Cholesterol
Cholesterol is a waxy substance found in your blood. Your body uses cholesterol to build cells and make hormones and vitamins. Your liver makes most of the cholesterol you need.
Cholesterol travels through the blood attached to particles called lipoproteins. LDL cholesterol can build up in artery walls. When LDL levels are too high, plaque can form inside the arteries. Plaque is a buildup of fat and other materials that can narrow blood vessels and reduce blood flow. High cholesterol increases the risk of heart attack, stroke, and other vascular conditions.
Symptoms
High cholesterol usually doesn't cause symptoms. Many people learn they have high cholesterol through routine blood tests.
In some cases, very high cholesterol that runs in families can cause:
Small, fatty bumps under the skin, often near the elbows, knees, hands, or ankles
A pale gray or white ring around the colored part of the eye
Most people don't feel any different when cholesterol is high. Serious symptoms may occur only after plaque significantly narrows or blocks an artery. Call 9-1-1 right away if you notice signs of a heart attack or stroke, such as chest pain, sudden weakness, trouble speaking, or severe shortness of breath.
Causes & Risk Factors
High cholesterol develops when there is more cholesterol in the blood than the body can use or remove. Several causes and risk factors can contribute.
Causes
High LDL cholesterol can occur when:
The liver produces too much cholesterol
The body does not remove LDL cholesterol efficiently
Cholesterol builds up in artery walls faster than the body can clear it
Inherited conditions, such as familial hypercholesterolemia, affect how the body processes LDL cholesterol. People with this condition often have very high LDL levels starting at a young age.
Risk Factors
Some risk factors can be changed. Others cannot.
Modifiable risk factors
Diet high in saturated fats
Physical inactivity
Excess body weight
Smoking
Poorly controlled diabetes
Certain medications
Non-modifiable risk factors
Family history of high cholesterol
Genetic conditions such as familial hypercholesterolemia
Increasing age
High cholesterol is more common in some populations due to a combination of genetics, environment, and access to care.
Diagnosis
Clinicians diagnose high cholesterol with a blood test called a lipid panel. This test measures:
LDL cholesterol
HDL cholesterol, often called “good” cholesterol
Total cholesterol
Triglycerides
You usually need to fast before the test, depending on your clinician’s instructions.
A single test can identify high cholesterol. However, clinicians may repeat testing to confirm results or monitor response to treatment. Your clinician will also consider your age, medical history, blood pressure, diabetes status, and overall cardiovascular risk when deciding on treatment.
Treatment
The goals of treatment are to lower LDL cholesterol and reduce the risk of heart attack and stroke. Your treatment plan depends on your cholesterol levels and overall cardiovascular risk. Not every person needs medication.
Lifestyle Changes
Lifestyle changes are important for most people with high cholesterol.
Choose foods lower in saturated fat
Eat more vegetables, fruits, whole grains, and lean proteins
Be physically active most days of the week
Reach and maintain a healthy weight
Avoid tobacco products
Even moderate changes can improve cholesterol levels.
Medications
Some people need medication in addition to lifestyle changes.
Statins are the most commonly prescribed medicines for lowering LDL cholesterol. They help the liver remove more LDL from the blood. Other medications may be used if statins are not enough or are not well tolerated.
Your clinician will review the benefits and possible side effects before prescribing medication. Treatment decisions are individualized based on your overall risk.
Procedures
Procedures don't treat high cholesterol directly. However, if plaque narrows or blocks an artery, clinicians may recommend procedures to restore blood flow. These procedures treat complications of long-standing plaque buildup. Lifestyle changes and medications remain essential for managing cholesterol levels long term.
Living With/Prevention
High cholesterol is a long-term condition for many people. Ongoing care focuses on lowering cardiovascular risk and preventing complications.
Regular follow-up visits help track cholesterol levels and adjust treatment when needed. Blood tests show how well lifestyle changes or medications are working.
Prevention strategies include:
Eating a balanced eating pattern
Staying physically active
Maintaining a healthy weight
Avoiding tobacco
Managing blood pressure and diabetes
Knowing your cholesterol numbers empowers you to take an active role in your health. Small, consistent steps can reduce your risk and support long-term heart and vascular health.
Know Your Numbers
Ask your clinician about your cholesterol levels and cardiovascular risk. Regular screening and early management can help protect your heart and blood vessels.
References
Centers for Disease Control and Prevention. Risk factors for high cholesterol. Updated May 15, 2024. Accessed February 12, 2026.
American Heart Association. Cholesterol medications. Reviewed February 20, 2024. Accessed February 12, 2026.
National Heart, Lung, and Blood Institute. Symptoms. Updated April 18, 2024. Accessed February 12, 2026.
Rosenzweig JL, Bakris GL, Berglund LF, et al. Primary prevention of ASCVD and T2DM in patients at metabolic risk: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(9):3939-3985. doi:10.1210/jc.2019-01338
Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9). doi:10.1016/j.jacc.2023.07.002
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