High cholesterol which is also called hypercholesterolemia, hyperlipidemia or hyperlipoproteinemia, is excess of the waxy fat-like substance that is found in all the cells in your body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. Cholesterol is also found in foods from animal sources, such as egg, meat, and diary products.
If you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque. Plaque sticks to the walls of your arteries. This buildup of plaque is known as atherosclerosis. It can lead to coronary artery disease, where your coronary arteries become narrow or even blocked.
Cholesterol is carried in your blood by proteins. When the 2 combine, they’re called lipoproteins. The main types of lipoprotein are:
- High-density lipoprotein (HDL) – carries cholesterol away from the cells and back to the liver, where it’s either broken down or passed out of the body as a waste product; for this reason, HDL is referred to as “good cholesterol”, and higher levels are better.
- Low-density lipoprotein (LDL) – carries cholesterol to the cells that need it, but if there’s too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries; for this reason, LDL is known as “bad cholesterol.”
- Triglycerides – are the most common type of fat in the body. They store excess energy from your diet. A high triglyceride level combined with high LDL (bad cholesterol) or low HDL (good cholesterol) is linked with fatty buildups within the artery walls, which increases the risk of heart attack and stroke.
What Can Cause High Cholesterol Levels?
An unhealthy lifestyle can increase your risk of developing high blood cholesterol. This includes:
- Unhealthy eating habits, such as eating lots of bad fats. Saturated fat, is found in some meats, dairy products, chocolate, baked goods, and deep fried and processed foods. Another type, trans fat, is in some fried and processed foods. Eating these fats can raise your low-density lipoprotein (LDL) bad cholesterol.
- Lack of exercise or physical activity, with lots of sitting and little exercise can increase the level of “bad cholesterol” (low-density lipoprotein, or LDL).
- Obesity is also another cause. If you’re overweight, it’s likely that you’ll have higher levels of LDL cholesterol and triglycerides, and a lower level of high-density lipoprotein (HDL).
- Drinking excessive amounts of alcohol regularly can increase your cholesterol and triglyceride levels.
- Smoking is also a risk factor. A chemical in cigarettes called acrolein stops “good cholesterol” (HDL) transporting cholesterol from fatty deposits to the liver, leading to narrowing of the arteries (atherosclerosis).
- Genetics may also cause people to have high cholesterol. For example, familial hypercholesterolemia (FH) is an inherited form of high cholesterol.
Other medical conditions and certain medicines may also cause high cholesterol. People with high blood pressure (hypertension) and diabetes often have high cholesterol. Some other health conditions that can also cause raised levels of cholesterol include:
- kidney disease.
- Liver disease.
- An underactive thyroid gland (hypothyroidism).
There are a number of factors associated with high cholesterol that can’t be changed, and increase your risk of having a heart attack or stroke. Doctors refer to these as “fixed factors”. They include:
- Family history of early coronary heart disease (CHD) or stroke. you’re more likely to have high cholesterol if you have a close male relative (father or brother) aged under 55, or a female relative (mother or sister) aged under 65, who’s had CHD or stroke.
- Age. The older you are, the greater the likelihood of your arteries narrowing (atherosclerosis).
- Males are more likely to have heart attacks than females.
How is High Cholesterol Diagnosed?
There are usually no signs or symptoms that you have high cholesterol, but there is a blood test to measure your cholesterol level. When and how often you should get this test depends on your age, risk factors, and family history.
The general recommendations are:
For people who are age 19 or younger
- The first test should be between ages 9 to 11.
- Children should have the test again every 5 years.
- Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke.
For people who are age 20 or older:
- Younger adults should have the test every 5 years.
- Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years.
- Overweight or obese should be tested.
- If you have another medical condition, such as kidney disease, an underactive thyroid, or an inflamed pancreas (pancreatitis), these conditions can cause increased levels of cholesterol or triglycerides.
- Having high blood pressure or diabetes.
How to Treat and Reduce High Cholesterol Levels
Lifestyle changes including diet and exercise are the first line of action to reduce cholesterol levels. A report from Harvard Health has identified 11 cholesterol-lowering foods that actively decrease cholesterol levels. They are:
- Barley and whole grains.
- Eggplant and okra.
- Vegetable oil (canola, sunflower).
- Fruits (mainly apples, grapes, strawberries, and citrus).
- Soy and soy-based foods.
- Oily fish (particularly salmon, mackerel, tuna, and sardines).
- Foods rich in fiber.
But, if you’ve made these important lifestyle changes and your cholesterol levels remain high, your doctor might recommend medication. The choice of medication or combination of medications depends on various factors, including your personal risk factors, your age, your health and possible drug side effects. Common choices include:
- Statins. Statins block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Statins can also help your body reabsorb cholesterol from built-up deposits on your artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
- Bile-acid-binding resins: Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
- Cholesterol absorption inhibitors: Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Ezetimibe can be used with a statin drug.
- Injectable medications: A newer class of drugs, known as PCSK9 inhibitors, can help the liver absorb more LDL cholesterol — which lowers the amount of cholesterol circulating in your blood. Alirocumab (Praluent) and evolocumab (Repatha) might be used for people who have a genetic condition that causes very high levels of LDL or in people with a history of coronary disease who have intolerance to statins or other cholesterol medications.
If you also have high triglycerides, your doctor might prescribe:
- Fibrate: The medications fenofibrate (TriCor, Fenoglide, others) and gemfibrozil (Lopid) reduce your liver’s production of very-low-density lipoprotein (VLDL) cholesterol and speed the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides. But using fibrates with a stain can increase the risk of statin side effects.
- Niacin: Niacin limits your liver’s ability to produce LDL and VLDL cholesterol. But niacin doesn’t provide additional benefits over statins. Niacin has also been linked to liver damage and strokes, so most doctors now recommend it only for people who can’t take statins.
- Omega-3 fatty acid supplements: Omega-3 fatty acid supplements can help lower your triglycerides. They are available by prescription or over-the-counter. If you choose to take over-the-counter supplements, get your doctor’s OK. Omega-3 fatty acid supplements could affect other medications you’re taking.
- MedlinePlus – Cholesterol
- Heart.Org – Prevention & Treatment of High Cholesterol
- FamilyDoctor – Cholesterol
- MayoClinic – Symptoms and Causes