Cholesterol is a thick waxy substance found in your blood. While it is important for building healthy cells, too much cholesterol can increase your risk of heart disease. Your doctor will perform blood tests to look at your cholesterol levels. If they are too high, you can take steps with your doctor to lower them to safer levels.
Familial Hypercholesterolemia or “FH” is a disease passed down from generation to generation. A genetic alteration from one or both parents causes high cholesterol. Sometimes it is possible to trace the disease over several generations. About 1 in 500 people in the world have FH. If one parent has FH, there is a 50% chance that their son or daughter will also have it. This is called heterozygous FH. When both parents have FH, their children inherit the defective gene from both parents. This is called homozygous FH. Homozygous FH is much rarer; but it is more severe and more difficult to treat.
Eating excess amounts of dietary fats will cause them to be absorbed by the body and raise levels of LDL-C in the blood. Saturated and trans fats raise LDL cholesterol levels in the blood, thereby increasing the risk of heart disease. Foods high in animal fat (full-fat milk, cheese, meat); foods prepared with butter, shortening, or partially hydrogenated oils; and sweets (cookies and cakes), are often the main culprits.High cholesterol can also be passed down from your parent or parents. This is called familial hypercholesterolemia and is often more difficult to treat than high cholesterol caused by foods.
Many people don’t know that they have high levels of cholesterol in their blood because there are usually no signs or symptoms associated with an early buildup of cholesterol in the arteries. For some people, the first sign of elevated cholesterol may be a heart attack or stroke. You should also know that people with high total cholesterol are twice as likely to develop heart disease; about 1 in 3 American adults has high blood levels of LDL-C, or “bad cholesterol”.Your doctor can measure your cholesterol levels by taking blood samples. If the levels are high, he or she will want to work with you to lower them by helping you lose weight, exercise, change your diet, and/or start medication.
- Type 2 diabetes, which lowers HDL-C, or “good cholesterol” levels and raises LDL-C levels; this combination increases the risk of heart disease and stroke
- Obesity, which is linked to higher triglyceride levels, higher LDL-C levels, and lower HDL-C levels and can also lead to heart disease, high blood pressure, and diabetes
- Other conditions such as familial hypercholesterolemia (FH) can cause very high LDL-C levels
- Eating a diet high in saturated fat and trans fat may contribute to high cholesterol and related conditions, such as heart disease
- Not getting enough physical activity, which can contribute to weight gain and can lead to high cholesterol
- Smoking, which damages blood vessels and makes them more likely to collect fatty deposits, may also lower HDL-C levels
High cholesterol in the blood usually has no signs or symptoms. The only way to know whether or not you have high cholesterol is to have a healthcare professional conduct a blood test to check the cholesterol level.
Desirable Cholesterol Levels
Less than 200 mg/dL
LDL-C, or “bad cholesterol”
Less than 100 mg/dL
HDL-C, or “good cholesterol”
Greater than or equal to 60 mg/dL
Less than 150 mg/dL
Cholesterol numbers are important; but they are just part of the overall health picture. It is important to consider family history, age, gender, and other lifestyle or health factors, such as smoking, which can increase your risk for high cholesterol.
Lowering elevated levels of LDL-C, or “bad cholesterol” can often be helped by making healthier lifestyle choices. Choices made every day can affect cholesterol levels.
Four (4) things that can make a difference include:
- Following a heart-healthy plan, such as the Mediterranean or DASH diets, which focus on ways to adopt healthier eating habits
- Exercising regularly
- Staying at a healthy weight and losing any extra pounds
- Not smoking, and staying away from secondhand smoke
Many people with elevated cholesterol, particularly those with familial hypercholesterolemia, also need to take medication, which can include the following:
- Statins—in combination with lifestyle changes—are a treatment of choice, and there are at least seven statins currently available.
- Other medications (non-statins) that may be prescribed include:
- Ezetimibe, a cholesterol absorption inhibitor
- PCSK9 inhibitors, alirocumab and evolocumab, which help increase LDL-C clearance from the blood
- Evinacumab, for homozygous FH, a severe and rare, inherited form of high cholesterol
- Bile-acid-binding sequestrants
- High-dose omega-3 fatty acids
Cholesterol numbers are important, but they are just part of the overall health picture. It is important to consider family history, age, gender, and other lifestyle or health factors, such as smoking, which can increase the risk for high blood cholesterol (hypercholesterolemia). Adopting a heart-healthy diet and getting regular exercise are the most important steps you can take to prevent or control cholesterol problems and heart disease. Here are some general tips:
- Exercise, exercise, exercise!
- Take time to read and understand food labels
- Try to avoid full-fat dairy products, processed foods, and foods high in salt (sodium) and preservatives
- Replace butter or margarine with healthier fats, such as olive oil, avocado or nut oils, and others
- Start keeping a food diary
- Consider seeing a dietitian or nutritionist
- Limit alcohol
Patients with familial hypercholesterolemia have more difficult-to-treat cholesterol levels. Medication, coupled with the items above, is most often the most effective way to promote overall health.
- What is cholesterol and why is it important?
- What is “bad” cholesterol and what does it do?
- How can I decrease my level of “bad” cholesterol?
- What is “good” cholesterol and what does it do?
- How can I increase the level of “good” cholesterol?
- Why is familial hypercholesterolemia so hard to manage?
- What medications are available for high cholesterol?
- What medications are available for familial hypercholesterolemia?
- How often should I have my cholesterol checked?
- Does high cholesterol cause symptoms?
- American College of Cardiology (ACC) CardioSmart. High cholesterol. Last Edited November 30, 2018. Accessed March 25, 2021. https://www.cardiosmart.org/topics/high-cholesterol
- Centers for Disease Control and Prevention (CDC). CDC. Getting your cholesterol checked. Reviewed September 8, 2020. Accessed March 25, 2021. www.cdc.gov/cholesterol/cholesterol_screening.htm
- Centers for Disease Control and Prevention (CDC). Knowing your risk for high cholesterol. Reviewed January 31, 2020. Accessed March 25, 2021. www.cdc.gov/cholesterol/risk_factors.htm
- Grundy SM, Stone NJ, Bailey AL, et al. 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 Foundation/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e285-e350.
- US Department of Health and Human Services (HHS). MyHealthFinder. Get your cholesterol checked. Updated October 15, 2020. Accessed March 25, 2021. https://healthfinder.gov/healthtopics/category/doctor-visits/screening-tests/get-your-cholesterol-checked
- Ose L. National Lipid Association (NLA). Familial Hypercholesterolemia. An Educational Booklet for Patients with Familial Hypercholesterolemia. Accessed March 25, 2021. http://nlaresourcecenter.lipidjournal.com/Content/PDFs/FA-Patient-Book-English.pdf