High cholesterol, also known as hypecholesterolemia, is an extremely common condition in the United States. Cholesterol is a waxy, fat-like substance that your body needs to function properly, but high levels can be damaging to your health.
There are a few different types of fats (lipids) that your body maintains a fine balance of, including high-density lipoprotein (HDL, or “good cholesterol”) and low-density lipoprotein (LDL, or “bad cholesterol.”) High LDL and low HDL levels increase your risk of cardiovascular diseases, including heart attack and stroke.1
This article will discuss who is more likely to develop high cholesterol, the associated risk factors, and how it’s diagnosed. Fortunately, for many people, high cholesterol can be prevented with lifestyle changes. For those who can’t lower their cholesterol on their own, medications are available to help.
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What Causes High Cholesterol?
If you’re living with high cholesterol levels, you’re not alone. In fact, over 93 million Americans over the age of 20 have high cholesterol.2 There are certain risk factors that increase your chances of having high cholesterol levels. Some of these you can control, while others you can’t. Your doctor can help you better understand which risk factors may be contributing to your elevated cholesterol.
Age
While high cholesterol levels can affect children and teenagers, they’re more likely to be diagnosed in older adults between the ages of 40 to 59. The older you are, the harder your liver has to work to remove “bad cholesterol” from your bloodstream. This can cause your cholesterol levels to slowly rise over time.3
Sex
Sex can also play a role in your high cholesterol risk. Men are at a greater risk for high cholesterol between the ages of 20 to 39. On the other hand, the risk for women increases after menopause, typically between the ages of 45 to 55. This is because menopause reduces the amount of estrogen and progesterone in a woman’s body — these hormones usually protect against high LDL cholesterol. Some women also see their HDL cholesterol levels decrease.3
Race or Ethnicity
According to the National Heart, Lung, and Blood Institute (NHLBI), certain racial and ethnic groups are at a higher risk of high cholesterol levels, including:3
- African Americans: While African Americans are more likely to have high levels of “good cholesterol,” they’re also more likely to have other risk factors, including diabetes, high blood pressure, and obesity — and all of these increase the risk of high “bad cholesterol” levels.
- Non-Hispanic white people: This group is more likely than others to have high levels of total cholesterol (HDL, LDL, and triglycerides)
- Hispanic Americans: Hispanic Americans are more likely than others to have lower levels of “good cholesterol.”
- Asian Americans: This group, in particular people who are of Japanese, Vietnamese, Indian, and Filipino descent, is more likely to have high levels of “bad cholesterol” compared to other racial and ethnic groups.
Family History
Your genes play a large part in your risk of developing certain conditions, including high cholesterol. Some genes may cause familial hypercholesterolemia, which increases your LDL levels to an unhealthy amount. Even with proper diet and exercise, people with familial hypercholesterolemia still have high cholesterol. Most of them need medications to control it properly.4
Other Medical Conditions
If you have one or more medical conditions, your chances of other health complications increase. Some conditions are associated with increased cholesterol levels, especially those associated with other cardiovascular issues. These include:
- Being overweight or obese: Many people who are overweight or obese have high cholesterol levels due to poor diet and lack of exercise. This also increases the chance of developing sleep apnea, diabetes, and other metabolic disorders that affect cholesterol.5
- Diabetes: People with diabetes tend to have higher LDL and triglyceride levels, and lower HDL levels. Type 2 diabetes is also associated with insulin resistance, which occurs when your cells can no longer use insulin to take up sugar for fuel. This resistance is associated with dysfunctional LDL particles and cardiovascular complications.6
- Polycystic ovarian syndrome (PCOS): PCOS is also associated with insulin resistance and obesity, increasing the risk of high cholesterol. Women with this condition also tend to have extra abdominal fat, which may lower HDL levels and raise triglycerides.7
- Systemic lupus erythematosus (SLE): Lupus is an autoimmune condition that causes widespread inflammation, affecting joints, skin, kidneys, and heart. Inflammation also interferes with your body’s cholesterol metabolism, which may raise your LDL levels. Certain medications used to treat lupus can also affect your cholesterol levels.8
Taking Certain Medications
All medications come with side effects, and some can affect your cholesterol levels. Different prescription drugs may increase your “bad cholesterol” levels, while others may lower your “good cholesterol” levels. These medications may throw off your body’s cholesterol balance, increasing your chances of health complications.
It’s important to note that just because you take one or more of these medications doesn’t mean you’ll experience side effects.
Medications that may affect your cholesterol levels include:
- Diuretics: Diuretics help your body get rid of extra water, treating high blood pressure and swelling (edema). These medications may raise your LDL cholesterol and total cholesterol levels.9
- Corticosteroids: Corticosteroids are drugs that treat inflammation in several autoimmune diseases. Studies show that they can raise your LDL and lower your HDL cholesterol levels within weeks of beginning treatment. For this reason, many doctors only prescribe corticosteroids short-term.10
- Beta-blockers: Beta-blockers lower high blood pressure by relaxing your blood vessels. While they’re typically prescribed to treat heart disease (which is caused by high cholesterol), they can reduce your HDL levels.11
- Immunosuppressive medications: Immunosuppressants are used to dampen inflammation created by your immune system to treat autoimmune diseases and prevent organ rejection after a transplant. Research shows that some medications, such as cyclosporine, can raise your LDL levels.9
- Protease inhibitors: Protease inhibitors treat human immunodeficiency virus (HIV) infection by blocking the virus from hijacking your cells — this prevents it from replicating. Researchers have found that newer protease inhibitors may raise cholesterol levels.9
- Amiodarone: Amiodarone treats abnormal heart rhythms (arrhythmias) caused by faulty electrical signals in the heart muscle. Amiodarone may raise LDL cholesterol levels, but it doesn’t appear to affect HDL levels.9
- Chemotherapy: Chemotherapy is a type of cancer treatment that targets and kills rapidly dividing cells in the body. Studies show that some cancer patients who receive chemotherapy see an increase in their LDL cholesterol, total cholesterol, and triglyceride levels.12
Lifestyle Choices
Your habits and lifestyle choices also play a large role in affecting your cholesterol levels and overall health. These include:
- Smoking: Smoking tobacco damages your blood vessels, raises your LDL cholesterol levels, and lowers your HDL levels (particularly in women).13
- Eating an unhealthy diet: Diets that are high in saturated fats (typically in animal products such as full-fat dairy and red meats) can raise LDL levels.14
- Excess alcohol consumption: Drinking too much alcohol is associated with an increase in blood pressure, LDL cholesterol, and triglyceride levels. Drinking alcohol may also contribute to excess abdominal fat, which can affect cholesterol levels and put you at risk of heart disease.15,16
- Lack of exercise: Exercise helps your body get rid of extra cholesterol by increasing your HDL levels. Your HDL levels may be too low without the proper amount of physical activity.17
- Stress: Stress releases cortisol, a natural hormone similar to corticosteroid drugs. Studies have found that stress can raise LDL cholesterol levels and triglycerides while lowering HDL levels.18
High Cholesterol Symptoms
Typically, there are no direct physical symptoms of high cholesterol. Most people don’t know that they have high cholesterol until they have routine bloodwork done at their doctor’s office. However, those with familial hypercholesterolemia tend to have extremely high LDL levels that can cause some physical signs, including:4
- Painful, swollen Achilles tendon (the cord that connects your calf muscle to your heel)
- Yellow-colored areas around your eyes
- Bumps caused by an accumulation of fat around your feet, knees, hands, elbows, or buttocks, known as xanthomas
- Gray-colored rings that look similar to half-moons around the colored parts of your eyes (cornea), known as corneal arcus
Your doctor may also suspect you have familial hypercholesterolemia if you have a family history of the condition, early heart disease, or heart attacks.
How Does High Cholesterol Affect Your Body?
Over time, high cholesterol levels may cause a condition known as atherosclerosis — or the buildup of fatty deposits (plaques) in your arteries. Your arteries are blood vessels that are responsible for transporting oxygen-rich blood from your heart to other parts of your body.19 Plaques are sticky and collect cholesterol, other fats, calcium, and blood-clotting materials. Eventually, this buildup narrows the arteries and prevents oxygen from reaching your organs and limbs. Atherosclerosis can cause several different health complications, depending on which arteries are affected.
Coronary Artery Disease
Coronary artery disease (CAD) is the most common form of heart disease, which is caused by plaque buildup in your heart’s arteries. You may feel short of breath, have chest pain or pressure, or feel fatigued. Heart attacks occur when a coronary artery is completely blocked.20
A heart attack is a medical emergency, so it’s important to know the signs to look out for. These include:21
- Chest pain in the center to the left side of your chest that lasts for a few minutes; it may feel like a full, heavy, squeezing pressure
- Shortness of breath
- Pain in your neck, jaw, or back
- Breaking out in a cold sweat
- Feeling faint or lightheaded
- Pain in your shoulders or arms
- Nausea
Peripheral Artery Disease
Peripheral artery disease (PAD) occurs when plaque builds up in your extremities, primarily your legs. You may experience pain in your calf, thigh, hip, or buttock while walking because your muscles are getting less oxygen than normal. These symptoms tend to improve with rest. Other symptoms of PAD include:22
- Smooth, shiny, tight-feeling skin
- Open sores or ulcers that don’t heal properly
- Muscle weakness
- Numb toes
- Skin that’s cool to the touch
Stroke
Plaque can also build up in your carotid arteries, which are in the neck and supply blood to your brain. If a piece of plaque or blood clot breaks off and travels to your brain, it may block blood flow, causing an ischemic stroke. Some people may have a “mini-stroke” or transient ischemic attack (TIA) that’s only a temporary blockage of blood flow.23
To remember the warning signs of a stroke, it’s important to think FAST:24
- Face: Is your face drooping on one side when you smile?
- Arms: If you lift both of your arms, is one drifting downward?
- Speech: Is your speech strange or slurred?
- Time: If you notice any of the above signs, call 9-1-1 immediately
How Is High Cholesterol Diagnosed?
High cholesterol is diagnosed based on your personal medical history, family history, and bloodwork results. During an appointment, your doctor will ask if you’ve previously had any cholesterol issues and if you’ve recently started any new medications. They’ll also ask about your:25
- Diet
- Exercise level
- Family history of high cholesterol and other cardiovascular issues
- Risk factors for other cardiovascular issues
A simple blood test known as a lipid panel is used to measure your cholesterol levels (HDL, LDL, triglycerides, and total cholesterol). You’ll have to fast for nine to 12 hours before a lipid panel to ensure accurate results.
Your doctor will also perform a physical exam to look for any signs of familial hypercholesterolemia, including xanthomas and yellowing around your eyes.
The following numbers (milligrams of cholesterol per deciliter of blood, mg/dL) are considered high cholesterol based on age:26
| Age | High Non-HDL Cholesterol | High LDL Cholesterol | High Total Cholesterol |
| 19 years and younger | ≥ 145 | ≥ 130 | ≥ 200 |
| 20 years and older | — | 160 to 189 | ≥ 240 |
*Total cholesterol = HDL + LDL + 20 percent triglycerides
*Non-HDL cholesterol = Total cholesterol – HDL cholesterol
Preventing High Cholesterol
If you don’t currently have high cholesterol but you’re at an increased risk, the Centers for Disease Control and Prevention (CDC) recommend taking certain steps to keep your levels in check. These include:27
- Choose foods high in fiber to help reduce your LDL cholesterol and boost your HDL levels
- Limit or avoid foods high in saturated fats — choose heart-healthy options that are low in saturated fat, trans fat, added sugar, and sodium
- Try to get at least 30 minutes of exercise five days a week
- Maintain a healthy weight to reduce LDL levels and prevent other cardiovascular complications
- Limit alcohol consumption
- Quit smoking to prevent blood vessel damage
Living with High Cholesterol
If you’re living with high cholesterol, heart disease, or another cardiovascular complication, there are resources available to help you better understand your condition and manage your cholesterol levels.
