Key takeaways
- Your body needs cholesterol for certain processes, but high levels of low-density lipoprotein (LDL) cholesterol raises the risks of complications like heart attack.
- Elevated LDL often presents with no noticeable symptoms, making regular bloodwork crucial for detection and monitoring.
- Managing high LDL levels generally involves a combination of lifestyle adjustments, such as increased physical activity and eating a balanced diet, and prescription medications like statins.
Blood cholesterol, a waxy, fat-like substance, is made by your liver. Cholesterol is essential for processes such as hormone creation and digesting fatty foods.
Cholesterol is carried through the blood on two types of proteins called lipoproteins. These lipoproteins include low-density lipoprotein (LDL), which is sometimes referred to as “bad” cholesterol, and high-density lipoprotein (HDL), or what is typically referred to as “good” cholesterol.
If cholesterol is essential for overall health, why would one type be bad?
In simple terms, if there is too much LDL cholesterol running through your blood vessels, it can start to build up on the sides of those blood vessels over time. This buildup is typically referred to as “plaque.”
Plaque buildup in your blood vessels can eventually cause those vessels to become narrower. The more narrow your blood vessels are, the harder it is for blood to reach your heart and other organs.
When blood flow becomes very blocked, it can cause chest pain (angina) and even a heart attack.
HDL cholesterol, on the other hand, returns cholesterol to the liver so it can be flushed from the body.
In general, most adults should aim to keep their LDL cholesterol levels
| LDL cholesterol level | Category |
|---|---|
| less than 100 mg/dL | optimal |
| 100 to 129 mg/dL | above optimal |
| 130 to 159 mg/dL | borderline high |
| 160 to 189 mg/dL | high |
| 190 mg/dL and higher | very high |
Because a lot of personal factors can affect these numbers, it’s important to have a healthcare professional check your levels to help them create specific recommendations for you to follow.
High cholesterol typically causes no symptoms, so you may not even know you have it — but it can still raise your risk of complications even when asymptomatic. This is why routine blood work is so important.
If you have
High LDL complications
Besides heart attack, there are other serious complications of not treating “bad” cholesterol. High cholesterol can raise your risk of:
These complications generally become more common with age, but the risks can start compounding earlier in life. Large-scale research from 2021 suggests that even younger adults who have moderately high LDL levels for a long time are at an increased risk of serious events like stroke and heart attack.
This means it’s essential to catch high cholesterol early and promptly take steps to manage it.
You can find out whether you have high LDL cholesterol by having your doctor order a blood test that checks your levels. Your doctor will also request and review your family history, as high cholesterol can sometimes be hereditary.
The test your doctor will likely order is called a lipid panel. This panel shows your LDL, HDL, and other types of blood lipids like triglycerides that can raise your risk of complications.
Your doctor will make a diagnosis of “high cholesterol” if your non-HDL cholesterol level is higher than what your doctor thinks is ideal for you. Your doctor will also review your lab tests to see if your HDL, the healthy cholesterol, is too low.
There may be follow-up tests and visits if your doctor is concerned that you may need medications or further intervention.
Who needs to get checked?
The recommendation from organizations like the American Heart Association (AHA) is for every adult to start cholesterol screenings at age 19 and get re-checked every 5 years.
As you age, your doctor may want to check your levels more often.
If your doctor is concerned about your LDL levels, they may prescribe one or more medications. Statins are the most common choice to help lower LDL levels and reduce the risk of complications like heart attack and stroke.
There are also several statin alternatives, including:
- ezetimibe (Zetia), a cholesterol absorption inhibitor
- bile acid sequestrants, such as colesevelam (Welchol)
- fibrates, like fenofibrate (Lipofen)
- PCSK9 inhibitors, such as alirocumab (Praluent)
Each drug has its own side effects, so it’s important to talk with your doctor about why they’re prescribing a specific medication and what the possible side effects might be.
Your doctor will also likely recommend specific lifestyle changes regardless of whether they prescribe medication.
Certain lifestyle changes can make a positive impact on your cholesterol as a whole.
Increase physical activity
In addition to lowering your cholesterol, regular physical activity can help regulate your blood pressure levels and help you maintain a moderate weight. If you’re new to a physical activity regimen, start slow and work your way up to moderately intense aerobic activity (like brisk walking, cycling, or yard work) for a few hours a week.
Eat a heart-healthy diet
Focusing on the things you can eat on a heart-healthy diet, instead of focusing on things you should not eat, can make this lifestyle change seem less daunting. When you’re eating for heart health and to lower cholesterol, it’s a great idea to focus on:
- lean meats
- seafood
- whole grains
- fruits and vegetables
- minimally processed foods
Eating foods that are naturally high in fiber, like oatmeal and beans, as well as unsaturated fats, like olive oil, avocados, and nuts, are also good choices when you’re eating for heart health.
Talking with a registered dietitian is a great way to make sure your new diet includes all the nutrients you need to stay healthy and energized.
Limit alcohol
Drinking too much alcohol can raise triglycerides. When you combine elevated triglycerides with high LDL cholesterol levels, it can increase your risk for heart attack and stroke. Limiting your alcohol intake, or cutting it out entirely, can help lower your risk.
Quit smoking
Smoking can compound the effects of LDL in narrowing your blood vessels. If you smoke, talk with your doctor about cessation options and other supportive resources that can help you.
Getting your cholesterol levels checked, especially if you have a family history of high cholesterol, is an essential part of staying informed about your health.
If you see high LDL levels on your lipid test, remember you’re not alone. It’s very common, and there are many ways to manage it. Work with your doctor to find a cholesterol management plan that works for you.
