Cholesterol is a waxy, fat-like substance that your body needs for good health, but in the right amounts. Unhealthy levels of cholesterol can lead to a condition called high blood cholesterol.
Cholesterol in your blood is carried on lipoproteins:
- Low-density lipoprotein (LDL), sometimes called “bad” cholesterol
- High-density lipoprotein (HDL), sometimes called “good” cholesterol.
High levels of “bad” LDL cholesterol cause plaque (fatty deposits) to build up in your blood vessels. This may lead to heart attack, stroke, or other health problems.
“Good” HDL cholesterol returns cholesterol to your liver so it can be removed from the body. In healthy people high levels of HDL cholesterol may lower your risk of heart attack, stroke, and other health problems.
Unhealthy cholesterol levels are often caused by lifestyle habits, such as unhealthy eating patterns, in combination with the genes that you inherit from your parents.
Routine blood tests can show whether your cholesterol levels are healthy. To help get your cholesterol levels into the healthy range, you may need heart-healthy lifestyle changes or medicines.
Explore this Health Topic to learn more about high blood cholesterol, our role in research and clinical trials to improve health, and where to find more information.
Causes - Blood Cholesterol
An unhealthy lifestyle is the most common cause of high “bad” LDL cholesterol or low “good” HDL cholesterol. However, that you from your parents, other medical conditions, and some medicines may also cause unhealthy cholesterol levels.
Unhealthy lifestyle habits
Unhealthy habits such as these are a common cause of unhealthy cholesterol levels:
- Eating a lot of foods high in saturated fats or , which increase “bad” LDL cholesterol. Saturated fats are found in fatty cuts of meat and dairy products. No more than 10% of your daily calories should come from saturated fats. Trans fats are often found in packaged snacks or desserts. Read the label and eat as little food with trans fats as possible.
- Lack of physical activity, such as spending a lot of time in front of a TV or computer. These patterns are linked with lower levels of “good” HDL cholesterol.
- Smoking, which lowers HDL cholesterol, particularly in women, and raises LDL cholesterol.
- Stress, which may raise levels of certain , such as . These can cause your body to make more cholesterol.
- Drinking too much alcohol or binge drinking, which can raise your total cholesterol level.
Learn about heart-healthy lifestyle changes you can make to lower your risk for high blood cholesterol.
Some people may develop high “bad” LDL cholesterol because of , or changes, in their genes. These may be passed from parent to child, which can cause . If you have a family history of high blood cholesterol, it may be more difficult for your body to remove LDL cholesterol from your blood or break it down in the liver.
Other medical conditions
Some medical conditions may raise LDL cholesterol levels or lower HDL cholesterol.
- Chronic kidney disease
- HIV infection
- Lupus erythematosus
- Multiple myeloma
- Overweight and obesity
- Polycystic ovary syndrome (PCOS)
- Sleep apnea
Some medicines that you take for other health problems can raise your level of “bad” LDL cholesterol or lower your level of “good” HDL cholesterol.
- Antiretroviral medicines used to treat HIV
- Arrhythmia medicines, such as amiodarone
- Beta-blockers for relieving angina chest pain or treating high blood pressure
- Chemotherapy medicines used to treat cancer
- Diuretics such as thiazide to treat high blood pressure
- Immunosuppressive medicines, such as cyclosporine, to treat diseases or to prevent rejection after organ transplant
- Retinoids to treat acne
- Steroids, such as prednisone, to treat inflammatory diseases including lupus, rheumatoid arthritis, and psoriasis
Risk Factors - Blood Cholesterol
Your risk for high blood cholesterol may be higher because of your age, family history and genetics, race or ethnicity, or sex.
Unhealthy levels of cholesterol can affect people of all ages, even young children. However, high cholesterol is most commonly diagnosed in people between the ages of 40 and 59. As you age, your body’s metabolism changes. Your liver does not remove “bad” LDL cholesterol as well as it did when you were young. These normal changes may increase your risk for developing high blood cholesterol as you get older.
Family history and genetics
Family members usually have similar cholesterol levels. This suggests that your genes can raise your risk of having unhealthy cholesterol levels.
In addition, your genes may raise your risk for another type of “bad” cholesterol. High levels of lipoprotein-a, also called Lp(a), may mean you are at high risk of heart or blood vessel diseases, even if your other cholesterol levels are healthy. Genes determine how much Lp(a) you have. Your Lp(a) level is unlikely to change much from childhood to old age.
Lp(a) is not usually part of a routine lipid panel. Your doctor may order an Lp(a) test if you have a family history of early heart or blood vessel disease, such as heart attack, or do not know your family medical history. If you have a high Lp(a) level, your doctor may prescribe a to prevent heart and blood vessel disease, even if your other cholesterol levels are in the healthy range.
Race or ethnicity
Your race or ethnicity may affect your risk of high blood cholesterol.
- Overall, non-Hispanic white people are more likely than other groups to have high levels of total cholesterol.
- Asian Americans, including those of Indian, Filipino, Japanese, and Vietnamese descent, are more likely to have high levels of “bad” LDL cholesterol than other groups.
- Hispanic Americans are more likely to have lower levels of “good” HDL cholesterol than other groups.
- African Americans are more likely than other groups to have high levels of “good” HDL cholesterol. However, they are more likely to have other risk factors, such as high blood pressure, obesity, or diabetes, that may overcome the health benefit of higher HDL levels.
Between the ages of 20 and 39, men have a greater risk for high total cholesterol than women. Women are more likely to have high blood cholesterol than men at other ages. Women usually have higher levels of “good” HDL cholesterol.
Conditions and medicines that may raise a woman’s risk for high blood cholesterol include:
- Birth control pills. However, not all types of birth control pills affect cholesterol levels, and the effect is not very strong.
- Menopause, which lowers levels of female hormones that may protect against high blood cholesterol. After menopause, women’s levels of total and “bad” LDL cholesterol usually go up, while their levels of “good” HDL cholesterol go down.
- Pregnancy may cause your total cholesterol levels to rise, but usually not enough to cause problems for you or your unborn baby. Usually, cholesterol levels return to normal after pregnancy.
Screening and Prevention - Blood Cholesterol
Your doctor may order a blood test called a panel to screen for unhealthy cholesterol levels. Adopting a heart-healthy lifestyle starting in childhood and continuing throughout your life can help prevent high blood cholesterol.
Lipid panel tests to screen for high blood cholesterol
A lipid panel usually measures total cholesterol, LDL cholesterol, and HDL cholesterol. Your test results may also show the level of non-HDL cholesterol, which includes all fats (including "bad" LDL cholesterol) that raise your risk of heart and blood vessels diseases. It may also include a test for triglycerides.
Ask your doctor if you need to fast before a lipid panel. This means you do not eat or drink anything except water for 9 to 12 hours before your visit. Ask your doctor about taking your medicines before the test.
How often you get a lipid panel done depends on your age, risk factors, and family history of high blood cholesterol or cardiovascular diseases, such as atherosclerosis, heart attack or stroke. Here is a general guide:
- Age 19 or younger. Screening begins at ages 9 to 11 and should be repeated every 5 years. Screening may be performed as early as age 2 if there is a family history of high blood cholesterol, heart attack, or stroke.
- Age 20 to 65. Younger adults should be screened every 5 years. Men ages 45 to 65 and women ages 55 to 65 should be screened every 1 to 2 years.
- Older than 65. Older adults should be screened every year.
If your blood cholesterol levels are not within the healthy range for your age and sex, your doctor may order a repeat lipid profile test, especially if you were not fasting before your first lipid panel. Also, it is important to know that your risk of coronary heart disease and stroke is based on several other factors, not just your cholesterol levels. These factors include things like your age, race, and lifestyle habits.
Living a heart-healthy lifestyle may help prevent unhealthy levels of blood cholesterol. This includes:
- Eating healthy
- Being physically active
- Aiming for a healthy weight
- Quitting smoking
- Managing stress
- Getting enough good quality sleep
Limiting how much alcohol you drink may also lower your risk of high blood cholesterol.
Signs, Symptoms, and Complications - Blood Cholesterol
High “bad” LDL cholesterol usually does not cause symptoms, so most people do not know they have it until they are tested during a routine doctor’s visit. Very high levels may cause symptoms such as fatty bumps on your skin, called xanthomas, or grayish-white rings around the corneas in your eye, called corneal arcus. These mostly develop in people who have familial hypercholesterolemia.
Undiagnosed or untreated high blood cholesterol can lead to serious problems, such as heart attack and stroke.
High blood cholesterol can lead to a condition called atherosclerosis, in which plaque builds up in the blood vessels throughout your body. Over time, uncontrolled high blood cholesterol can cause the following heart or blood vessel diseases:
- Carotid artery disease
- Coronary heart disease. You may feel chest pain (called angina)
- Heart attack
- Peripheral artery disease
- Sudden cardiac arrest
Your doctor may use a risk calculator to estimate the chances of having one of these complications in the next 10 years or over your lifetime. For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Estimator considers your cholesterol levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol.
Talk with your doctor about your cholesterol levels and your risk of developing heart and blood vessel disease. Knowing your level of risk helps your doctor decide whether you need medicine to treat high cholesterol and what healthy lifestyle changes you may need to make to lower your risk.
To treat complications, you may need heart-healthy lifestyle changes, medicines, surgery, or other procedures. Certain medical devices, such as a stent to hold open a narrowed artery or a pacemaker to correct a rhythm disorder, can help keep your heart healthy. Learn more about steps you can take to prevent complications from high blood cholesterol.
Do you know how high blood cholesterol can cause complications?
Your cells need some cholesterol but too much can cause problems. Cholesterol in your blood is carried on lipoproteins such as HDL and LDL. HDL carries cholesterol to your liver, where it can be removed from the body. In this way, HDL cholesterol helps protect your heart from atherosclerosis. That’s why HDL cholesterol is sometimes called “good” cholesterol.
LDL carries most of the cholesterol in your blood to tissues throughout the body. LDL cholesterol is removed from the blood by the liver to be reused or removed from the body. When LDL cholesterol in the blood is too high, the liver cannot remove all of it. Instead, the LDL cholesterol builds up in the blood vessels, leading to atherosclerosis. That’s why LDL cholesterol is sometimes called “bad” cholesterol.
Diagnosis - Blood Cholesterol
Your doctor will diagnose you with high blood cholesterol based on blood tests of your cholesterol levels, your medical and family history, and a physical exam. Your doctor may do other tests to assess your risk of complications from high blood cholesterol.
Confirming unhealthy cholesterol levels
A lipid panel usually measures total cholesterol, LDL cholesterol, and HDL cholesterol. Your test may also show the level of non-HDL cholesterol, which includes LDL and all other types of “bad” cholesterol that raise your risk of atherosclerosis and complications.
Your doctor may diagnose you with high blood cholesterol if your total or non-HDL cholesterol level is higher than what is healthy for you. Your doctor might also find that your level of “good” HDL cholesterol is too low.
Your doctor may ask that you fast before a lipid panel. This means you do not eat or drink anything except water for 9 to 12 hours before your blood is drawn. Ask you whether you should take your usual medicines before the test and if there are any other special instructions.
Your doctor may order other tests to help decide whether medicines are needed to lower your risk of heart and blood vessel diseases. These may include a coronary calcium scan, and blood tests for levels of C-reactive protein (CRP) and lipoprotein-a.
Medical history and physical exam
Your doctor will ask about your eating habits, physical activity, family history, medicines you are taking, and risk factors for heart or blood vessel diseases.
During your physical exam, your doctor will check for signs of very high blood cholesterol, such as xanthomas, or signs of other health conditions that can cause high blood cholesterol.
Treatment - Blood Cholesterol
Unhealthy blood cholesterol levels are treated with heart-healthy lifestyle changes and medicines. People who have familial hypercholesterolemia may need special procedures.
If a medical condition or medicine is causing your blood cholesterol problem, your doctor may treat the condition or change your medicine or its dose.
Talk with your doctor about your cholesterol levels, your risk of developing heart or blood vessel disease, other medical conditions you have, and your lifestyle. Your doctor can tell you about the benefits and side effects of medicines for lowering your blood cholesterol. Together, you can set up a treatment plan that will work for you.
Healthy lifestyle changes
To help you lower your LDL cholesterol level, your doctor may talk to you about adopting a healthy lifestyle.
- Heart-healthy eating. As recommended in the 2015–2020 Dietary Guidelines for Americans, heart-healthy eating includes limiting saturated and trans fats that are found in fatty cuts of meat, dairy products, and many packaged snacks or desserts. The guidelines also recommend eating fish high in omega-3 fatty acids, nuts, and certain vegetable oils such as olive oil. The Therapeutic Lifestyle Changes and DASH eating plans can help you lower your “bad” LDL cholesterol. These plans also encourage eating whole grains, fruits, and vegetables rather than refined carbohydrates such as sugar. Talk to your doctor about other nutritional changes that you can make.
- Get regular physical activity. There are many health benefits to being physically active and getting the recommended amount of physical activity each week. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your “good” HDL cholesterol. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
- Aim for a healthy weight. If you have high blood cholesterol and overweight or obesity, you can improve your health by aiming for a healthy weight. Research has shown that adults with overweight and obesity can lower “bad” LDL cholesterol and raise “good” HDL cholesterol by losing only 3% to 5% of their weight.
- Manage stress. Research has shown that chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels.
- Quit smoking. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
- Get enough good quality sleep. Sleep helps heal and repair your heart and blood vessels. The recommended amount for adults is 7 to 9 hours of sleep a day.
- Limit alcohol. Visit the National Institute on Alcohol Abuse and Alcoholism for resources on support and treatment to stop drinking.
Depending on your risk for complications such as heart attack and stroke and whether you are able to lower your high blood cholesterol levels with lifestyle changes alone, your doctor may prescribe a medicine.
If your doctor prescribes medicines as part of your treatment plan, be sure to continue your healthy lifestyle changes. The combination of the medicines and heart-healthy lifestyle changes can help lower and control your blood cholesterol levels.
Doctors now have a range of medicines they can prescribe to treat high blood cholesterol.
- Statins are the most common medicine used to treat high blood cholesterol. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol. Statins usually don’t cause side effects, but they may raise the risk of diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who have prediabetes, overweight or obesity, or metabolic syndrome. Statins may also cause abnormal results on liver tests, but actual liver damage is extremely rare. Other rare side effects include muscle damage. Learn more about how you can stay safe while taking statins.
- Ezetimibe may be used if you have familial hypercholesterolemia, if statins cause side effects, or if statin treatment and lifestyle changes do not lower your “bad” LDL level enough. In rare cases, ezetimibe can cause liver injury.
- Bile acid sequestrants may be prescribed if you cannot take statins or if you need to lower your cholesterol even more than a statin taken alone. This medicine may cause diarrhea, make some other medicines less effective, or raise your blood triglyceride level.
- PCSK9 inhibitors are a type of medicine that you inject under your skin every 2 or 4 weeks. Your doctor may prescribe a PCSK9 inhibitor and a statin if you are at high risk of complications like heart attack or stroke, or if you have familial hypercholesterolemia. The most common side effects are itching, pain, or swelling at the place where you injected it.
- Lomitapide may be prescribed if you have familial hypercholesterolemia. If you take lomitapide, your doctor will check your liver enzymes regularly, because this medicine can cause liver injury. Your doctor will also recommend that you take vitamin E and other supplements.
- Mipomersen may also be used to treat familial hypercholesterolemia. If you take this medicine, your doctor will regularly check your liver because of the risk of liver injury.
Want to know how these medicines work to manage cholesterol?
- Statins work by lowering the amount of cholesterol made by the liver and by helping the liver remove cholesterol from the blood. Statins also work against atherosclerosis by reducing .
- Ezetimibe keeps cholesterol in your food from being absorbed in the intestine.
- Bile acid sequestrants help bile acids, which are made of cholesterol, stay in the intestines so they can be removed from the body instead of being reabsorbed. Bile acids help you digest fats and oils. Once they are removed, the liver uses up more cholesterol to make more bile acids. This lowers cholesterol in the blood.
- PCSK9 inhibitors are monoclonal antibodies that prevent LDL receptors on your liver from being destroyed. With more receptors, the liver can remove more “bad” LDL cholesterol from the blood.
- Lomitapide prevents the liver from releasing a needed to make “bad” LDL cholesterol. This in turn lowers the levels of “bad” LDL cholesterol in the blood.
- Mipomersen lowers levels of non-HDL cholesterol in the blood.
Some people with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis is similar to dialysis, in that it uses a filtering machine to remove unwanted substances from the body. In lipoprotein apheresis, the machine removes “bad” LDL cholesterol from the blood, then returns the remainder of the blood to your body.
Living With - Blood Cholesterol
If you have been diagnosed with unhealthy levels of blood cholesterol, it is important that you continue your treatment. Follow-up care depends on your cholesterol levels, your risk of complications such as a heart attack or a stroke, and your response to treatment.
Monitor your condition
Follow up with your doctor regularly to see how well your treatment is working, whether you need to add or change medicines, and whether your health condition has changed.
- Take all medicines regularly, as prescribed. Do not change the amount of your medicine or skip a dose unless your doctor tells you to.
- Talk with your doctor about how often you should schedule office visits and blood tests.
- Call your doctor if you have any symptoms of complications or if you have problems with your blood pressure or blood sugar.
- Adopt a heart-healthy lifestyle. Your doctor will recommend that you make lifelong lifestyle changes, including heart-healthy eating, being physically active, quitting smoking, managing stress, and managing your weight. Your doctor may refer you to a dietitian to help you plan healthy meals and an exercise professional who can help you increase activity and improve your fitness level.
If heart-healthy lifestyle changes alone are not enough, your doctor may prescribe a statin or another medicine to help lower and control your high blood cholesterol levels.
If you start taking a statin or another cholesterol medicine, your doctor may order a lipid panel one to three months later to see whether the drug is working. Repeat tests may be done every three to 12 months after that to make sure your cholesterol levels remain healthy.
Learn the warning signs of serious complications and have a plan
High blood cholesterol can lead to serious cardiovascular complications, such as heart attack or stroke. If you think that you are or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.
Heart attack symptoms include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. This discomfort can feel like pressure, squeezing, fullness, heartburn, or indigestion. There also may be pain down the left arm or in the neck. Although both men and women can experience these symptoms, women are more likely to have other, less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.
Read more about the signs and symptoms of a stroke.
Learn about other precautions to help you stay safe while taking statins
Statins are the most common medicine used to treat high blood cholesterol. Learn some tips to stay safe if your doctor gives you statins.
- Keep taking your statin medicine as prescribed. If you started taking a statin after you recently had a heart attack, a stroke, or another complication, you should not stop taking this medicine on your own, because that can increase your risk for a repeat event or even death. Ask your doctor if you have any concerns about your medication or if you would like to stop or change to a different treatment.
- Ask your doctor what medicines, nutritional supplements, or foods you should avoid. Some of these can interact with statins to cause serious side effects or make them less effective. For example, grapefruit (fresh or as juice) affects how your liver breaks down some statins.
- Tell your doctor about any symptoms or side effects. Sometimes, people report muscle problems while taking statins. If you start having muscle pain, your doctor may order a blood test to look for muscle damage. The pain may go away if you switch to a different statin. Muscle damage with statins is rare, and your muscles may heal when you switch to a different medicine.
- If you are a woman who is planning to become pregnant, talk to your doctor about your options. You should stop taking statins about three months before getting pregnant. Also, you should not take statins if you are breastfeeding.
Research for Your Health
Improving health with current research
- Blood Cholesterol
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have high blood cholesterol. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
- NHLBI Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. We support the development of guidelines based on up-to-date research to evaluate and manage risk for heart and blood vessel complications, such as heart attacks, in children and adolescents. Research shows that having high blood cholesterol and other risk factors for heart and blood vessel disease during childhood raises your risk for developing plaque in your blood vessels in adulthood. Visit Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report for more information.
- Advancing Research in HIV/AIDS-Related Heart and Blood Vessel Diseases. In 2019, the NHLBI became the primary steward of the Multicenter AIDS Cohort Study(MACS)/Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MACS/WIHS-CCS). This trans-NIH collaborative research effort aims to understand and reduce the impact of chronic health conditions that affect people living with HIV. The MACS/WIHS-CCS will build on decades of research using thousands of men and women participants, to further our understanding of chronic heart, lung, blood, sleep, and other disorders associated with HIV. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) tests the effectiveness of statins to reduce high blood cholesterol and the risk of heart and vascular diseases in adults living with HIV.
- Supporting Coordinated Community Interventions to Prevent Heart Disease. The NHLBI DECIPHeR (Disparities Elimination through Coordinated Interventions to Prevent and Control Heart Disease Risk) initiative is exploring strategies to prevent heart disease, including controlling cholesterol levels in the blood. The strategies will be matched to the needs and resources of communities across the United States
- Federal Dietary Guidelines for Americans. We continue to provide medical, nutritional, and other scientific expertise to the United States Department of Agriculture and HHS that publish the 2015–2020 Dietary Guidelines for Americans with information about the latest science-based nutritional recommendations. With NHLBI input, the dietary guidelines are updated to reflect current research about the effect of eating patterns on blood cholesterol levels. For example, the 2015 guidelines showed that dietary cholesterol might not affect amounts of cholesterol in the blood as much as was thought in the past.
- Global Leadership in Cardiovascular Health. We are proud to serve as a global leader and respond to legislative calls to increase U.S. global health efforts. The Health Inequities and Global Health Branch seeks to stimulate global health research, education, and training for many conditions, including high blood cholesterol.
- Advancing Research in Dementia and Disability as well as Heart Attacks and Cardiovascular Deaths. In 2019, we co-funded with the National Institute on Aging a major study called Pragmatic Evaluation of Events and Benefits of Lipid-Lowering in Older Adults (PREVENTABLE). The researchers looked at the overall benefits and risks of cholesterol-lowering statins in adults age 75 or older without heart or blood vessel disease. The study will help determine whether a statin can help prevent dementia and disability in this age group, as well as heart attacks, while not increasing risks of adverse health outcomes.
- South Asian Origin as a Key Risk Factor for Coronary Heart Disease. We supported the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, the first long-term study to look at the factors leading to coronary heart disease in South Asians in the United States and guide prevention and treatment. The American Heart Association used MASALA data in its cholesterol guidelines, which recommend that South Asians be considered a high-risk group and therefore carefully considered for statin treatment.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
- Discovering cholesterol as a risk factor for cardiovascular disease. The Framingham Heart Study began in 1948 and helped discover that LDL and HDL cholesterol levels can help predict the risk of heart and blood vessel diseases such as heart attack and stroke. Visit the Framingham Heart Study for more information.
- Conducting research that helped discover statins. The Lipid Research Clinics Coronary Prevention Trial was done from 1973 to 1989 and provided data to see whether lowering LDL cholesterol and total cholesterol could decrease rates of heart disease and mortality. This stimulated new research that helped develop statins as a treatment to decrease LDL cholesterol levels in the blood. Visit Lipid Research Clinics Coronary Primary Prevention Trial for more information.
- Investigating how heart and blood vessel diseases develop and progress in children and young adults. The Bogalusa Heart Study ran from 1973 to 1996. It found, among other things, that PCSK9 variants are associated with significantly lower LDL cholesterol levels. This discovery helped catalyze new research into PCSK9 that led to Food and Drug Administration (FDA)–approved treatments for high blood cholesterol that inhibit PCSK9 protein. Visit Bogalusa Heart Study for more information.
- Studying how plaque forms in the blood vessels. The Atherosclerosis Risk in Communities Study (ARIC) was done from 1987 to 2016 to assess the progression and causes of plaque buildup and find out how cholesterol and other factors increase the risk for plaque buildup. ARIC also examined how risk factors, medical care, and disease vary based on location, time, and race and gender of the patient. Visit the Atherosclerosis Risk in Communities Study for more information.
- Discovering how the DASH eating plan lowers high blood pressure and cholesterol. The NHLBI funded the DASH trial from 1993 to 1997. The study showed the health benefits of the DASH eating plan in lowering high blood pressure and LDL cholesterol. It found that while the DASH plan also decreases HDL cholesterol, it helps overall in preventing heart disease. Visit the DASH Eating Plan for more information.
- Comparing effects of statin and diet treatment with diet alone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study began in 1994 and lasted eight years. One of its purposes was to compare the effects of a cholesterol-lowering statin medicine and diet with the effects of diet alone to prevent heart and blood vessel diseases. At the end of the study, both groups had significantly lower cholesterol, probably because many participants in the usual care group received a cholesterol-lowering drug. Visit the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial for more information.
- Studying HDL cholesterol. The NHLBI Proteomics Initiative began in 2002 and ended in 2009. It involved a consortium of 10 research centers that developed innovative technologies in proteomics—the study of large groups of proteins in cells, tissues, and organs. One of the proteins studied was HDL; researchers looked at its various functions, such as its ability to carry cholesterol to the liver and prevent modifications of LDL that are related to plaque formation.
- Improving HDL cholesterol benefits of the DASH eating plan. The OmniHeart Study, funded by the NHLBI from 2003 to 2005, was developed to try to improve the DASH eating plan. The goal was to maintain DASH’s “bad” LDL cholesterol–lowering effect while increasing “good” HDL cholesterol. Researchers replaced carbohydrates with either protein or monounsaturated fats and found that protein had a better effect on the lipid profiles of study subjects by lowering LDL cholesterol and triglycerides. Monounsaturated fats lowered triglycerides and increased HDL cholesterol but had no effect on LDL cholesterol. Visit the OmniHeart Study for more information.
- Assessing heart disease risk in young adults. Findings from the NHLBI’s Coronary Artery Risk Development in Young Adults (CARDIA) study have contributed substantially to our knowledge about the importance of lifestyle and environmental factors in the development of coronary heart disease and its complications later in life. The study collected data on risk factors such as blood pressure, levels of cholesterol and other lipids, and blood glucose (sugar) levels. CARDIA showed the importance of encouraging young people to maintain a healthy lifestyle to reduce their risk of heart and blood vessel complications, including heart attack, in middle age.
- Informing treatment for high blood cholesterol. The Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) Study helped to inform best clinical care practices for increasing levels of “good” HDL cholesterol. It discovered that adding niacin to statin treatment was not more effective in preventing heart attacks and strokes than statin treatment alone. The study ended early and led the FDA to stop approving the use of niacin with statins to prevent heart attack or stroke.
Advancing research for improved health
- Blood Cholesterol
In support of our mission, we are committed to advancing high blood cholesterol research in part through the following ways.
- We perform research. Our Division of Intramural Research, which includes investigators in our Lipoprotein Metabolism Laboratory within our Cardiovascular Branch, seeks to better understand cholesterol metabolism to advance the treatment and prevention of heart and blood vessel disease.
- We fund research. The research we fund today will help improve our future health. Our Division of Cardiovascular Sciences oversees much of the research on high blood cholesterol we fund, helping us to understand, prevent, and manage heart and blood vessel conditions. Search the NIH RePORTer to learn about research the NHLBI is funding on high blood cholesterol.
- We stimulate high-impact research. Our Trans-Omics for Precision Medicine (TOPMed) program includes participants who have high blood cholesterol, which may help us understand how genes contribute to differences in disease severity and how patients respond to treatment. The NHLBI Strategic Vision highlights ways in which we may support research over the next decade, including new efforts to understand high blood cholesterol.
Learn about exciting research the NHLBI is exploring in the area of high blood cholesterol.
- How cholesterol levels in pregnancy may affect the placenta. NHLBI scientists found that the placentas of pregnant women who had unhealthy cholesterol levels early in pregnancy aged faster. Rapid placental aging raises the risk of pregnancy complications such as preeclampsia (high blood pressure during pregnancy) and preterm birth. Taking steps to get high blood cholesterol under control before or early in pregnancy may help keep the placenta healthy and reduce pregnancy risks.
- The link between sleep in teens and risk factors for heart and blood vessel diseases. Teens who do not get enough sleep may have a higher likelihood of developing risk factors for heart disease, such as high blood cholesterol and excess body fat. A large study, partly funded by the NHLBI, tracked sleep and daytime activity of more than 800 teens for 7 to 10 days. Nearly a third of the teens slept less than 7 hours a night. These teens tended to have less healthy cholesterol levels, more body fat, and higher blood pressure. Visit Poor sleep among teens may increase their risk of heart disease to learn more.
- The role of gut immune cells in metabolism and risk for heart and blood vessel disease. NHLBI-funded researchers studied mice that did not have a type of immune cell in the lining of their guts. The cells, called intraepithelial T lymphocytes or natural IELs, slow down the body’s metabolism and conserve the energy it gets from food. Mice without these natural IELs had faster metabolisms. Even when their diet was very high in fat and sugar, the mice did not develop high blood cholesterol or atherosclerosis. This research could lead to new ideas based on targeting IELs in humans for possibly preventing and treating heart and blood diseases caused by high blood cholesterol in humans. Visit Some gut cells slow down metabolism, accelerate cardiovascular disease for more information.
- Finding a vaccine to reduce blood cholesterol. The PCSK9 protein prevents the liver from removing “bad” LDL cholesterol from the blood. The NHLBI is funding research to develop a vaccine that may reduce the PCSK9 protein, decreasing blood cholesterol levels in blood.
- Using big data to personalize statin therapy. About half of people who are prescribed statins do not get the full benefit of their treatment, because they stop using the statins within a year of starting. Sometimes people stop because of side effects, but other times they stop because they do not fully understand the importance of long-term treatment to lower cholesterol. The NHLBI is supporting a study that will use data from health records and insurance claims to create a personalized tool to help doctors prescribe statins in a way that makes it easier for people to stick with their treatment plan. Visit Personalized Statin Treatment Plan to Optimize Clinical Outcomes Using Big Data for more information.
Participate in NHLBI Clinical Trials
We lead or sponsor many studies on high blood cholesterol. See if you or someone you know is eligible to participate in our and .
Trials at the NIH Clinical Center
Testing for cholesterol and other fats in the blood
Statin use to decrease cholesterol plaque buildup
High levels of cholesterol and other fats in the blood
Studying genes in families that have high levels of cholesterol and other fats in the blood
Research on cholesterol disorders
To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment 800-411-1222.
Are you living with HIV and high blood cholesterol or high blood pressure?
Do you or does your child have a lipid disorder and want to improve future diagnosis and treatment?
Do you or your child have obesity and high blood cholesterol or triglycerides?
Do you take medicine for high blood pressure or high blood cholesterol?
Are you being treated for a chronic health condition in Wisconsin?
Are you interested in getting text messages to remind you to take your medicines for heart health or diabetes?
Do you or your child have a lipid disorder and want to help research?
After reading our High Blood Cholesterol Health Topic, you may be interested in additional information found in the following resources.
Related Health Topics
- Blood Cholesterol
- Atherosclerosis Risk in Communities Study (ARIC)
- Cardiovascular Health Study
- Coronary Artery Risk Development in Young Adults Study (CARDIA)
- Framingham Heart Study (FHS)
- Heart and Vascular Diseases
- Jackson Heart Study
- Multi-Ethnic Study of Atherosclerosis (MESA)
- Pediatric Heart Network (PHN)
- Population and Epidemiology Studies
- Sleep Health
- Strong Heart Study (SHS)
- The Heart Truth® for Women Campaign
- Trans-Omics for Precision Medicine (TOPMed) Program
- Vascular Dementia: Exercise, Blood Flow, and the Aging Brain
- Women’s Health
- Women’s Health Initiative (WHI)
- Blood Cholesterol
- Atherosclerosis (National Library of Medicine [NLM], MedlinePlus)
- Atrial Fibrillation (NLM, Medline Plus)
- Cholesterol (NLM MedlinePlus)
- Cholesterol Good and Bad Video (NLM, MedlinePlus)
- Controlling Cholesterol with Statins (Food and Drug Administration)
- Coronary Artery Disease (Centers for Disease Control and Prevention [CDC])
- Coronary Artery Disease (NLM, MedlinePlus)
- Diabetes (NLM, MedlinePlus)
- Dietary Guidelines for Americans 2015–2020, Eighth Edition (U.S. Department of Health and Human Services [HHS] and U.S. Department of Agriculture)
- Heart Attack (NLM, MedlinePlus)
- Heart Disease and Stroke (CDC)
- Heart Disease and Women (Office on Women’s Health, HHS)
- Heart Disease in Women (NLM, MedlinePlus)
- High-Risk Pregnancy (Eunice Kennedy Shriver National Institute on Child Health and Human Development [NICHD])
- Million Hearts® (CDC and Centers for Medicare & Medicaid Services, HHS)
- Physical Activity Guidelines (HHS)
- Preeclampsia and Eclampsia (NICHD)
- Recovering After Stroke (NLM, MedlinePlus)
- Statins (NLM, MedlinePlus)
- Stroke (NLM, MedlinePlus)
- Stroke Information Page (National Institute of Neurological Disorders and Stroke [NINDS])
- Transient Ischemic Attack Information Page (NINDS)