats, such as canola and olive oil.
  • Choose foods that are low in saturated fat.
  • Limit processed and packaged foods like chips, crackers, and cookies.
  • Limit sodium and alcohol.
  • Limit drinks and foods with added sugar.
• Be as active as you can every day. For many people, walking is a good choice. Or you may want to swim, bike, or be active in other ways. Housework and yard work count too.
• Stay at a weight that's healthy for you. Talk to your doctor if you need help losing weight.
• Don't smoke or vape. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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What Happens

Having high cholesterol can lead to the buildup of fatty deposits called plaque (say "plak") in artery walls. This is called atherosclerosis. It can lead to coronary artery disease (CAD), heart attack, stroke or transient ischemic attack (TIA), and peripheral arterial disease.

Atherosclerosis can cause these problems because it may:

• Narrow your arteries. As plaque builds up, it may narrow your arteries. This happens over many years. In time, plaque may limit blood flow throughout your body, including the heart and brain.
• Harden your arteries. A healthy artery can widen so that more blood can flow through when needed, such as during activity. When hard plaque builds up in the walls of an artery, the artery may become too stiff to widen. "Hardening" of your arteries can also limit blood flow in your body.
• Block your arteries. If the plaque cracks or breaks open, a blood clot can form. This can block the artery and lead to a heart attack or stroke.

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When to Call a Doctor

High cholesterol usually has no symptoms. Sometimes the first sign that you have high cholesterol or other risk factors for heart disease is a heart attack, a stroke, or a transient ischemic attack (TIA). If you have any symptoms of these, call 911 or other emergency services.

Heart attack symptoms include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

Symptoms can vary. The most common symptom is chest pain or pressure. But females are somewhat more likely than males to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Stroke and TIA symptoms include:

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

Exams and Tests

A blood test is used to check cholesterol levels. The test measures the level of total cholesterol plus the level of different types of cholesterol and fats in your blood. These include LDL cholesterol, HDL cholesterol, and triglycerides.

When to have a cholesterol test

Doctors use guidelines to decide when you should have a cholesterol test and how often.

Checking cholesterol levels regularly may be recommended:

• Every 4 to 6 years for everyone ages 20 to 39 and more often for adults ages 40 to 75.
• For anyone who has risk factors (such as family history) for coronary artery disease, heart attack, or stroke.

How often you should get a cholesterol test also depends on your cholesterol level, other health problems, and your overall risk of heart disease.

An adult who is being treated for high cholesterol may need more frequent tests, depending on the cholesterol level and the type of treatment being used.

Children and teens

Your child's doctor may suggest a cholesterol test based on your child's age, a physical exam, or a family history of early heart disease or an inherited lipid disorder. You can ask your child's doctor if your child should have a cholesterol test.

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Treatment Overview

The two main types of treatment for high cholesterol are a heart-healthy lifestyle and medicines. The goal of treatment is to reduce your risk of having a heart attack or stroke.

Your doctor can help you know your risk. The doctor can also help you weigh the benefits and risks of your treatment options.

Heart-healthy lifestyle

A heart-healthy lifestyle includes:

• Eating heart-healthy foods.
• Staying at a weight that's healthy for you. Talk to your doctor if you need help losing weight.
• Being active on most days of the week.
• Not smoking or vaping.
• Managing other health problems.

Medicines

Some people decide to take medicines called statins along with having a healthy lifestyle. Statins can reduce the risk of having a heart attack or stroke. Sometimes other medicines are also used.

Plant products and supplements

Talk with your doctor before using plant products or supplements to lower cholesterol. Some plant products, such as fiber (psyllium) or red yeast rice, may help lower cholesterol. Research has not proven that these products lower the risk of heart attack and stroke. Taking some plant products or supplements together with medicines can cause problems.

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Self-Care

A healthy lifestyle is always important, even if you also take medicines for high cholesterol.

To care for yourself:

• Eat heart-healthy foods.
  • Eat fruits, vegetables, whole grains (like oatmeal), beans, nuts, and other high-fiber foods.
  • Eat lean proteins, such as seafood, lean meats, and soy products (like tofu).
  • Eat healthy fats, such as canola and olive oil.
  • Choose foods that are low in saturated fat.
  • Limit processed and packaged foods like chips, crackers, and cookies.
  • Limit sodium and alcohol.
  • Limit drinks and foods with added sugar.
• Be as active as you can every day. For many people, walking is a good choice. Or you may want to swim, bike, or be active in other ways. Housework and yard work count too.
• Stay at a weight that's healthy for you. Talk to your doctor if you need help losing weight. Making a plan for change, managing stress, seeing a dietitian, and tracking your food and activity can help.
• Don't smoke or vape. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Manage other health conditions, such as diabetes and high blood pressure. This can help keep your heart and body as healthy as possible. If you think you may have a problem with alcohol or drug use, talk to your doctor.
• If you take medicine, take it exactly as prescribed. Talk with your doctor if you think you are having a problem with your medicine.
• Talk with your doctor before using plant products or supplements to lower cholesterol. Some plant products, such as fiber (psyllium) or red yeast rice, may help lower cholesterol. Research has not proven that these products lower the risk of heart attack and stroke. Taking some plant products or supplements together with medicines can cause problems.

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Medicines

If you have high cholesterol, you may choose to take medicines called statins. They reduce your risk of a heart attack or stroke.

You and your doctor can work together to decide what treatment is best for you. Your doctor may recommend that you take statins if the benefits outweigh the risks.

Statins are always used along with a plan for a heart-healthy lifestyle, not instead of it.

Your doctor may talk with you about also taking a cholesterol absorption inhibitor or a PCSK9-inhibitor. These medicines can also reduce the risk of heart attack and stroke for some people.

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