High Blood Cholesterol

Also known as Hypercholesterolemia
High blood cholesterol is a condition that causes the levels of certain bad fats, or lipids, to be too high in the blood. This condition is usually caused by lifestyle factors, such as diet, in combination with the genes that you inherit from your parents. Less commonly, it is caused by other medical conditions or some medicines.

You may be diagnosed with high blood cholesterol if you consistently have high levels of bad cholesterol in your blood in a routine test called a lipid panel. To treat high blood cholesterol, your doctor may recommend heart-healthy lifestyle changes, such as heart-healthy eating, quitting smoking, or aiming for a healthy weight. Your doctor may also prescribe medicines, such as statins, to lower and control your high blood cholesterol. Untreated high blood cholesterol can lead to the buildup of plaque in the blood vessels, called atherosclerosis. Plaque buildup increases your risk for heart attack, stroke, and peripheral artery disease.

Explore this Health Topic to learn more about high blood cholesterol, NHLBI’s role in research and clinical trials to improve health, and where to find more information.
Causes

The most common cause of high blood cholesterol is an unhealthy lifestyle. However, the genes that you inherit from your parents, other medical conditions, and some medicines may also cause high blood cholesterol.

Unhealthy lifestyle habits

Unhealthy eating patterns, lack of physical activity, and smoking can cause high blood cholesterol. 

  • Unhealthy eating patterns, such as consuming high amounts of saturated fats or trans fats , can increase bad low-density lipoprotein cholesterol ( LDL cholesterol ).
  • Lack of physical activity, such as spending a lot of time during the day sitting and watching TV or using the computer, is linked with lower levels of good high-density lipoprotein cholesterol ( HDL cholesterol ).
  • Smoking lowers HDL cholesterol, particularly in women, and increases LDL cholesterol.

Read heart-healthy lifestyle changes to learn about eating heart-healthy, being physically active, aiming for a healthy weight, managing stress, and quitting smoking.

Genes

Some people may develop high blood cholesterol because of mutations , or changes, in their genes. These mutations make it harder for the body to clear LDL cholesterol from the blood or break it down in the liver. Familial hypercholesterolemia is one inherited form of high blood cholesterol.

Other medical conditions

The following medical conditions may cause high blood cholesterol:

Medicines

Some medicines that you take for other medical conditions can increase your cholesterol. Examples of these medicines include the following:

  • Diuretics such as thiazide that are used for high blood pressure
  • Immunosuppressive drugs such as cyclosporine that are used to treat inflammatory diseases such as psoriasis or to prevent rejection after a transplant
  • Steroids such as prednisone that are used to treat inflammatory diseases such as lupus and psoriasis
  • Retinoids such as retinol that are used to treat acne
  • Antiretroviral medicines used to treat HIV
  • Antiarrhythmic medicines such as amiodarone that are used in treatment for irregular rhythm of the heart

Look for

  • Treatment will discuss heart-healthy lifestyle changes that your doctors may recommend if you are diagnosed with high blood cholesterol.
Risk Factors

You may have an increased risk for high blood cholesterol because of your age, your family history and genetics, and your race.

Age

Your body’s metabolism and chemistry change as you age. For example, your liver does not remove low-density lipoprotein (LDL) cholesterol as efficiently as when you were young. These normal age-related changes may increase your risk of developing high blood cholesterol.

Family history and genetics

Genetic studies have found that related family members tend to have similar levels of bad or good high-density lipoprotein (HDL) cholesterol. Depending on the genes in your family, you may have an increased risk for high blood cholesterol. Learn more about current research to better understand how genetic differences may affect how our bodies absorb cholesterol from the foods that we eat, how much cholesterol the liver produces and removes, and how we respond to high blood cholesterol treatments.

Race

Your race may also increase your risk for high blood cholesterol. Compared to whites, blacks have higher HDL and LDL cholesterol levels.

Screening and Prevention

Your doctors will order routine lipid panel blood tests to screen for high blood cholesterol. The timing and frequency of these blood tests will depend on your age and risk factors or family history for high blood cholesterol or other cardiovascular diseases such as heart attack or stroke. Learn about heart-healthy lifestyle changes that your doctor may recommend to help you prevent high blood cholesterol.

Lipid panel tests to check for healthy blood cholesterol levels

Doctors use lipid panels to check whether you have healthy levels of cholesterol in your blood. A lipid panel will measure the total cholesterol, high-density lipoprotein (HDL) cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol levels in your blood. Non-HDL cholesterol includes low-density lipoprotein (LDL) cholesterol and is calculated by subtracting your HDL cholesterol levels from your total cholesterol levels. See the table below to learn whether you have healthy blood cholesterol levels based on your age and sex.

Healthy blood cholesterol levels differ by age and sex. If you are age 19 or younger, your total cholesterol levels should be less than 170 milligrams per deciliter (mg/dL) of blood, your non-HDL cholesterol level should be less than 120 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be more than 45 mg/dL. If you are age 20 or older, your total cholesterol should be between 125 and 200 mg/dL, your non-HDL cholesterol level should be less than 130 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be 40 mg/dL or higher if you are a man or 50 mg/dl or higher if you are a woman.
Healthy blood cholesterol levels differ by age and sex. If you are age 19 or younger, your total cholesterol levels should be less than 170 milligrams per deciliter (mg/dL) of blood, your non-HDL cholesterol level should be less than 120 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be more than 45 mg/dL. If you are age 20 or older, your total cholesterol should be between 125 and 200 mg/dL, your non-HDL cholesterol level should be less than 130 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be 40 mg/dL or higher if you are a man or 50 mg/dl or higher if you are a woman.

When you receive this screening will depend on your age, risk factors, and family history of high blood cholesterol and cardiovascular diseases such as atherosclerosis , heart attack, or stroke.

  • 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 or older. 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.

If your blood cholesterol levels are not within the healthy range for your age and sex, your doctor may also recommend heart-healthy lifestyle changes to help you lower or control your high blood cholesterol and order a repeat lipid profile test.

Did you know that cholesterol is an important part of many organs in our body and that high levels of bad types of cholesterol can increase your risk of cardiovascular disease?

Heart-healthy lifestyle changes to prevent high blood cholesterol

To prevent high blood cholesterol or if you have certain risk factors, your doctor may recommend that you adopt heart-healthy lifestyle changes, including eating healthy, being physically active, aiming for a healthy weight, quitting smoking, and managing stress.

Look for

  • Diagnosis will explain how doctors use lipid panel tests to diagnose high blood cholesterol.
  • Living With will discuss some additional medical care or lifestyle changes that your doctor may recommend to prevent your condition from recurring, getting worse, or causing serious complications such as heart attack or stroke.
  • Research for Your Health will explain how we are using current research and advancing research to prevent high blood cholesterol.
  • Participate in NHLBI Clinical Trials will explain our ongoing clinical studies that are investigating treatments for high blood cholesterol.
Signs, Symptoms, and Complications

High blood cholesterol does not cause specific symptoms . But people who have very high blood cholesterol may show signs such as xanthomas and corneal arcus . Undiagnosed or untreated high blood cholesterol can lead to serious complications such as heart attack and stroke.

Complications

High blood cholesterol levels lead to atherosclerosis, or the buildup of plaque deposits in blood vessels throughout the body. Over time, chronic or uncontrolled high blood cholesterol can cause serious complications including the following:

Do you know why high blood cholesterol can cause these complications?

Look for

  • Diagnosis will explain tests and procedures used to detect signs of high cholesterol and help rule out other conditions that may be causing high blood cholesterol.
  • Treatment will discuss heart-healthy lifestyle changes or medicines that can help lower or control high blood cholesterol and help reduce the risk of complications.
  • Living With will discuss some additional medical care or lifestyle changes that your doctor may recommend to prevent your condition from recurring, getting worse, or causing serious complications such as heart attack or stroke.
Diagnosis

Your doctor may diagnose you with high blood cholesterol based on your medical and family history, your physical exam, or whether you have consistently high low-density lipoprotein (LDL) cholesterol levels on repeat lipid panel blood tests. Your doctor may do more tests to see if other medical conditions may be causing high blood cholesterol.

Confirming unhealthy blood cholesterol levels

Doctors use lipid panel tests to diagnose high blood cholesterol. A lipid panel will measure the total cholesterol, good high-density lipoprotein (HDL) cholesterol, and non-high-density lipoproteins (non-HDL) cholesterol levels in your blood. Non-HDL cholesterol includes LDL cholesterol and is calculated by subtracting your HDL cholesterol levels from your total cholesterol levels.

Your doctor may diagnose you with high blood cholesterol if your total or non-HDL level, which includes LDL cholesterol, is higher than what is considered to be healthy for your age, sex, and health status.

Healthy blood cholesterol levels differ by age or sex. If you are age 19 or younger, your total cholesterol levels should be less than 170 milligrams per deciliter (mg/dL) of blood, your non-HDL cholesterol level should be less than 120 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be more than 45 mg/dL. If you are age 20 or older, your total cholesterol should be between 125 and 200 mg/dL, your non-HDL cholesterol level should be less than 130 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be 40 mg/dL or higher if you are a man or 50 mg/dl or higher if you are a woman.
Healthy blood cholesterol levels differ by age and sex. If you are age 19 or younger, your total cholesterol levels should be less than 170 milligrams per deciliter (mg/dL) of blood, your non-HDL cholesterol level should be less than 120 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be more than 45 mg/dL. If you are age 20 or older, your total cholesterol should be between 125 and 200 mg/dL, your non-HDL cholesterol level should be less than 130 mg/dL, your LDL cholesterol level should be less than 100 mg/dL, and your HDL cholesterol level should be 40 mg/dL or higher if you are a man or 50 mg/dl or higher if you are a woman.

Medical history

Your doctor will ask about your eating and physical activity habits, family history, and other risk factors for high blood cholesterol, heart attack, or stroke. Your doctor may ask whether you have any other signs or symptoms. This information can help your doctor determine whether you have complications or other conditions that may be causing you to have high blood cholesterol.

Physical exam

During your physical exam, your doctor will check for signs of very high blood cholesterol, such as xanthomas, or signs of other diseases that can cause high blood cholesterol.

Tests for other medical conditions

Your doctor may order some of the following tests for other medical conditions that may be causing your high blood cholesterol:

  • Blood tests to check your thyroid hormone levels can help rule out hypothyroidism as a cause of high blood levels of cholesterol or other fats, such as triglycerides. Total testosterone and dehydroepiandrosterone sulphate tests can help rule out polycystic ovary syndrome (PCOS).
  • Pelvic ultrasound to examine the ovaries and detect cysts. This can help rule out PCOS, which can affect cholesterol levels.
  • Skin biopsy to help rule out inflammatory diseases, such as psoriasis, which can affect cholesterol levels.

Reminders

  •  Return to Risk Factors to review family history, lifestyle habits, or other environmental factors that increase your risk of developing high blood cholesterol.
  • Return to Screening and Prevention to learn more about lipid panel tests.  
Treatment

High blood cholesterol is treated with heart-healthy lifestyle changes and medicines to control or lower your high blood cholesterol. Lipoprotein apheresis is a procedure that can be used to treat familial hypercholesterolemia.

Heart-healthy lifestyle changes

To help you lower or control your high blood cholesterol, your doctor may recommend that you adopt the following lifelong heart-healthy lifestyle changes:

  • Heart-healthy eating. As recommended in the 2015–2020 Dietary Guidelines for Americans, heart-healthy eating includes limiting the amount of saturated and trans fats that you eat. It also includes consuming fish high in omega-3 fatty acids and vegetable oils that can help lower blood cholesterol levels and the risk of cardiovascular disease. The Therapeutic Lifestyle Changes diet and the DASH Eating Plan can help you lower your bad low-density lipoprotein (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.
  • Being physically active. 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 increase good high-density lipoprotein (HDL) cholesterol. Before starting any exercise program, ask your doctor what level of physical activity is right for you.
  • Aiming for a healthy weight. If you have high blood cholesterol and are overweight or obese, you can improve your health by aiming for a healthy weight. Research has shown that adults with overweight and obesity can reduce LDL cholesterol and increase HDL cholesterol by losing only 3 percent to 5 percent of their weight. Achieving 5 percent to 10 percent weight loss in 6 months is recommended.
  • Managing stress. Research has shown that chronic stress can sometimes increase LDL cholesterol levels and decrease HDL cholesterol levels.
  • Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart [PDF  2.19 MB]. 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).

Medicines

If you are unable to lower or control your high blood cholesterol levels with lifestyle changes alone, your doctor may prescribe a medicine.

  • Statins inhibit cholesterol synthesis in the liver by blocking the protein HMG-CoA reductase from making cholesterol. Liver cells try to compensate for the low cholesterol by synthesizing more LDL receptors on the cell surface to increase LDL uptake from blood. Statins are the most common medicine used to treat high blood cholesterol in people who are 10 years old or older. In certain cases, doctors may prescribe statins in people younger than 10 years old. Visit the Food and Drug Administration (FDA) Controlling Cholesterol with Statins for more information about statins.
  • PCSK9 inhibitors lower LDL cholesterol by decreasing the destruction of LDL receptor in the liver, which helps remove and clear LDL cholesterol from the blood.
  • Bile acid sequestrants block the reabsorption of bile acids and increase conversion of cholesterol to bile acids. This has the effect of lowering plasma cholesterol levels.
  • Ezetimibe blocks dietary cholesterol from being absorbed in the intestine.
  • Fibrates promote removal of very low-density lipoprotein (VLDL) cholesterol, part of non-HDL.
  • Lomitapide blocks the liver from releasing VLDL cholesterol into the blood. It is used only in patients who have familial hypercholesterolemia.
  • Mipomersen decreases levels of non-HDL cholesterol in the blood. It is used only in patients who have familial hypercholesterolemia.
  • Niacin (nicotinic acid) decreases bad LDL cholesterol and triglycerides and raises HDL cholesterol.

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 the heart-healthy lifestyle changes helps to lower and control your high blood cholesterol. Talk to your doctor about possible side effects to help decide which medicine is best for you.

Lipoprotein apheresis

Some patients with familial hypercholesterolemia may benefit from lipoprotein apheresis to lower their blood cholesterol levels. Lipoprotein apheresis is a dialysis-like process in which LDL cholesterol is removed from the blood by a filtering machine, with the remainder of the blood being returned to the patient.

Look for

  • Research for Your Health will explain how the NHLBI is using current and advancing new research to treat people with high blood cholesterol.
  • Living With will discuss some additional medical care or lifestyle changes that your doctor may recommend to prevent your condition from recurring, getting worse, or causing serious complications such as heart attack or stroke.
  • Participate in NHLBI Clinical Trials will discuss our ongoing clinical studies that are investigating treatments for high blood cholesterol.
Living With

If you have been diagnosed with high blood cholesterol, it is important that you continue your treatment. Follow-up care can vary depending on your cholesterol levels, your risk of having a cardiovascular complication such as a heart attack or a stroke, and your response to treatment.

Monitor your response to treatment

Follow up with your doctor periodically to see how well your treatment is working, whether you need to add or change medicines, and whether your health condition has changed.

  • Heart-healthy lifestyle changes. Initially, your doctor will recommend that you adopt 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 registered dietitian and an exercise physiologist.
  • Medicines. If heart-healthy lifestyle changes alone are not enough, your doctor may prescribe a statin or other medicine to help lower or control your high blood cholesterol levels.
  • Additional blood tests to screen for side effects of medicines or changes in health. Your doctor may order creatine kinase blood tests if you experience symptoms such as muscle fatigue, aching, tenderness, or stiffness while taking a statin. Liver enzyme tests can help determine whether a statin or other medicine is affecting your liver. Blood glucose tests can determine whether you have diabetes.

Monitor your risk of heart attack or stroke

High blood cholesterol increases your risk of cardiovascular complications such as a heart attack or stroke. Your doctor may periodically evaluate your risk for these complications by using a calculator such as the Atherosclerotic Cardiovascular Disease Estimator. This calculator estimates your risk of having a heart attack or stroke in the next 10 years. It considers your total and good high-density lipoprotein (HDL) cholesterol levels, age, and systolic blood pressure. It also factors in whether you have diabetes, smoke, or use medicines to control high blood pressure.

Your doctor will consider how unhealthy your blood cholesterol levels are and your 10-year risk calculation when deciding how best to treat your high blood cholesterol and to manage your risk of cardiovascular complications. Your doctor may recommend aspirin to prevent a first heart attack or stroke.

Keep in mind that this 10-year cardiovascular risk calculator may not accurately estimate risk in certain situations, such as when you are taking a statin; or in certain populations, such as Asians, Hispanics, or Native Americans.

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

Signs of heart attack 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. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm.

Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms such as shortness of breath, nausea, vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.

Stroke

If you think someone may be having a stroke, act F.A.S.T. and do 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 for help immediately. Early treatment is essential.

Read more about the signs and symptoms of a stroke.

Reminders

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discoveries to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including high blood cholesterol. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research

Learn about the following ways in which the NHLBI continues to translate current research and science into improved health for people with high blood cholesterol:

  • NHLBI Systematic Evidence Reviews Support Development of Guidelines for Blood Cholesterol in Adults. We continue to perform systematic reviews of the latest science. These reviews help partner organizations update their clinical guidelines, which health professionals use to treat adults who have high blood cholesterol. Visit Managing Blood Cholesterol in Adults Systematic Evidence Review From the Cholesterol Expert Panel, 2013 for more information.
  • NIH Task Force to Develop First Nutrition Strategic Plan. We will collaborate with other institutes to develop a 10-year plan to increase research in nutrition, including experimental design and training. Visit NIH task force formed to develop first nutrition strategic plan for more information.
  • 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.
  • 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.

Learn about some of the landmark NHLBI-funded studies that we have made over the years that have improved clinical care.

Advancing research for improved health

In support of our mission, we are committed to advancing high blood cholesterol research in part through the following ways:

Learn about exciting research areas NHLBI is exploring that involve high blood cholesterol.

Look for

Participate in NHLBI Clinical Trials will discuss our ongoing clinical studies that are investigating treatments for high blood cholesterol.

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 clinical trials .

Are you 40 or older and being treated for HIV?

This study is testing whether a certain statin can prevent plaque from building up in the blood vessels of patients who are taking antiretroviral therapy to treat HIV. To participate in this study, you must be between 40 and 75 years old and have HIV. There are 128 study locations in 32 states, the District of Columbia, and Puerto Rico, Botswana, Brazil, Canada, India, Peru, South Africa, and Thailand.

Are you a healthy adult with no history of heart problems?

This study is testing whether a fish oil with high content of omega-11 fatty acid can contribute to a healthy lipid profile and decrease the risk of heart disease. To participate in this study, you must be 18 years old or older. Women should not be breastfeeding or using oral contraceptives. The study is being conducted in Bethesda, Maryland.

Are you an adult who is interested in helping research on lipid disorders?

This study is comparing how lipids, or fats, such as cholesterol travel in the blood of healthy adult volunteers and adults who have lipid disorders, particularly disorders that may be caused by unknown genetics factors. To participate in this study, you must be 18 years old or older. Women should not be pregnant. The study is being conducted in Bethesda, Maryland.

Are you an adult who wants to prevent high blood cholesterol?

This study is investigating whether niacin, or vitamin B3, can prevent high blood cholesterol and its complications such as heart attacks. To participate in this study, you must be 18 years old or older. Women should not be pregnant or breast-feeding. The study is being conducted in Bethesda, Maryland.

Do you or does your child have a lipid disorder and want to improve future diagnosis and treatment?

This study is exploring how different diagnostic tests can help us understand how lipid disorders, including high blood cholesterol, affect the body. Information from this study may help improve the way lipid disorders are diagnosed or treated in the future. To participate, you or your child must be at least 2 years old. The study is being conducted in Bethesda, Maryland.

Do you or your child have a lipid disorder and want to help research?

This study is assessing factors affecting proteins that transport lipids in the blood of patients with lipid disorders. Participants will follow a specific eating pattern during the study and will have blood tests. Information from this study may help improve the way in which lipid disorders are diagnosed or treated in the future. To participate, you must have been diagnosed with a lipid disorder. The study is being conducted in Bethesda, Maryland.
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