High cholesterol is a condition that occurs when levels of cholesterol in your blood are elevated enough to cause health problems, including heart disease and stroke.  Sometimes known as hyperlipidemia, high cholesterol is painless and doesn’t cause any symptoms until a person develops severe heart disease.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause.

Approximately 93 million Americans over 20 years old, or almost 40 percent of the U.S. population, have high cholesterol.Slightly more than half of adults with high cholesterol are getting treatment to lower it, the CDC notes.

Produced by your liver, cholesterol is a dense, fatty substance that’s found in every cell of your body, and it is considered essential to many life-sustaining functions. It helps your body make hormones and vitamin D, and it's also found in compounds that your body creates to help you digest food, such as bile.

Circulating in the bloodstream in small bundles of fat and protein called lipoproteins, cholesterol comes in two primary types: low-density lipoprotein (LDL), which contributes to the buildup of fatty plaques, and high-density lipoprotein (HDL), which is thought to protect from heart disease and stroke.  A blood test known as a lipid panel can measure both LDL and HDL cholesterol, as well as triglycerides, the most common type of fat in the blood.

Although scientists have long focused on measuring LDL cholesterol through a blood test, new research suggests that this narrow focus on LDL cholesterol levels does not necessarily lead to overall improved health outcomes for patients.Some people with healthy LDL levels may still develop heart disease.
Currently, the American Heart Association (AHA)and the CDCboth recommend that healthy adults over 20 get their cholesterol levels measured every four to six years. People who already have high cholesterol, cardiovascular disease, or other risk factors may need to check their cholesterol levels more often.

Signs and Symptoms of High Cholesterol

Typically, high cholesterol doesn’t cause any symptoms until it causes a medical emergency, like a heart attack or stroke. These heart-disease-related events don’t occur until high cholesterol levels have led to fatty plaque building up in the arteries. In turn, this leads to a narrowing of the arteries and a change in the makeup of the arterial lining, also known as heart disease.

Causes and Risk Factors of High Cholesterol

According to the CDC, both hereditary and lifestyle-related factors contribute to high cholesterol, including the following.

Heredity

Having a family history of high cholesterol or heart disease also means you are more likely to have high cholesterol.

Although it is relatively rare, some people also carry a genetic condition called familial hypercholesterolemia, which causes extremely high LDL levels at a young age and, if left untreated, can lead to early-onset coronary artery disease and heart attacks. The CDC estimates that 1 million Americans, or a third of a percent of the U.S. population, have familial hypercholesterolemia.

Age

Due to age-related metabolic changes, including how the liver removes LDL cholesterol from the blood, everyone’s risk of high cholesterol increases as they get older.

Gender

Women over 55 or who have completed menopause tend to have lower LDL cholesterol levels than men. In general, men tend to have higher HDL cholesterol levels than women.

Diet

Eating a diet high in cholesterol, saturated fat, and trans fats is known to contribute to high cholesterol levels. Most animal and full-fat dairy products, and certain oils that are solid at room temperature, contain high levels of saturated fat. In recent years, the AHA has stopped explicitly recommending against dietary cholesterol, after finding that it did not significantly correlate with heart disease risk.Reducing the amount of saturated and trans fat in your diet is considered the best dietary change to lower your cholesterol.

Level of Physical Activity

According to the AHA, getting little to no physical activity in your everyday life can lower HDL cholesterol, which can make it difficult for your body to clear LDL cholesterol in the arteries.Moderate to intense levels of exercise can increase HDL cholesterol levels and decrease the size of LDL cholesterol particles, making it less harmful.

Tobacco Use

Tobacco use is known to damage blood vessels and lower HDL cholesterol, which at normal levels protects against heart disease, particularly in women.No conclusive evidence shows that smoking tobacco increases LDL cholesterol, but it does create an arterial environment that promotes fatty plaque buildup.

Obesity

According to the CDC, obesity — defined as a body mass index (BMI) over 30 — is linked to higher levels of triglycerides, HDL cholesterol, and LDL cholesterol. Although people considered overweight or obese using the BMI scale have an increased risk for high cholesterol, people with a lower BMI can be affected by high cholesterol as well.

Diabetes

Type 2 diabetes — another chronic condition sensitive to lifestyle factors, body weight, and metabolism — is also associated with lower HDL cholesterol and elevated LDL cholesterol. According to a study, the reasons for this relationship are only partially understood, but the changes in insulin metabolism and overall inflammation may be contributing factors.People with type 1 diabetes are also more likely to have lipid profiles that contribute to heart disease, even if their levels are normal overall.

 

Duration of High Cholesterol

Although people can have high cholesterol for years, medication and lifestyle changes can reduce cholesterol levels to desirable levels within a few months, with some studies finding levels can improve in as little as four weeks with a plant-based diet. In a meta-analysis of 49 studies on the effect of plant-based dietary interventions lasting under four weeks, researchers found that plant-based diets correlated with decreased LDL cholesterol and total cholesterol.

Prevention of High Cholesterol

Regardless of family history or any previous history of heart disease, you can prevent high cholesterol by eating a healthy diet, getting regular physical activity, and quitting smoking. Maintaining a normal weight and limiting alcohol intake can also help.

Regularly monitoring your cholesterol levels can also help prevent your numbers from getting too high or low. In general, healthy adults should check their cholesterol every four to six years, but your doctor may ask to check your cholesterol more often depending on your age, overall health, and other risk factors. There are other ways to prevent high cholesterol, too

Eat a Healthy Diet

Eating a diet low in saturated and trans fat and high in fiber and unsaturated fats can help prevent high cholesterol. Foods like oatmeal, beans, avocados, and vegetable oils can lower LDL cholesterol and increase HDL cholesterol levels.

Although the AHA once recommended against consuming dietary cholesterol, which is found in foods like eggs, it has recently stopped explicitly recommending this because of a lack of robust data.

Get Regular Physical Activity

The latest physical activity guidelines for Americansrecommend that adults get at least 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes if engaging in more vigorous physical activity, like jogging or running.Doing weight or resistance-based strength training on two or more days a week adds additional health benefits.

Quit Smoking

Quitting smoking, or not starting, is one of the major recommendations by the AHA to prevent high cholesterol and heart disease. After 15 years of not smoking, a former smoker’s risk of heart disease is similar to someone who has never smoked.
For cholesterol levels specifically, tobacco use is known to damage blood vessels and lower HDL cholesterol, which at normal levels protects against heart disease, particularly in women.

Maintain a Normal Weight

Having a BMI in the overweight or obese range highly correlates with having excess body fat, which in turn can affect how your body processes cholesterol. Excess body fat also slows down the ability to remove LDL cholesterol from the blood, raising your levels and increasing your risk of heart attack and stroke.

Limit Alcohol Intake

Excess alcohol intake, defined as more than two drinks a day for men and one drink for women, can raise cholesterol and triglyceride levels. A study published in 2020 reviewed the effects of alcohol on high cholesterol and heart disease and found that the effects of alcohol in overall health vary widely, depending on amount and consumption pattern.

Research and Statistics: How Many People Have High Cholesterol?

The CDC estimates that approximately 93 million Americans over 20, or close to 40 percent of the U.S. population, have high cholesterol, which puts them at increased risk of heart disease and stroke.

Heart disease is the leading cause of death in the United States, and stroke is the fifth leading cause.

Related Conditions

High cholesterol is associated with other medical conditions:

  • High Blood Pressure High cholesterol is linked to high blood pressure because cholesterol-filled plaques can narrow arteries, forcing the heart to pump harder.
  • Heart Disease Without management, high cholesterol contributes to the development of heart conditions like heart attack and peripheral arterial disease.
  • Stroke If left untreated over the long term, high cholesterol contributes to the risk of stroke, a type of severe blood clot or blockage of blood flow to the brain.
  • Type 2 Diabetes People with diabetes tend to have high LDL and low HDL cholesterol levels, as well as higher levels of triglycerides.

Editorial Sources and Fact-Checking

  • Blood Cholesterol? National Heart, Lung, and Blood Institute.
  • High Cholesterol: Symptoms and Causes. Mayo Clinic. July 20, 2021.
  • High Blood Cholesterol: What You Need to Know. National Heart, Lung, and Blood Institute.
  • HDL (Good), LDL (Bad) Cholesterol, and Triglycerides. American Heart Association. November 6, 2020.
  • Triglycerides: Why Do They Matter? Mayo Clinic. September 29, 2020.
  • High Cholesterol Facts. Centers for Disease Control and Prevention. September 8, 2020.

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