Cholesterol is a waxy substance produced by the liver and found in certain foods such as meat, dairy, and tropical oils. While cholesterol is essential for many bodily functions, having too much—especially of the wrong type—can increase your risk of heart disease and stroke.

 

Types of Cholesterol

Cholesterol is necessary for building cell membranes, producing hormones like estrogen, and making vitamin D and bile acids. However, not all cholesterol functions the same. The main types include:

Low-Density Lipoprotein (LDL):
Often referred to as "bad" cholesterol, high levels of LDL can contribute to plaque buildup in your arteries, narrowing them and increasing the risk of heart attack or stroke.

High-Density Lipoprotein (HDL):
Known as "good" cholesterol, HDL helps remove LDL from the bloodstream by transporting it to the liver, where it is broken down and removed from the body.

Total Cholesterol:
This number includes your LDL, HDL, and a portion of your triglycerides—a type of fat in your blood.

Non-HDL Cholesterol:
This value equals your total cholesterol minus HDL. It includes all cholesterol that may contribute to artery buildup, such as LDL and very low-density lipoprotein (VLDL).

 

Symptoms of High Cholesterol

High cholesterol usually has no symptoms, making it difficult to detect without a blood test. However, in rare cases or genetic conditions like familial hypercholesterolemia (FH), visible signs may appear:

  • Corneal Arcus: A grey or white ring around the iris due to cholesterol deposits.

  • Xanthomas: Fatty deposits that form bumps under the skin, often on the elbows, knees, hands, or buttocks.

 

Causes of High Cholesterol

Several factors can contribute to high cholesterol levels:

  • Unhealthy Diet: Diets high in saturated and trans fats (found in fried foods, red meat, full-fat dairy, and tropical oils) can raise LDL levels.

  • Genetics: Inherited conditions like FH impair your body’s ability to process LDL cholesterol.

  • Physical Inactivity: A sedentary lifestyle may lower HDL cholesterol.

  • Smoking and Alcohol Use: These habits increase LDL and total cholesterol and may reduce HDL.

  • Chronic Stress: Elevated cortisol levels from long-term stress can raise cholesterol levels.

 

Risk Factors

Some factors increase the likelihood of developing high cholesterol:

  • Age: Cholesterol metabolism slows with age.

  • Family History: Having relatives with high cholesterol increases your risk.

  • Health Conditions: Obesity, diabetes, and metabolic syndrome are linked to unhealthy cholesterol levels.

  • Certain Medications: Some drugs, like steroids or beta-blockers, can alter cholesterol profiles.
     

 

Diagnosis

High cholesterol is diagnosed using a lipid panel, a blood test that measures:

  • LDL cholesterol

  • HDL cholesterol

  • Triglycerides

  • Total cholesterol

You may be asked to fast for several hours before the test. Normal cholesterol levels are generally:

  • HDL: ≥ 60 mg/dL

  • LDL: < 70–130 mg/dL (depending on risk factors)

  • Total cholesterol: < 200 mg/dL

 

Treatment Options

Lifestyle Changes

  • Quit Smoking: Quitting tobacco significantly lowers heart disease risk and improves cholesterol levels.

  • Eat a Heart-Healthy Diet: Increase intake of fiber-rich foods like fruits, vegetables, legumes, whole grains, and healthy fats such as olive oil and nuts. Reduce intake of saturated fats from processed meats, full-fat dairy, and fried foods.

  • Exercise Regularly: Aim for at least 150 minutes of moderate-intensity activity per week to raise HDL and lower LDL.

  • Manage Weight: Weight loss, even in small amounts, can improve cholesterol levels and reduce cardiovascular risk.

Medications

When lifestyle changes aren’t enough—or in cases of genetic high cholesterol—medications may be prescribed, such as:

  • Statins

  • PCSK9 inhibitors

  • Fibrates

  • Cholesterol absorption inhibitors (e.g., ezetimibe)

  • Bile acid sequestrants

Your healthcare provider will determine the best approach based on your individual health profile.

 

Prevention

To prevent high cholesterol, adopt and maintain heart-healthy habits:

  • Don’t smoke

  • Eat a balanced diet low in saturated fat

  • Exercise regularly

  • Limit alcohol intake

  • Get adequate sleep

  • Manage stress

Regular screenings are important. Most adults should have their cholesterol checked at least every five years, while men aged 45–65 and women aged 55–65 may need testing more frequently.

 

Potential Complications

If left untreated, high cholesterol can lead to atherosclerosis—a condition where plaque builds up in arteries, making it harder for blood to flow. This can result in:

  • Angina (chest pain)

  • Carotid artery disease

  • Heart attack

  • Peripheral artery disease

  • Stroke

 

 

A Quick Summary

Cholesterol plays essential roles in the body, but excess levels—particularly of LDL—can increase the risk of serious cardiovascular events. Because high cholesterol often presents no symptoms, regular testing is key. If your levels are high, your healthcare provider may recommend lifestyle changes, medications, or both to reduce your risk of complications and support long-term heart health