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High Cholesterol Levels (Hypercholesterolemia)
Updated on November 28, 2022
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High Cholesterol Levels (Hypercholesterolemia)

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: 

  • Low-density lipoprotein (LDL) cholesterol - also known as “bad cholesterol,” this is the type of cholesterol that can cause plaque build-up in arteries and contribute to the hardening and narrowing of these arteries (atherosclerosis).
  • High-density lipoprotein (HDL) cholesterol - also known as “good cholesterol,” this is the type of cholesterol that binds to cholesterol in the blood and carries it to the liver, where it’s broken down and eliminated.

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 

What Is High Cholesterol?

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  

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Signs of High Cholesterol Levels

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:

  • Familial hypercholesterolemia (a genetic disorder that causes high cholesterol levels)
  • Diabetes
  • Liver disease 
  • Hypothyroidism (underactive thyroid)

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

High Cholesterol Risk Factors

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 

  • Lack of exercise
  • Being overweight and obese
  • Eating a diet high in trans and saturated fats
  • Smoking
  • Type 2 diabetes
  • Excess alcohol consumption

Certain diseases and conditions can cause high cholesterol as well as hypothyroidism, kidney disease, and diabetes.1

How To Test For High Cholesterol

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:

  • Total cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides

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.

What Is Considered A High Cholesterol Level?

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

Total Cholesterol:

  • Optimal: under 200 mg/dL
  • Borderline high: 200 to 239 mg/dL
  • High: 240 mg/dL and higher

LDL Cholesterol:

  • Optimal: under 100 mg/dL
  • Near optimal: 100 to 129 mg/dL
  • Borderline high: 130 to 159 md/dL
  • High: 160 to 189 mg/dL
  • Very high: 190 mg/dL or higher

HDL Cholesterol:

  • Low: less than 40 mg/dL 
  • Normal: 40 to 59 mg/dL
  • High: 60 mg/dL or higher

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

  • Age (45 years or older for men, 55 years or older women)
  • Family history of heart disease
  • High blood pressure
  • Diabetes 
  • Smoking
  • Low HDL cholesterol levels (less than 40 mg/dL for men, less than 55 mg/dL for women)

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.

What To Do If You Have High Cholesterol

If your cholesterol level is high, there are many different treatment options including lifestyle changes and medications. 

Lifestyle Changes

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

  • Avoiding trans fats found in fried foods like french fries, baked goods including cakes and pies, and margarine
  • Limiting the amount of saturated fat you eat. Saturated fats are found in butter, fatty cuts of meat, and cheese
  • Eating a diet high in fiber, fruits and vegetables, and fatty fish
  • Exercising for at least 150 minutes a week at a moderate intensity 
  • Quitting smoking
  • Limiting your alcohol consumption
  • Losing weight 
  • Managing stress

Medications

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:

  • Statins - These drugs reduce how much cholesterol the liver makes. Lipitor (atorvastatin) and Zocor (simvastatin) are two commonly-prescribed statins.
  • Drugs that block cholesterol absorption - These limit the absorption from your diet such as Zetia (ezetimibe)
  • Bile acid-binding resins - These prevent cholesterol from being reabsorbed from the gut 
  • PCSK9 inhibitors - These drugs work by increasing the breakdown of cholesterol in the liver.
  • Bempedoic acid (Nexletol) - This is a relatively new drug that works similarly to statins. It’s often used in combination with Zetia (ezetimibe).

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.

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Updated on November 28, 2022
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7 sources cited
Updated on November 28, 2022
  1. Hypercholesterolemia” StatPearls
  2. Hypertriglyceridemia” StatPearls 
  3. Is a High HDL-Cholesterol Level Always Beneficial?” Biomedicines
  4. Physiology, Cholesterol” StatPearls 
  5. Hypertension from the patient’s perspective” British Journal of General Practices
  6. Cholesterol screening” StatPearls
  7. 7. “Cholesterol levels” StatPearls
Dr. Rizza Mira
Dr. Rizza Mira
Medical Reviewer
Dr. Rizza Mira is a medical doctor and a general practitioner who specializes in pediatrics, nutrition, dietetics, and public health.

As a pediatrician, she is dedicated to the general health and well-being of children and expecting parents. She believes that good nutrition, a healthy lifestyle, and prevention of illness are key to ensuring the health of children and their families.

When she’s not in the hospital, Rizza advocates and mobilizes causes like breastfeeding, vaccination drives, and initiatives to prevent illness in the community.
Will Hunter
Will Hunter
Content Contributor
Will is a content writer for KnowYourDNA. He received his B.A. in Psychology from the University of California, Los Angeles. Will has 7 years of experience writing health-related content, with an emphasis on nutrition, alternative medicine, and longevity.
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