a type of fat (lipid) in your blood. Your cells need
cholesterol, and your body makes all it
needs. But you also get cholesterol from the food you eat.
If you have too much cholesterol, it starts to build up in your arteries.
(Arteries are the blood vessels that carry blood away from the heart.) This is
called hardening of the arteries, or
atherosclerosis. It is usually a slow process that
gets worse as you get older.
To understand what happens, think
about how a clog forms in the pipe under a kitchen sink. Like the buildup of
grease in the pipe, the buildup of cholesterol narrows your arteries and makes
it harder for blood to flow through them. It reduces the amount of blood that
gets to your body tissues, including your heart. This can lead to serious
heart attack and
Your cholesterol is measured by a blood test:
High cholesterol doesn't
make you feel sick. By the time you find out you have it, it may already be
narrowing your arteries. So it is very important to start treatment even though
you may feel fine.
Many things can
cause high cholesterol, including:
need a blood test to check your cholesterol. There are
several kinds of tests:
If you have high cholesterol, you need treatment to lower your risk of heart attack and stroke. The two main treatments are
lifestyle changes and medicine.
Some lifestyle changes are important for
everyone with high cholesterol. Your doctor will probably want you to:
Changing old habits may not be easy, but it is very
important to help you live a healthier and longer life. Having a plan can help.
Start with small steps. For example, commit to adding one fruit or one vegetable a day for a week. Instead of having dessert, take a short walk.
If these lifestyle changes don't lower your
cholesterol enough, or if your risk of heart attack is
high, you may also need to take a cholesterol-lowering medicine, such as a statin. Knowing your heart attack risk is
important, because it helps you and your doctor decide how to treat your
To find out your risk, use the
Interactive Tool: Are You at Risk for a Heart Attack?
Health Tools help you make wise health decisions or take action to improve your health.
Learning about high cholesterol:
Living with high cholesterol:
High cholesterol can be caused by:
High cholesterol does not cause symptoms. It is usually found during a
blood test that measures cholesterol levels.
Some people with rare lipid disorders may have symptoms such as bumps in the skin, hands, or feet, which are caused by deposits of extra cholesterol and other types of fat.
cholesterol can lead to the buildup of plaque in artery walls. This buildup is called
atherosclerosis. It can lead to coronary artery disease
(CAD), heart attack, stroke or transient ischemic attack (TIA), and peripheral arterial disease.
Atherosclerosis can cause these problems because it:
For more information, see:
Some things that increase
your risk for
high cholesterol are things you can change, but some are
not. It's important to lower your risk as much as possible.
Things you can change include:
Each of these things can raise your LDL, lower your HDL, or both.
Things you cannot change include:
For more information, see Cause.
High cholesterol usually has no symptoms. Sometimes the first sign that you
have high cholesterol or other risk factors for heart disease is a
heart attack, a
stroke, or a
transient ischemic attack (TIA). If you have any
symptoms of these, call 911 or other emergency services.
Heart attack symptoms include:
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Stroke and TIA symptoms include:
Any of the following doctors,
nurses, or specialists can order a cholesterol test and treat high
registered dietitian can help you with a diet to lower
People who have rare
lipid disorders, which can be hard to treat,
may need to see a specialist, such as a lipidologist or an endocrinologist.
A blood test tells you if you have
Your numbers help your doctor know your risk of getting heart disease or having a heart attack or stroke.
Your total cholesterol level is important. But your levels of
LDL, HDL, and triglycerides help your doctor decide if you need treatment for high cholesterol. Your doctor
will also consider your overall health and your risk of heart
attack. For more information, see the topic High Cholesterol Treatment Guidelines Based on Heart Attack Risk.
To learn about the results and numbers for cholesterol tests, see the topic Cholesterol and Triglyceride Tests.
Your total cholesterol number shows if your
cholesterol is too high.
If you have high cholesterol, your doctor will want
to know your LDL and HDL levels before deciding whether you need treatment and
what sort of treatment you need.
You want your LDL level to be low. But how low your LDL should be depends
on your risk of heart attack.
Your doctor will help decide what your LDL goal is. The higher your risk of heart attack,
the lower your LDL goal.
You want your HDL level to be high. An HDL level of 60 or higher is linked to a lower risk of heart disease. A high HDL number also can help
offset a high LDL number.
When you visit your doctor to talk about your cholesterol
test, you will talk about other things that increase your risk for heart
problems. These include:
If your risk is high, or if you
already have heart problems, your doctor will be more likely to prescribe
medicine along with lifestyle changes.
To find out your risk for a heart attack, see the Interactive Tool: Are You at Risk for a Heart Attack?
Most doctors recommend that everyone older than 20 be checked for high
cholesterol. How often you need to be checked depends on whether you have other
health problems and your overall chance of heart disease.
Your child's doctor may suggest a cholesterol test based on your child's age, family history, or a physical exam. A cholesterol test can help a doctor find out early if your child has a cholesterol level that could affect his or her health.
The goal in treating
high cholesterol is to reduce your chances of having a
heart attack or
The two types of treatment for high cholesterol are:
Your doctor may suggest that you make
one or more of the following changes:
For more information, see Making Lifestyle Changes.
Many people try lifestyle changes first. But if lifestyle changes aren't enough to reach your cholesterol goal, you will need to take medicine too. Even if you take medicine for high cholesterol, keeping healthy lifestyle habits is still important.
Some people need to start taking medicine right away because their risk of heart attack is higher than average. Your doctor will base your need for medicine on your risk level.
Once you know your risk for heart attack, you can learn more about treatment for your risk level.
You may also need treatment for other health problems, such as high blood pressure.
A heart-healthy lifestyle can help you prevent high cholesterol. This includes:
Heart-healthy diets include the Mediterranean diet and the American Heart Association diet recommendations. This chart compares several heart-healthy diets(What is a PDF document?).
Some people may not be able to prevent high cholesterol with lifestyle changes. Family history or certain conditions that cause the body to make too much cholesterol can raise levels even with lifestyle changes. In these cases, medicine can help.
Remember that high cholesterol is just
one of the things that increase your risk for
heart attack and stroke.
Controlling other health problems, such as
high blood pressure and
diabetes, can also help reduce your overall
Lifestyle changes are important to help control
high cholesterol, especially if you have other risk
heart disease and
Even if your doctor has
prescribed medicine for you, you may still need to make changes at home to lower
your cholesterol and reduce your risk. Some people can even take less
medicine after making these changes.
One Man's Story:
"The walking was the easy part for me. I get out every evening for a walk. The food part took some thought. Each week, I added a food that was good for me and took something away that was bad for me."—Joe
Read more about how Joe is improving his cholesterol by making one change at a time.
lifestyle changes to help lower your cholesterol:
Making healthy eating habits a part of your daily life is one of the best things you can do to lower your cholesterol. Your doctor may recommend that you follow the Therapeutic Lifestyle Changes (TLC) diet. The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat raises your cholesterol.
If you have questions about which diet to follow, talk to your doctor.
For more information about food and high cholesterol, see:
Losing just 5 lb to 10 lb (2.3 kg to 4.5 kg) can lower your cholesterol. Losing weight can also help lower your blood pressure.
physical activity raises "good" HDL cholesterol. Getting active has many other benefits too. It can help you lose weight. And it can lower your blood pressure.
Quitting can help raise your HDL and improve your heart health. "Good" HDL levels often go up soon after a person quits smoking.
For more information, see:
One Woman's Story:
"Terri's heart attack scared me to death. I decided that this time, I'm doing the whole package. I'm quitting smoking for good."—Linda
Read more about Linda and how quitting smoking improved her cholesterol.
If high cholesterol runs in your family, these lifestyle changes may not be enough. You may need to take medicine too. But no matter what treatment you use, you can lower your high cholesterol.
"I'm just not that type of person who can change everything at once."—Joe
Read more about Joe and how using the TLC plan helped him take charge of his cholesterol.
You can learn simple steps to help you make lifestyle changes, like setting goals. Work on one small goal at a time. Expect slip-ups. Get support from others. Reward yourself for each success. To find out more about making healthy lifestyle changes, see Change a Habit by Setting Goals.
When changing a lifestyle habit, barriers can sometimes get in your way. Figuring out what those barriers are and how you can get around them can help you reach your healthy eating goals.
For help, see:
"I've learned to not beat myself up [when I slip up]. Instead, I refocus on my plan and get right back to eating healthy food. What keeps me going is the results—I've lost weight, my cholesterol's getting better, and I feel younger every day."—Joe
Read more about how Joe is controlling his cholesterol.
Statins are the
medicines used the most often to treat
high cholesterol, and they often work the best. They can
reduce the risk for
stroke, and early death in people who are at high risk for a
heart attack or stroke. Other medicines also lower
cholesterol, and some may be used to lower
triglycerides or raise
Doctors may also prescribe
aspirin therapy if you have had a heart attack or
a stroke, or you have a high risk for heart attack or stroke.
Do you need to take medicine? That depends. The decision to use medicine to treat high cholesterol is usually based on your cholesterol goal, LDL level, and your risk for heart attack and stroke.
always used along with a diet and exercise plan, not instead of it.
You and your doctor will decide if you will take medicine for high cholesterol.
"I don't mind taking a pill a day. As long as it's doing me some good. And I no longer have any doubts about that."—Tony
Read more about Tony and how medicine helps him keep his cholesterol low.
The following medicines can be
used to lower LDL and triglyceride levels in the blood and to raise HDL.
Some people find it hard to take their
medicines properly. If you do take medicine, it is important to use it the right way.
Some people don't see why they should take medicines every day
when they don't feel sick. High cholesterol doesn't make you feel sick. But it's important to treat
it, because it damages your blood vessels and eventually your heart, even though you don't have symptoms.
Some side effects are more likely and may be worse when you use higher
doses of statins. If you're having side effects, tell your doctor. You may be able to take a different medicine or a different dose.
Be sure to tell your doctor everything you take for high cholesterol, even herbs or other supplements or treatments. Sometimes they can interact with other medicines and cause problems.
If you have trouble taking your medicine for any reason, talk to your doctor.
Some plant products can help lower high cholesterol. But don't use them to replace your doctor's treatment. Whether
or not you use such products, be sure to continue your diet, exercise,
and prescription medicines.
As with any new form of treatment, make sure to talk with your doctor first. This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects.
Psyllium is an ingredient in some dietary supplements—Metamucil, for example. It's a fiber from fleawort and plantago seeds.
Doctors aren't sure how it helps cholesterol levels. It may make the small intestine absorb less cholesterol, so less of it enters your blood.
Psyllium is approved by the U.S. Food and Drug Administration (FDA). The main side effect is increased bowel movements. Products
containing psyllium aren't recommended to replace foods as a source of
Sterol and stanol esters are used in cholesterol-lowering margarine spreads.
Sterol esters might limit how much cholesterol the small intestine can absorb. Cholesterol-lowering margarines can help lower cholesterol levels, particularly in people who have high cholesterol levels or who consume too much fat in their diets. These margarines are used along with a healthy diet to lower cholesterol.
Red yeast rice contains a natural form of lovastatin, a statin medicine. This supplement may keep your body from producing too much cholesterol. But this supplement can cause dangerous side effects.
Talk to your doctor before you try red yeast rice. Serious side effects include rhabdomyolysis and hepatitis. Red yeast rice is not regulated by the U.S. Food and Drug Administration (FDA), so you cannot be sure of the amount of red yeast in a supplement. This means you cannot be sure of its dose and safety.
If you take red yeast rice, call your doctor right away if you have a bad reaction to it such as severe muscle pain or symptoms of hepatitis.
Do not take red yeast supplements if you are taking statins. Combining them can cause dangerous side effects.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
This website has health information for
people of all ages. Topics include the following: medicines, food and nutrition, medical
devices, cosmetics, and animal health. Spanish materials are also
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Cholesterol Education Program (NCEP) provides education and tips for patients about how to lower high cholesterol. The NCEP provides clinical practice guidelines for health professionals to treat high cholesterol. The goal of the NCEP is to help people lower high cholesterol because this can lower their risk of coronary artery disease. The NCEP is part of the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
CitationsGrundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.Berthold HK, et al. (2006). Effect of policosanol on lipid levels among patients with hypercholesterolemia or combined hyperlipidemia. JAMA, 295(19): 2262–2269.Other Works ConsultedBrunzell JD (2010). Diagnosis and treatment of dyslipidemia. In EG Nabel, ed., ACP Medicine, section 9, chap. 6. Hamilton, ON: BC Decker.Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.Drugs for lipids (2011). Treatment Guidelines From The Medical Letter,9(103): 13–20.Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.Genest J, Libby P (2012). Lipoprotein disorders and cardiovascular disease. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 975–995. Philadelphia: Saunders.Grundy S, et al. (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NIH Publication No. 02–5215). Bethesda, MD: National Institutes of Health. Also available online: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf.Grundy SM, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]Miller M, et al. (2011). Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 123(20): 2292–2333.Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262.National Heart, Lung, and Blood Institute (2005). Your Guide to Lowering Your Cholesterol With TLC (NIH Publication No. 06-5235). Available online: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.Pearson TA, et al. (2003). Markers of inflammation and cardiovascular disease: American Heart Association and the Centers for Disease Control and Prevention scientific statement. Circulation, 107(3): 499–511.Raymond JL, Couch SC (2012). Medical nutrition and therapy for cardiovascular disease. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 742–781. St Louis: Saunders.Red yeast rice (2009). Medical Letter on Drugs and Therapeutics, 51(1320): 71–72.Sacks FM, et al. (2006). Soy protein, isoflavones, and cardiovascular health: An American Heart Association science advisory for professionals from the Nutrition Committee. Circulation, 113(7): 1034–1044. Also available online: http://circ.ahajournals.org/cgi/content/full/113/7/1034.U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
June 29, 2012
Kathleen Romito, MD - Family Medicine & Robert A. Kloner, MD, PhD - Cardiology
How this information was developed to help you make better health decisions.
To learn more visit Healthwise.org
© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.