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Cholesterol is a waxy, fat-like substance (lipid) made by the liver that plays many essential roles in the body. It’s a key component in cell membranes, helps digest fats, and is a necessary ingredient in important hormones like vitamin D and testosterone.1
“The body makes cholesterol in amounts the body needs. But food sources like eggs, cheese, milk, and meat contribute to this,” says our in-house expert, Dr. Rizza Mira.
There are two main types of cholesterol found in the blood:
A third type of protein called very low-density lipoprotein (VLDL) also exists in the blood and mainly transports triglycerides as well as some cholesterol. Triglycerides are a type of fat found in the blood.
“The body needs low levels of VLDL. In excess, they contribute to plaque build-up. That’s why VLDL is also considered to be “bad cholesterol,” says Dr. Mira.
High levels of LDL cholesterol and triglycerides increase your risk for heart disease and stroke.1, 2
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High cholesterol, or hypercholesterolemia, typically refers to high LDL cholesterol levels.
High cholesterol may also sometimes refer to high total cholesterol. Total cholesterol is simply your HDL, LDL, and VLDL cholesterol levels combined.
Having a high HDL cholesterol level by itself is generally not an issue but can be dangerous if your levels become very high (above 90 mg/dL).3
Many people with high cholesterol also have high levels of triglycerides.
Over time, high cholesterol and triglyceride levels can increase your risk for heart disease by contributing to fatty plaques that build up in the walls of your blood vessels. This causes the blood vessels to narrow and harden (atherosclerosis). Eventually, these plaques may rupture, block blood vessels, and cause heart attacks or strokes.1
Cholesterol makes up a lot of vital parts of our bodies, such as cell walls and even important vitamins. However, having a high cholesterol level (specifically low-density lipoprotein (LDL) cholesterol) or a high amount of every kind of cholesterol can increase your risk for heart disease and stroke.
In most cases, there are no signs or symptoms of high cholesterol. This means there is no way to “feel” high cholesterol. A blood test is the only way to tell if you have high cholesterol.
“High cholesterol is a silent disease. Its most dreaded complication is stroke, heart attack, or even sudden death,” says Dr. Mira.
People with extremely high cholesterol levels may develop cholesterol-rich deposits under the skin called xanthomas. These typically form around the joints, eyes, hands, and feet. Conditions associated with xanthomas include:
Instead, you may notice symptoms caused or aggravated by high cholesterol, such as high blood pressure. If your blood pressure is very high, you may experience headaches, chest pain, fatigue, and problems with your vision.5
Certain factors can put you at an increased risk of high cholesterol. Some of these risk factors are not under your control, such as your age, your sex, or even a family history of high cholesterol.2
However, most of these factors are within your control.
Lifestyle factors that increase your risk of high cholesterol include:2
Certain diseases and conditions can cause high cholesterol as well as hypothyroidism, kidney disease, and diabetes.1
The only way to test for high cholesterol is by performing a lipid panel. A lipid panel is a group of tests which also measures your cholesterol and triglycerides. The specific tests include:
A lipid panel requires a blood draw which is usually performed at a medical clinic, hospital, or laboratory. Your doctor may ask you to fast for nine to 12 hours before drawing your blood.
The National Cholesterol Education Program (NCEP) is an expert panel of doctors and scientists that has created evidence-based guidelines to help doctors diagnose and treat high cholesterol levels.6
These guidelines are as follows:7
Doctors will use your lipid panel results as well as take into account any heart disease risk factors you have when deciding whether to treat your high cholesterol levels. This information also helps them determine which course of treatment is best.
Major heart disease risk factors include:1
If you have borderline high cholesterol levels and one or more of these risk factors, your doctor may be more diligent in lowering your levels in comparison to someone without any risk factors.
If your cholesterol level is high, there are many different treatment options including lifestyle changes and medications.
Your doctor may first advise you to make certain lifestyle changes before prescribing medications.
In people with slightly elevated cholesterol, these changes are often enough to bring high cholesterol levels down to a healthy level.1
Steps you can take to help lower or prevent high cholesterol include:1
If lifestyle changes alone cannot lower your cholesterol, your doctor may prescribe certain medications to help lower it. It’s important to note that these medications are not meant to be a replacement for making healthy lifestyle changes.
“The choice of medication will also depend on not only the results of the lipid panel but also from liver, kidney, or heart function tests,” says Dr. Mira.
Medications used to treat high cholesterol include:
If your triglycerides are high, your doctor may also prescribe fibrates (drugs that lower triglycerides), niacin (vitamin B3), or omega-3 fatty acids.
If your cholesterol levels are high, your doctor may test your levels more frequently to see how you are progressing or responding to treatment.
High cholesterol isn't the end of the world. You're on the right track as long as you make appropriate lifestyle changes and get active. If you need medical intervention, your doctor will put you through a lipid panel to see what may work best for you medication-wise.
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