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High blood cholesterol levels

Cholesterol - high; Lipid disorders; Hyperlipoproteinemia; Hyperlipidemia; Dyslipidemia; Hypercholesterolemia

Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems.

The medical term for high blood cholesterol is lipid disorder, hyperlipidemia, or hypercholesterolemia.

Test Your Cholesterol Knowledge

  • What does a lipid profile (also called a lipid panel) measure?

     

    A. Total cholesterol

     

    B. LDL cholesterol

     

    C. HDL cholesterol

     

    D. Triglycerides

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. The test measures the level of these fats, or lipids, in your blood. Cholesterol is found in all parts of the body. Your body needs a little bit of cholesterol. But too much cholesterol can clog your arteries and lead to heart disease and stroke. Some cholesterol is considered "good" (HDL) and some is considered "bad." (LDL)
  • Having high LDL cholesterol is healthy.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. When you have too much LDL, or "bad," cholesterol in your blood, it can build up on artery walls, causing them to become hard and narrow. The lower your LDL, the lower your risk for heart disease. Ask your doctor what your LDL level should be.
  • Which type of cholesterol is called "good" cholesterol?

     

    A. HDL cholesterol

     

    B. LDL cholesterol

    Correct Answer
    The correct answer is HDL. HDL helps remove LDL cholesterol from artery walls. HDL levels of 60 mg/dL or above helps protect you from heart disease. HDL below 40 mg/dL for men and below 50 mg/dL for women can increase your risk for heart disease.
  • Having high cholesterol and triglyceride levels increases your risk for:

     

    A. The buildup of fat, cholesterol, and other substances on your artery walls that makes them narrower (atherosclerosis)

     

    B. Heart attack

     

    C. Stroke

     

    D. All of the above

    Correct Answer
    The correct answer is all of the above. When plaque builds up on your artery walls, blood clots can form that block blood flow to the heart or brain, causing a heart attack or stroke. Talk with your doctor about how you can lower your risk for heart disease.
  • Medicine is the only treatment for high cholesterol and triglycerides.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Improving your health habits can lower cholesterol and triglyceride levels. Sometimes, lifestyle changes alone aren't enough, so your doctor may prescribe medicine.
  • Which habits can lead to high cholesterol levels?

     

    A. Smoking

     

    B. Obesity

     

    C. Eating foods high in fat and cholesterol

     

    D. Not getting enough exercise

     

    E. High alcohol use

     

    F. All of the above

    Correct Answer
    The correct answer is all of the above. Family history, diabetes, and other medical problems also increase your risk. Ask your doctor about healthy changes you can make to help lower high cholesterol.
  • If you are overweight, losing 5 to 10 pounds can help lower cholesterol levels.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. To lose about one pound a week, eat about 500 fewer calories a day. You can lose weight by eating smaller portions. Also replace low-fiber, high-fat foods with lean meats and other proteins, whole grains, low-fat dairy products, and plenty of fruits and vegetables.
  • Getting regular exercise can improve your cholesterol numbers.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Exercising 30 minutes a day at least 5 days a week can increase HDL levels by about 5 percent. If you haven't been active, check with your doctor before starting to exercise. Start by walking just a few minutes several times a week. Build up to 30 minutes of brisk exercise 5 days a week.
  • Heart-healthy fats include:

     

    A. Saturated fats and trans fats

     

    B. Monounsaturated and polyunsaturated fats

    Correct Answer
    The correct answer is monounsaturated and polyunsaturated fats. They are found in fish, nuts, seeds, avocados, and olive, canola, corn, soy, and sunflower oils. Replacing saturated and trans fats with these healthy fats helps lower LDL and increase HDL. Omega-3s from fish help lower high triglycerides.
  • Quitting smoking can help you:

     

    A. Increase your HDL, or "good," cholesterol by 10%

     

    B. Decrease your risk of a heart attack 24 hours after quitting

     

    C. Lower your risk of heart disease by half one year after quitting

     

    D. All of the above

    Correct Answer
    The correct answer is all of the above. Quitting isn't easy, but keep in mind that the more times you attempt to quit, the more likely you are to be successful.

Causes

There are many types of cholesterol. The ones talked about most are:

  • Total cholesterol -- all the cholesterols combined
  • High density lipoprotein (HDL) cholesterol -- often called "good" cholesterol
  • Low density lipoprotein (LDL) cholesterol -- often called "bad" cholesterol

For many people, abnormal cholesterol levels are partly due to an unhealthy lifestyle. This often includes eating a diet that is high in fat. Other lifestyle factors are:

  • Being overweight
  • Lack of exercise

Some health conditions can also lead to abnormal cholesterol, including:

  • Diabetes
  • Kidney disease
  • Polycystic ovary syndrome
  • Pregnancy and other conditions that increase levels of female hormones
  • Underactive thyroid gland

Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:

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

Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.

Exams and Tests

A cholesterol test is done to diagnose a lipid disorder. Different experts recommend different starting ages for adults.

  • Recommended starting ages are between 20 to 35 for men and 20 to 45 for women.
  • Adults with normal cholesterol levels do not need to have the test repeated for 5 years.
  • Repeat testing sooner if changes occur in lifestyle (including weight gain and diet).
  • Adults with a history of elevated cholesterol, diabetes, kidney problems, heart disease, and other conditions require more frequent testing.

It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer doctors away from targeting specific levels of cholesterol. Instead, they recommend different medicines and doses depending on a person's history and risk factor profile. These guidelines change from time to time as more information from research studies becomes available.

General targets are:

  • LDL: 70 to 130 mg/dL (lower numbers are better)
  • HDL: More than 50 mg/dL (high numbers are better)
  • Total cholesterol: Less than 200 mg/dL (lower numbers are better)
  • Triglycerides: 10 to 150 mg/dL (lower numbers are better)

If your cholesterol results are abnormal, you may also have other tests such as:

  • Blood sugar (glucose) test to look for diabetes
  • Kidney function tests
  • Thyroid function tests to look for an underactive thyroid gland

Treatment

Steps you can take to improve your cholesterol levels and to help prevent heart disease and a heart attack include:

  • Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke.
  • Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
  • Use low-fat toppings, sauces, and dressings.
  • Avoid foods that are high in saturated fat.
  • Exercise regularly.
  • Lose weight if you are overweight.

Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:

  • Your age
  • Whether or not you have heart disease, diabetes, or other blood flow problems
  • Whether you smoke or are overweight
  • Whether you have high blood pressure or diabetes

You are more likely to need medicine to lower your cholesterol:

  • If you have heart disease or diabetes
  • If you are at risk for heart disease (even if you do not yet have any heart problems)
  • If your LDL cholesterol is 190 mg/dL or higher. 

Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190 mg/dL.

There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease. Other drugs are available if your risk is high and statins do not lower your cholesterol levels enough. These include ezetimibe and PCSK9 inhibitors.

Outlook (Prognosis)

High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.

Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.

References

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 48.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24);e285-e350. PMID: 30423393 www.ncbi.nlm.nih.gov/pubmed/30423393.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 206.

U.S. Preventive Services Task Force recommendation summary. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/statin-use-in-adults-preventive-medication1. Updated November 2016. Accessed March 21, 2018.

U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for lipid disorders in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2016;316(6):625-633. PMID: 27532917 www.ncbi.nlm.nih.gov/pubmed/27532917.

  • Cholesterol and triglyceride test

    Cholesterol and triglyceride test

    Animation

  •  

    Cholesterol and triglyceride test - Animation

    Maybe you've been eating fast food more often than you should, or you're not getting your recommended two-and-a-half hours of exercise each week. Or, it could be that you smoke, or your blood pressure is too high. Well, for whatever reason, you may be concerned about your risk of getting heart disease. Well, a few tests can help you learn that risk, so you can start making healthy lifestyle changes to reduce it. A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. Why is it important to know these levels? Because if you have too much of these substances in your blood from eating foods like burgers and French fries, they can clog your arteries. Eventually your arteries can become so clogged that you'll have a heart attack or stroke. Men should have their cholesterol tested by the time they're 35. Women should have it checked by age 45. If you have a condition like diabetes, heart disease, stroke, or high blood pressure, have your cholesterol checked now, no matter what your age. To measure your cholesterol, your doctor will give you a blood test. If you're also having your triglyceride level checked, you may be told not to eat or drink anything for 8 to 12 hours before the test. Depending upon your heart risk, the doctor may measure just your total cholesterol level, or your total cholesterol along with your LDL, or bad cholesterol, HDL, or good cholesterol, and triglycerides. If you're of average risk of getting heart disease, your goal is to have total cholesterol of less than 200 milligrams per deciliter, LDL cholesterol lower than 130 milligrams per deciliter, HDL cholesterol higher than 40 milligrams per deciliter if you're a man, or 50 if you're a woman -- the higher the better, and triglycerides of less than 150 also, the lower the better. Although some illnesses, like arthritis, can raise your cholesterol level, generally having high cholesterol means that you're at increased risk for heart disease and stroke. It's a sign you need to work harder to keep your heart healthy. If your cholesterol levels are normal, that's great! That means that you're eating right, you're exercising, and you're taking good care of your health. You don't need to have another cholesterol test for about five years. But if your cholesterol level is high, or you've already got heart disease, high blood pressure, or diabetes, you'll need to have your cholesterol levels checked more often. Keeping close tabs on your cholesterol and triglyceride levels is one way that you can take charge of your health, and change it for the better.

  • Cholesterol producers

    Cholesterol producers - illustration

    Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources our liver produces it, and we consume it in meat and dairy products.

    Cholesterol producers

    illustration

  • Coronary artery disease

    Coronary artery disease - illustration

    The coronary arteries supply blood to the heart muscle itself. Blood supply through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the heart can slow or stop, causing chest pain (stable angina), shortness of breath, heart attack, or other symptoms.

    Coronary artery disease

    illustration

  • Cholesterol

    Cholesterol - illustration

    Cholesterol is a soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver and is needed for normal body functions including the production of hormones, bile acid, and Vitamin D. Excessive cholesterol in the blood contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases.

    Cholesterol

    illustration

  • Developmental process of atherosclerosis

    Developmental process of atherosclerosis - illustration

    The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.

    Developmental process of atherosclerosis

    illustration

  • Cholesterol and triglyceride test

    Animation

  •  

    Cholesterol and triglyceride test - Animation

    Maybe you've been eating fast food more often than you should, or you're not getting your recommended two-and-a-half hours of exercise each week. Or, it could be that you smoke, or your blood pressure is too high. Well, for whatever reason, you may be concerned about your risk of getting heart disease. Well, a few tests can help you learn that risk, so you can start making healthy lifestyle changes to reduce it. A coronary risk profile is a group of blood tests that measure your cholesterol and triglyceride levels. Why is it important to know these levels? Because if you have too much of these substances in your blood from eating foods like burgers and French fries, they can clog your arteries. Eventually your arteries can become so clogged that you'll have a heart attack or stroke. Men should have their cholesterol tested by the time they're 35. Women should have it checked by age 45. If you have a condition like diabetes, heart disease, stroke, or high blood pressure, have your cholesterol checked now, no matter what your age. To measure your cholesterol, your doctor will give you a blood test. If you're also having your triglyceride level checked, you may be told not to eat or drink anything for 8 to 12 hours before the test. Depending upon your heart risk, the doctor may measure just your total cholesterol level, or your total cholesterol along with your LDL, or bad cholesterol, HDL, or good cholesterol, and triglycerides. If you're of average risk of getting heart disease, your goal is to have total cholesterol of less than 200 milligrams per deciliter, LDL cholesterol lower than 130 milligrams per deciliter, HDL cholesterol higher than 40 milligrams per deciliter if you're a man, or 50 if you're a woman -- the higher the better, and triglycerides of less than 150 also, the lower the better. Although some illnesses, like arthritis, can raise your cholesterol level, generally having high cholesterol means that you're at increased risk for heart disease and stroke. It's a sign you need to work harder to keep your heart healthy. If your cholesterol levels are normal, that's great! That means that you're eating right, you're exercising, and you're taking good care of your health. You don't need to have another cholesterol test for about five years. But if your cholesterol level is high, or you've already got heart disease, high blood pressure, or diabetes, you'll need to have your cholesterol levels checked more often. Keeping close tabs on your cholesterol and triglyceride levels is one way that you can take charge of your health, and change it for the better.

  • Cholesterol producers

    Cholesterol producers - illustration

    Cholesterol is a waxy, fat-like material that is found in all parts of the body. It comes from two sources our liver produces it, and we consume it in meat and dairy products.

    Cholesterol producers

    illustration

  • Coronary artery disease

    Coronary artery disease - illustration

    The coronary arteries supply blood to the heart muscle itself. Blood supply through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the heart can slow or stop, causing chest pain (stable angina), shortness of breath, heart attack, or other symptoms.

    Coronary artery disease

    illustration

  • Cholesterol

    Cholesterol - illustration

    Cholesterol is a soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver and is needed for normal body functions including the production of hormones, bile acid, and Vitamin D. Excessive cholesterol in the blood contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases.

    Cholesterol

    illustration

  • Developmental process of atherosclerosis

    Developmental process of atherosclerosis - illustration

    The development of arterial atherosclerosis may occur when deposits of cholesterol and plaque accumulate at a tear in the inner lining of an artery. As the deposits harden and occlude the arterial lumen, blood flow to distant tissues decreases and a clot may become lodged, completely blocking the artery.

    Developmental process of atherosclerosis

    illustration

A Closer Look

 

Self Care

 

Tests for High blood cholesterol levels

 

 

Review Date: 2/22/2018

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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