High Cholesterol (Hypercholesterolemia)

Cholesterol is a waxy substance. Your body needs it to stay healthy. But too much can cause problems. It travels in your blood through the blood vessels. If you have a lot of cholesterol in your blood, it can build up along the walls of the blood vessels. This makes the vessels narrower. It decreases blood flow. You are then at greater risk of a heart attack or a stroke.

Your body needs cholesterol to build new cells and make certain hormones. There are 2 main kinds of cholesterol in your body:

  • HDL (high-density lipoprotein). This is known as "good cholesterol." It stops fatty deposits (plaque) from building up in your arteries. In this way it protects you against heart disease and stroke.

  • LDL (low-density lipoprotein). This is known as "bad cholesterol." It stays in your body and sticks to artery walls. It may later block blood flow to your heart and brain. This can cause a heart attack (acute myocardial infarction) or stroke.

Your body makes all the cholesterol it needs. But you also get cholesterol from many of the foods you eat. You need to limit how much cholesterol you get in your diet. But you also need to limit how much fat you eat. Cholesterol and dietary fat are not the same thing. But the fat in your diet affects your cholesterol levels. Your body makes cholesterol from the fat you eat. The type of fat you eat has the most impact on how much cholesterol your body makes. This cholesterol creates the most risk for disease.

Fats come in 2 kinds:

  • Good fats. These are the unsaturated fats. There are monounsaturated and polyunsaturated fats. They raise the level of good cholesterol. They lower the level of bad cholesterol. Good fats are found in vegetable oils. This includes olive, sunflower, corn, and soybean oils. Good fats are also found in nuts and seeds.

  • Bad fats. These are saturated fats and trans fats. These raise the risk for disease. They lower the good cholesterol. They raise the level of bad cholesterol. Bad fats are found in all red meat and whole-milk dairy foods. Some plants also have a lot of saturated fats. This includes coconut and palm plants. Trans fat raises bad cholesterol and lowers good cholesterol. Trans fats are found in stick margarines. They are found in many fast foods and baked goods. Soft margarine sold in tubs has less trans fat.

You may have high blood cholesterol if you eat a diet high in saturated fat and don’t get much exercise. In many cases, your family history plays a role. Your healthcare provider can diagnose high cholesterol with blood tests. Treatment consists of a diet low in saturated fat, weight loss, and exercise.

If these efforts don’t lower your cholesterol, your provider may prescribe medicines. They must be taken daily to keep your cholesterol levels low. Being overweight also raises the risk for high cholesterol and heart disease. Losing even a small amount of weight can help lower your risk.

Who may need statin medicine

If you are at higher risk of heart attack or stroke, you may need statin medicine to lower your cholesterol. This is in addition to having a healthy diet and lifestyle. Statins may help prevent heart attack or stroke. Talk to your healthcare provider if any of these apply to you:

  • You have had a heart attack

  • You have had stroke or a transient ischemic attack (TIA)

  • You have stable or unstable angina

  • You have atherosclerosis, when plaque builds up in arteries

  • You have peripheral vascular disease (PVD)

  • You had a procedure to restore blood flow through a blocked artery

  • You have diabetes and LDL cholesterol level of 70 to 189 mg/dL

  • You have a higher risk of a heart attack or stroke and LDL cholesterol level of 70 to 189 mg/dL

  • You are age 21 or older and have LDL cholesterol level of 190 mg/dL or higher

Home care

Follow these guidelines when caring for yourself at home:

  • Talk with your healthcare provider about starting a low-cholesterol diet or weight-loss program.

  • Eat less saturated fat and less cholesterol each day. This means eating less red meat and full-fat dairy foods. 

  • Eat foods with unsaturated fats. This includes vegetable oils, nuts, and seeds. Eat more fruits, vegetables, and fish. Eat whole grains and other high-fiber foods.

  • Learn to read food labels so you know what you are eating.

  • Talk with a registered dietitian. They can teach you how to plan meals and change your diet. You can ask your provider for a referral.

  • Aim for 40 minutes of physical activity 3 to 4 times a week. It should be moderate to vigorous. Pick activities you enjoy. Walking is a good choice if you want to lose weight. If you have diabetes, high blood pressure, or heart disease, ask your provider what activities they advise.

  • If your provider has prescribed medicines, take them as directed.

  • If you smoke, make a plan to quit. Talk with your provider. They can help you. Smoking lowers good cholesterol levels. It can increase the damage done by bad cholesterol. Smoking is a major risk factor for heart attack, stroke, and atherosclerosis disease.

  • Limit how much alcohol you drink.

  • If you have diabetes, talk with your provider and a dietitian about other food and lifestyle changes you can make. You will need to control your blood sugar to lower your risk for heart disease and stroke.

Follow-up care

Follow up with your healthcare provider as advised. It takes at least 3 months for food and lifestyle changes to show up in a blood test result for cholesterol. Have blood tests as often as advised by your provider. Ask how to prepare for the blood tests. You may need to not eat before the test.

If you had an X-ray, ECG (electrocardiogram), or other test, a specialist will look at it. You will be told if any results change your care.

Talk with your healthcare provider about your health history and family history of heart disease or high cholesterol. Talk with them about your treatment goals. Plan to have regular tests and follow-up visits. You may need more than 1 medicine to reach your cholesterol goals. Tell your provider if you have side effects from the statin medicines.

Call 911

Call 911 if you have any of these:

  • Chest, arm, shoulder, neck, or upper back pain

  • Shortness of breath

  • Weakness or numbness of an arm, leg, or 1 side of the face

  • Trouble with speech or vision

  • Weakness, dizziness, or fainting

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