High Cholesterol
Sources consulted
This article is original patient-education content.
- WHO—Health topics A–Z(2024)
- NHS—Health A to Z(2024)
- CDC—Health topics(2024)
Based on international clinical guidelines
Overview
High cholesterol means there is too much cholesterol, a waxy fat-like substance, in your blood. Your body needs some cholesterol to build healthy cells, but too much can build up inside blood vessels. Over time, this can make blood vessels narrower and raise the risk of heart disease, heart attack, and stroke. There are different types of cholesterol. LDL is often called “bad” cholesterol because it can build up in blood vessels. HDL is often called “good” cholesterol because it helps carry cholesterol away.
Key facts
- High cholesterol usually has no symptoms, so a blood test is the only way to know your level.
- Lifestyle changes can often help lower cholesterol and protect your heart.
- Some people need cholesterol-lowering medicines as well as healthy habits, especially if their risk of heart disease or stroke is higher.
Yes. High cholesterol is very common worldwide. Many adults have it without knowing. The NHS and many heart health groups recommend cholesterol checks for adults, especially if you have risk factors such as diabetes, high blood pressure, smoking, or a family history of early heart disease.
High cholesterol can affect adults of any age, and it can also affect children. Some people inherit high cholesterol from their parents. Others develop it over time because of diet, activity level, body weight, smoking, alcohol use, age, or other health conditions.
Symptoms
- Call your local emergency number immediately if you have chest pain, pressure, tightness, or heaviness, especially if it spreads to the arm, back, neck, jaw, or stomach.
- Call your local emergency number immediately if you have sudden shortness of breath, sweating, nausea, or feeling faint with chest discomfort.
- Call your local emergency number immediately if you have signs of a stroke: face drooping, arm weakness, speech trouble, sudden confusion, sudden vision loss, sudden severe headache, or sudden trouble walking.
- ⚠Seek same-day medical care if you have new or worsening chest discomfort that comes and goes, even if it is mild.
- ⚠Seek same-day medical care if you have new shortness of breath, unusual tiredness, or reduced ability to exercise.
- ⚠Seek same-day medical care if you notice painful swelling, redness, or warmth in one leg, or sudden pain in an arm or leg.
Common symptoms
- Most people have no symptoms.
- High cholesterol is often found during a routine blood test.
- Some people only learn they have high cholesterol after a heart or blood vessel problem, which is why screening matters.
Symptoms in children
- Children with high cholesterol usually do not have symptoms.
- A child may need testing if close family members have very high cholesterol or had heart disease at a young age.
- Rarely, inherited high cholesterol can cause fatty-looking deposits under the skin or around the eyes, but this is not common.
Symptoms in older adults
- Older adults usually do not feel symptoms from high cholesterol itself.
- Because the risk of heart and blood vessel disease rises with age, cholesterol checks are often part of routine health care.
- Older adults may also have other conditions, such as high blood pressure or diabetes, that affect treatment decisions.
Causes
Main causes
- Eating a diet high in saturated fat, which is fat found in many fatty meats, butter, full-fat dairy foods, and some processed foods.
- Not being physically active enough.
- Living with excess body weight, especially around the waist.
- Smoking, which lowers protective HDL cholesterol and harms blood vessels.
- Drinking more alcohol than recommended.
- Inherited high cholesterol, meaning it runs in families.
- Health conditions such as diabetes, an underactive thyroid, kidney disease, liver disease, and some hormone conditions.
Risk factors
- Family history of high cholesterol or early heart disease.
- Age, because cholesterol levels often rise as people get older.
- High blood pressure.
- Diabetes or raised blood sugar.
- Smoking or exposure to tobacco smoke.
- Low levels of physical activity.
- A diet low in fiber and high in saturated fat.
- Certain ethnic backgrounds may have a higher risk of heart disease, depending on family history and other factors.
- Some medicines can affect cholesterol levels, so your healthcare provider may review what you take.
When to see a doctor
See a doctor urgently if:
- Get urgent help if you have symptoms that could be heart-related, such as chest pain, shortness of breath, fainting, or sudden weakness.
- Get urgent help if you have stroke-like symptoms, such as face drooping, arm weakness, or speech trouble.
- Ask for same-day advice if you have very high cholesterol results and feel unwell, or if you are pregnant and have concerns about cholesterol or heart symptoms.
Book a routine appointment if:
- Book a routine appointment to ask whether you need a cholesterol test, especially if you are an adult over 40 or have risk factors.
- See a healthcare provider if high cholesterol runs in your family or a close relative had a heart attack or stroke at a young age.
- Arrange follow-up if you have already been told your cholesterol is high, so you can review your results and plan.
- Talk with your healthcare provider before starting major diet, exercise, or supplement changes, especially if you have a medical condition.
Diagnosis
High cholesterol is diagnosed with a blood test called a lipid profile or lipid panel. This test measures fats in the blood, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, which are another type of blood fat. Your healthcare provider will also look at your age, blood pressure, smoking status, diabetes status, family history, and other factors to estimate your overall risk of heart disease and stroke.
Tests that may be done
- Lipid profile or lipid panel blood test.
- Blood pressure check.
- Blood sugar test to look for diabetes or raised blood sugar.
- Tests for thyroid, liver, or kidney problems if your provider thinks they may be contributing.
- Family screening may be suggested if inherited high cholesterol is suspected.
What to expect at your appointment
A healthcare professional will take a small blood sample, usually from your arm or a finger prick. Some tests may require fasting, which means not eating for several hours, but many modern cholesterol tests do not. Your provider will explain what you need to do. After the results, they will talk with you about what the numbers mean and what steps may help.
Treatment
Treatment aims to lower harmful cholesterol and reduce your risk of heart attack and stroke. The right plan depends on your cholesterol results, overall heart risk, age, family history, and other health conditions. Treatment often includes lifestyle changes, and some people also need cholesterol-lowering medicine.
Self-care at home
- Choose more foods high in fiber, such as oats, beans, lentils, vegetables, fruit, nuts, seeds, and whole grains.
- Replace saturated fats with healthier unsaturated fats, such as those found in olive oil, avocado, nuts, seeds, and oily fish.
- Limit processed foods, fried foods, fatty meats, pastries, and foods high in added sugar.
- Be active regularly. Even brisk walking can help your heart when done often.
- If you smoke, ask your healthcare provider for support to stop.
- If you drink alcohol, keep within recommended limits or avoid it if advised.
- Aim for a healthy weight if recommended by your healthcare provider.
- Keep follow-up appointments and repeat blood tests as advised.
Medical treatments
If lifestyle changes are not enough, or if your heart risk is higher, your healthcare provider may recommend cholesterol-lowering medicines. These medicines work in different ways, such as reducing how much cholesterol your body makes, helping your body remove cholesterol from the blood, or lowering certain blood fats. Your provider will choose an option based on your health history, test results, possible side effects, pregnancy plans, and other medicines you take. Do not start, stop, or change any medicine without advice from a qualified healthcare provider.
When is surgery considered?
Surgery is not used to treat high cholesterol itself. If high cholesterol contributes to serious narrowing of blood vessels, some people may need procedures to improve blood flow, but this depends on the specific heart or blood vessel condition and should be discussed with a specialist.
Living with this condition
Living with high cholesterol often means building heart-healthy habits into normal life and keeping up with checkups. Small changes can add up. You do not need to be perfect; consistency matters more than strict rules.
Lifestyle tips
- Plan meals around vegetables, whole grains, beans, lentils, lean proteins, and healthy fats.
- Move your body in ways you enjoy, such as walking, cycling, swimming, dancing, or gardening.
- Try to sit less during the day by standing, stretching, or taking short walks.
- Get enough sleep when possible, because poor sleep can affect heart health.
- Manage stress with calming routines, social support, breathing exercises, time outdoors, or hobbies.
- Keep a list of your test results and questions for appointments.
Diet and exercise
A heart-healthy eating pattern can lower LDL cholesterol and improve overall health. Focus on fiber-rich foods and healthier fats, and reduce saturated fat. For exercise, aim to build up gradually. If you are not active now, start with short, gentle movement and ask your healthcare provider what is safe for you, especially if you have chest pain, breathlessness, joint problems, or a heart condition.
Mental health and emotional wellbeing
It is normal to feel worried, guilty, or frustrated after hearing your cholesterol is high. Try to be kind to yourself. High cholesterol is common, and there are many ways to lower risk. If worry, low mood, or stress is affecting your daily life, talk with a healthcare provider or mental health professional. If you ever feel at risk of harming yourself, call your local emergency number or a crisis support service immediately.
Prevention
Some high cholesterol can be prevented or improved with healthy habits, but inherited high cholesterol cannot always be prevented. Even then, early testing and treatment can greatly reduce risk. Healthy eating, regular activity, not smoking, limiting alcohol, and managing blood pressure and blood sugar all help protect your heart.
Vaccines
Vaccines do not prevent high cholesterol. However, staying up to date with recommended vaccines can help protect overall health, especially for people with heart disease or long-term health conditions. Ask your healthcare provider what is right for you.
Screening programmes
Screening means checking cholesterol before symptoms happen. Many guidelines, including NHS guidance, recommend cholesterol checks for adults based on age and risk factors. Children may need screening if inherited high cholesterol is possible. Ask a qualified healthcare provider how often you should be tested.
Complications
If left untreated
- Fatty buildup in blood vessels, called atherosclerosis, which means blood vessels become narrowed or stiff.
- Coronary heart disease, which means reduced blood flow to the heart.
- Heart attack.
- Stroke.
- Peripheral artery disease, which means reduced blood flow to the legs or other areas.
- Higher risk when high cholesterol occurs with smoking, diabetes, high blood pressure, or kidney disease.
Long-term outlook
The outlook is often very good when high cholesterol is found and managed. Many people lower their cholesterol and heart risk with lifestyle changes, medicines when needed, and regular follow-up. Starting now, even with small steps, can make a real difference over time.
Find support
International organisations
Local organisations
- NHS: High cholesterol ↗ · United Kingdom
- British Heart Foundation ↗ · United Kingdom
- American Heart Association ↗ · United States
- Heart Foundation ↗ · Australia
Helplines
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Always verify with your doctor
Health guidelines vary by country and region. The information in this article is based on international clinical guidelines but may not reflect the specific guidelines, medications, or practices in your country. Always discuss your health concerns with your own doctor or healthcare provider, and refer to your local national health guidelines where available.
Important notice This information is for educational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your specific situation. If you are experiencing a medical emergency, call your local emergency services immediately.