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by Scholten A
(Cholesterol, High; Hypercholesterolemia)

Definition

Cholesterol is a type of fat in the blood. High cholesterol is when there is too much of this fat. There are 2 types:

  • LDL or "bad cholesterol"—causes fats to build up in blood vessels.
  • HDL or "good cholesterol"—removes fats from the blood.

High LDL cholesterol can raise the risk of stroke and heart disease. High HDL cholesterol can lower the risk of stroke and heart disease.

Causes

Cholesterol is made in the liver and comes from food we eat. High cholesterol may be caused by one or more of the following:

  • Changes in liver
  • Genes that affect how your body makes cholesterol or uses cholesterol from food
  • Health issues or medical care
  • Behaviors like food choice and activity

Risk Factors

Things that raise the risk of high cholesterol are:

  • Family members with high cholesterol
  • Lifestyle habits such as:
    • Physical inactivity—can increase LDL and decrease HDL
    • Cigarette smoking—can decrease HDL
    • Excess alcohol intake
    • Diets that are very high in sugar or certain fats
  • Certain medical conditions such as:
    • Metabolic syndrome
    • Type 2 diabetes
    • Some diseases of the kidneys, liver or thyroid
    • Excess weight
  • Certain medicines such as:
    • Progestins in birth control pills
    • Steroids and corticosteroids
    • Protease inhibitors to treat HIV

Symptoms

High cholesterol levels usually do not cause symptoms.

Atherosclerosis
atherosclerosis
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Diagnosis

Cholesterol can be measured in the blood. The test is done as part of a regular screening. For healthy adults this may be every few years. Those with risk factors for heart disease may be screened more often. Children may be screened if they are obese or have a family history of high cholesterol.

Cholesterol screening is part of a blood test that will include:

  • Total cholesterol
  • HDL cholesterol
  • LDL cholesterol
  • Triglycerides

A doctor can advise how often a person should be tested for high cholesterol. This is often based on the person's family and medical history.

Treatment

The goal of treatment is to lower cholesterol levels. This will also help to lower the risk for heart disease and stroke. Treatment options include:

Medications

Statins are a medicine that may help lower cholesterol. They may reduce the risk of heart attack and stroke.

Even when using medicine, diet and exercise are important.

Lifestyle Changes

Other steps that can help lower cholesterol levels include:

  • Reaching and keeping a healthy weight
  • Quitting smoking
  • Exercising regularly
  • Treating and controlling other medical conditions

Diet Changes

Certain foods and drinks can affect cholesterol levels in some people. To help lower cholesterol levels, the doctor may advise:

Prevention

To help reduce the chance of having high cholesterol, talk to the doctor about:

  • When to get blood tests
  • How to eat a healthier diet
  • What type of exercise is best
  • How to quit smoking or drinking alcohol
  • How to control health problems such as diabetes

RESOURCES

American Heart Association  http://www.heart.org 

National Heart, Lung, and Blood Institute  https://www.nhlbi.nih.gov 

CANADIAN RESOURCES

Dietitians of Canada  https://www.dietitians.ca 

Heart and Stroke Foundation of Canada  http://www.heartandstroke.ca 

References

Balder J, Rimbert, A, et al. Genetics, lifestyle, and low-density lipoprotein cholesterol in young and apparently healthy women. Circulation. 2018 Feb 20;137(8):820-831.

High blood cholesterol. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/high-blood-cholesterol. Accessed January 2021.

Hypercholesterolemia. EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/hypercholesterolemia. Accessed January 18, 2021.

Prevention and treatment of high cholesterol. American Heart Association website. Available at: https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia. Accessed January 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 02/2021
  • Update Date: 01/18/2021