Conditions guide

High Cholesterol

High cholesterol means there is too much cholesterol, particularly LDL (often called bad cholesterol), in the blood. It usually causes no symptoms but can lead to plaque buildup in arteries and raise the risk of heart attack and stroke.

Last updated 4 sources

At a Glance

  • Cholesterol is a waxy, fat-like substance the body needs, but too much in the blood can build up in artery walls.
  • LDL cholesterol contributes to plaque buildup, while HDL cholesterol helps carry cholesterol away from arteries.
  • High cholesterol usually has no symptoms and is found with a blood test called a lipid panel.
  • Diet, physical activity, body weight, genetics, and other health conditions all affect cholesterol levels.
  • Treatment decisions generally consider overall cardiovascular risk, not just cholesterol numbers.
  • Lifestyle changes and medicines such as statins are commonly used to lower LDL cholesterol.

What It Is

Cholesterol is made by the liver and also comes from foods of animal origin. The body uses it to build cells and make certain hormones and vitamin D. Because cholesterol does not dissolve in blood, it travels inside particles called lipoproteins.

Low-density lipoprotein (LDL) carries cholesterol to tissues. When there is too much LDL, it can enter artery walls and contribute to plaque, a process called atherosclerosis. Plaque narrows arteries and can rupture, leading to blood clots that cause heart attacks or strokes. High-density lipoprotein (HDL) helps return cholesterol to the liver for removal.

Triglycerides are another type of blood fat often measured with cholesterol. High triglycerides are also linked with heart disease and, at very high levels, with pancreatitis.

Common Terminology

LDL cholesterol
Low-density lipoprotein cholesterol, often called bad cholesterol because high levels contribute to plaque in arteries.
HDL cholesterol
High-density lipoprotein cholesterol, often called good cholesterol because it helps remove cholesterol from the bloodstream.
Triglycerides
A type of fat in the blood that stores extra energy from food.
Non-HDL cholesterol
Total cholesterol minus HDL, representing all the cholesterol carried in potentially harmful particles.
Atherosclerosis
The buildup of fatty plaque inside artery walls, which narrows and stiffens the arteries.
Familial hypercholesterolemia
An inherited condition that causes very high LDL cholesterol from a young age.
Lipoprotein(a)
A type of lipoprotein whose level is largely determined by genetics and is linked with higher cardiovascular risk when elevated.

Common Causes and Associations

Cholesterol levels are influenced by both inherited and lifestyle factors.

  • Eating patterns high in saturated fat and trans fat can raise LDL cholesterol.
  • Physical inactivity and excess body weight are associated with higher LDL and triglycerides and lower HDL.
  • Smoking lowers HDL cholesterol and damages blood vessels.
  • Genetics plays a major role, and some people inherit very high cholesterol levels.
  • Cholesterol levels tend to rise with age, and in women LDL often increases after menopause.
  • Conditions such as type 2 diabetes, hypothyroidism, kidney disease, and liver disease can affect cholesterol.
  • Some medicines, including certain steroids and some HIV medicines, can raise cholesterol or triglycerides.

Symptoms and Features

This is a general description, not a diagnostic checklist. High cholesterol itself usually causes no symptoms; it is generally found through blood testing.

  • Most people with high cholesterol feel completely well and have no warning signs.
  • The first sign of untreated high cholesterol can be a complication, such as chest pain, heart attack, or stroke.
  • Very high inherited cholesterol can sometimes cause fatty deposits in tendons (xanthomas) or around the eyelids (xanthelasma).
  • A gray or white ring around the colored part of the eye (arcus) at a young age may be associated with high cholesterol.
  • Very high triglycerides can sometimes cause pancreatitis, with severe upper abdominal pain.

Tests and Evaluation

Cholesterol is measured with a blood test, and results are interpreted alongside other risk factors.

  • A lipid panel measures total cholesterol, LDL, HDL, and triglycerides.
  • Fasting is not always required, though it may be requested, especially when triglycerides are high.
  • As a general reference, an LDL below 100 mg/dL is often described as optimal for many adults, though labs differ and target levels depend on individual risk.
  • Clinicians often use risk calculators that combine cholesterol, blood pressure, age, diabetes, and smoking status to estimate cardiovascular risk.
  • Additional tests, such as lipoprotein(a), apolipoprotein B, or a coronary artery calcium scan, may be considered in some situations.
  • Tests for thyroid, kidney, liver function, and blood sugar may look for conditions that affect cholesterol.

Treatment Overview

Treatment plans are individualized by a clinician based on cholesterol levels and overall risk of heart disease and stroke.

  • Heart-healthy eating that limits saturated and trans fats and includes fiber, fruits, vegetables, whole grains, and healthy fats is commonly recommended.
  • Regular physical activity can lower LDL and triglycerides and raise HDL.
  • Maintaining a healthy weight, limiting alcohol, and not smoking support healthier cholesterol levels.
  • Statins, such as atorvastatin, are the most widely used medicines for lowering LDL and reducing cardiovascular risk.
  • Other medicines include ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran, which may be used alone or with statins.
  • Treatments aimed at high triglycerides may include lifestyle changes, managing blood sugar, and certain prescription medicines.
  • Follow-up lipid testing is commonly used to check how well treatment is working.

When Professional Care May Be Discussed

High cholesterol is usually managed in routine care. Chest pain that is sudden, severe, or comes with shortness of breath, sweating, or fainting, or sudden weakness, face drooping, or trouble speaking, is generally treated as a medical emergency; in the US, people are advised to call 911.

  • Regular cholesterol screening is generally recommended for adults, with timing based on age and risk factors.
  • A family history of very high cholesterol or early heart disease is often discussed with a clinician, as it may prompt earlier testing.
  • Muscle pain, weakness, or other possible side effects of cholesterol medicines are typically discussed with a clinician or pharmacist.
  • Children may be screened, especially when there is a family history of high cholesterol.
  • Lipid results are generally reviewed together with blood pressure, blood sugar, and other heart risk factors.

Questions to Ask a Healthcare Professional

General questions people often find useful to bring to an appointment:

  • What do the different numbers on a lipid panel mean?
  • How is overall cardiovascular risk estimated, and how does it affect treatment decisions?
  • Is fasting needed before a cholesterol test?
  • What dietary changes tend to have the most effect on LDL cholesterol?
  • How do statins and other cholesterol medicines generally work?
  • Should family members be tested if high cholesterol runs in the family?
  • How often is cholesterol generally rechecked?

Sources

This guide was written in plain language from the following authoritative references.

  1. Cholesterol — MedlinePlus (U.S. National Library of Medicine)
  2. Blood Cholesterol — National Heart, Lung, and Blood Institute (NHLBI)
  3. Cholesterol — Centers for Disease Control and Prevention (CDC)
  4. High cholesterol — NHS

Last updated October 8, 2026. FreeDoc guides are general educational information and are not a substitute for care from a qualified professional.