Cholesterol

What is cholesterol? 

Cholesterol is a fat-like, waxy substance produced by your body, known as blood cholesterol, and present in some foods, called dietary cholesterol. Your body uses cholesterol to aid in body functions, like building cells, making hormones, and aiding in digestion. The liver produces all the necessary blood cholesterol, so dietary cholesterol can become excessive if ingested in too high amounts. 

Cholesterol is a type of lipid, meaning cholesterol does not break down in water or in the bloodstream. Instead, cholesterol travels with the bloodstream to go to the areas of the body for proper functioning. Because cholesterol does not break down in the bloodstream, cholesterol can easily begin to build up in the body, preventing blood flow and leading to circulatory and heart problems. 

It is important to track your cholesterol levels with routine blood tests and regular doctor checkups to ensure your levels remain in a healthy range. With the right lifestyle, cholesterol is manageable and heart conditions can be prevented and your risk of other adverse conditions minimized. 

How do you measure cholesterol?

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Routine blood cholesterol tests look for cholesterol values to assess how much “good” and “bad” cholesterol are present in the bloodstream. Good cholesterol is high-density lipoprotein (HDL and helps clear your arteries and move cholesterol through the body while bad cholesterol, low-density lipoprotein (LDL), contributes to plaque and other build up in the arteries. 

The test, known as a lipid panel, detects a total cholesterol value, including more specific readings for each type of lipoprotein and fat. Your test results correspond to an overall cholesterol level as well as a cholesterol ratio that can place you in a healthy, at-risk, or dangerous level of detected cholesterol. 

Healthy levels vary with a person’s age and sex, but the following values capture the main ranges. 

Heart Healthy: Total cholesterol of less than 200, LDL cholesterol less than 100, and HDL cholesterol 60 or greater. 

At Risk: Total cholesterol of 200 to 239, LDL cholesterol of 100 to 159, and HDL cholesterol 40 to 59 for males assigned at birth or 50 to 59 for females assigned at birth. 

Dangerous: Total cholesterol of 240 or higher, LDL cholesterol of 160 or higher, and HDL cholesterol under 40 for males assigned at birth or under 50 for females assigned at birth. 

Without appropriate checks, cholesterol can build up over time without any indication. Early detection of elevated or dangerous levels of cholesterol is key to making lifestyle and diet changes to get cholesterol levels back into a healthy range to prevent potential heart conditions and other life-threatening complications.

What causes high cholesterol?

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Lifestyle factors, genetics, and medical history can all be causes of high cholesterol. 

Lifestyle: Certain aspects of your lifestyle can cause high cholesterol by decreasing good cholesterol, increasing bad cholesterol, or a combination of the two. 

  • Smoking: Smoking both raises bad LDL cholesterol and lowers good HDL cholesterol. 
  • Stress: Stress can signal to the body to produce more cholesterol. 
  • Diet: Foods high in cholesterol contribute to high cholesterol levels as does obesity. 
  • Alcohol: Regularly drinking alcohol can raise the amount of cholesterol in your body. 
  • Physical activity: A sedentary lifestyle can prevent your body from producing enough good cholesterol. Consistent physical activity can improve your good and bad cholesterol levels. 

Genetics: High cholesterol can be passed through your family’s genetics. The following conditions that cause high cholesterol are most often passed down in family lines:

  • Familial dysbetalipoproteinemia 
  • Familial combined hyperlipidemia 
  • Familial hypercholesterolemia 
  • Familial hypertriglyceridemia 

Medical Conditions: The following medical conditions can cause high levels of cholesterol:

  • Diabetes
  • Kidney disease
  • Polycystic ovary syndrome
  • Pregnancy and other hormone imbalance conditions 
  • Underactive thyroid gland or hyperthyroidism 

Medications: Some medications like birth control, diuretics, and beta-blockers can cause high cholesterol as a side effect. 

What are symptoms of high cholesterol?

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Until high cholesterol leads to adverse medical conditions, high cholesterol itself does not have traceable symptoms. Typically, the condition remains undetectable unless a person gets regular tests to monitor their cholesterol levels. High cholesterol does not impact your abilities, mental functions, or other bodily functions until enough cholesterol and plaque have built up in your arteries to cause issues like stroke or heart attack.

Are there any risk factors or groups for high cholesterol?

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Many of the same causes of high cholesterol correlate to your risk for developing high cholesterol. 

  • Lifestyle: Eating a diet high in saturated or trans fat, not exercising, smoking, and frequently consuming alcohol can all put you at a higher risk of high cholesterol. 
  • Race and ethnicity: African Americans are more likely to have higher good cholesterol than groups like Hispanic Americans who are more likely to have lower levels of good cholesterol. In contrast, Asian Americans are at a higher risk of having increased levels of bad cholesterol while non-Hispanic white people are most likely to have higher total cholesterol than other races and ethnicities. 
  • Age: People of any age can have unhealthy cholesterol levels. However, high cholesterol is most common in people older than 40. As you age, your risk for cholesterol issues continues to rise. 
  • Sex: Males assigned at birth and females assigned at birth have differing risks for developing high cholesterol. As both age, risk generally increases. Men tend to have a greater risk of higher total cholesterol while women experience a higher risk of having an imbalance of good and bad cholesterol. 
  • Health conditions: A variety of medical conditions put a person at a higher risk of high cholesterol. These conditions include diabetes, HIV, hypothyroidism, lupus, kidney disease, obesity, sleep apnea, and polycystic ovary syndrome (PCOS).
  • Family history: Your family’s genetic history of high cholesterol greatly impacts your risk. If high cholesterol runs in your family, you are more likely to develop high cholesterol yourself.
  • Medications: Some medications like beta-blockers, diuretics, steroids, retinoids, or chemotherapy can put you at a higher risk of imbalanced good and bad cholesterol.

How is high cholesterol diagnosed?

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High cholesterol is diagnosed during a routine blood cholesterol test. Since high cholesterol has no symptoms, your doctor will assess your risk factors for high cholesterol and consider other health information such as your medical history and current medications. After a health history review, your doctor may order a lipid panel test to identify your cholesterol levels. 

Your doctor will interpret your cholesterol levels and be able to diagnose high cholesterol based on your results. In determining your cholesterol level, your doctor may also conduct follow up tests or exams if your levels indicate other potential conditions.

How is high cholesterol treated?

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Medication and lifestyle changes are two main treatments that can help lower your cholesterol. 

Medication: 

Statins are the most common type of medication doctors prescribe to manage cholesterol. Statins work by preventing the liver from producing cholesterol to allow your body to remove the cholesterol already present. Examples of prescription statins include:

  • Fluvastatin (Lescol)
  • Lovastatin (Altoprev) 
  • Atorvastatin (Lipitor) 
  • Pravastatin (Pravachol) 
  • Rosuvastatin (Crestor) 
  • Simvastatin (Zocor)

Lifestyle changes: 

Exercise and diet are two key areas to make heart-healthy changes to lower your cholesterol, prevent heart complications, and improve your overall health. Regular exercise can help your body regulate cholesterol production and keep your body at a moderate weight to avoid complications from obesity. In addition, establishing healthy sleep habits, quitting smoking, and reducing stress all contribute to lowering cholesterol. 

A heart-healthy diet is essential to limiting your intake of foods high in cholesterol while you work to manage your body’s cholesterol levels. A dietary approach to treating high cholesterol should keep the following guidelines in mind. 

  1. Eat foods high in fiber. Look for whole grains; fiber-rich fruits, such as apples, oranges, and bananas; and legumes. 
  2. Monitor cholesterol intake. Cholesterol is highest in foods that come from animals, like eggs, meats, and dairy products. Be mindful of your choices to avoid too much cholesterol. 
  3. Incorporate foods high in omega-3 fatty acids. Fatty acids aid in the production of good cholesterol and help prevent certain heart-related conditions. 
  4. Get familiar with nutritional labels. Reading nutrition labels can help you identify foods you like that are low in cholesterol and a good source of helpful elements like fiber or fatty acids.

Should you see a doctor for high cholesterol?

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You should see a doctor regularly if you have a family history of high cholesterol or if you have previously had or currently have high cholesterol. Routine cholesterol checks based on your risk factors can help you manage your cholesterol levels and prevent more dangerous heart conditions. 

Together with your doctor, you can develop an effective treatment plan that will help you lower your cholesterol into a healthier range. High cholesterol can only be detected with a test, so it is important to visit your healthcare provider.

What is the outlook for people living with high cholesterol?

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With effective treatment, you can minimize the worst effects of high cholesterol and bring your levels down to have a positive outlook. However, high cholesterol can lead to the hardening of the arteries and create a buildup of plaque in the arteries, threatening proper heart and circulatory functions. Impaired heart and artery function can result in disease or stroke. There are proactive measures you can take to get ahead of these possible effects of high cholesterol with the help of your healthcare provider.

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