High Cholesterol Symptoms and Signs

Contrary to what some people think, you cannot feel if your cholesterol levels are high. As with conditions like high blood pressure or diabetes, the lack of symptoms doesn't mean that you are inherently OK or have less to worry about. If left untreated, high cholesterol can place you at risk of serious complications, including a heart attack or stroke.

High cholesterol is one of the main risk factors for heart disease (alongside high blood pressure and obesity). To better reduce your risk, you need to get your cholesterol tested on a regular basis, particularly as you get older or if you have risk factors for heart disease.

A doctor consulting his patient about high cholesterol
Monkey Business Images  / Getty Images

Heart disease is today the leading cause of mortality in the United States, accounting for over 655,000 deaths annually, according to the Centers for Disease Control and Prevention.

What Is High Cholesterol?

Cholesterol is a waxy type of fat (lipids) produced by the liver that is essential to the digestion of food and also used in the production of certain hormones and vitamin D. However, when certain cholesterol levels are high, they can adversely affect blood circulation and contribute to the onset of heart disease.

There are two main types of cholesterol:

  • Low-density lipoprotein (LDL) cholesterol: Often referred to as "bad" cholesterol, this is the type of cholesterol that can accumulate on the walls of arteries, causing plaques that narrow and harden blood vessels and increase blood pressure.
  • High-density lipoprotein (LDL) cholesterol: Often referred to as "good" cholesterol, this is the type that transports cholesterol from the rest of your body to the liver so that it can be removed from the body.

In the broadest sense, high cholesterol (also known as hypercholesterolemia) can be described as having too much LDL cholesterol and not enough HDL cholesterol.

There is another form of LDL, called very low-density (VLDL) cholesterol, that is responsible for transporting triglycerides through the body. Triglycerides are another type of lipid that, when elevated, can increase the risk of heart disease.

Signs and Symptoms

There are generally no overt signs or symptoms of high cholesterol. If you do have symptoms, they are generally related to the consequences of the disease rather than the disease itself. You ultimately cannot "feel" high cholesterol if you have it.

For example, high cholesterol can lead to hypertension (high blood pressure). If your high blood pressure becomes severe enough, you may experience fatigue, difficulty breathing, headaches, vision problems, irregular heartbeats, and chest pains.

Only in severe cases might high cholesterol lead to a skin condition known as xanthoma. These are waxy deposits that develop under the skin, particularly around the eyes, eyelids, hands, elbows, and knees. Xanthomas are mainly associated with a genetic form of the disease known as familial hypercholesterolemia.

Ultimately, the only way to know if you have high cholesterol is to get a blood test.

Risk Factors

Because you cannot tell if you have high cholesterol, knowing your risk factors can help you determine your need for testing—even if you are otherwise young and healthy. The more risk factors you have, the greater the need and frequency of cholesterol testing.

Some risk factors for high cholesterol are things that we can change, such as diet and exercise. Others cannot be changed, such as your age, sex, or genetics.

If you have any of the conditions listed below, you are at risk of hypercholesterolemia and should be checked:

The risk of high cholesterol also tends to increase with age due to changes in metabolism, warranting more frequent monitoring as you get older.

Complications

Some people don't ever think about having their cholesterol checked if they are feeling well. And this can be a mistake since untreated hypercholesterolemia can lead to a number of serious complications.

When cholesterol levels are high, fatty plaques can begin to form on the walls of blood vessels. The condition, referred to as atherosclerosis, causes the progressive obstruction of blood flow to the heart and rest of the body. This not only increases blood pressure but also raises the risk of a heart attack or stroke if a plaque breaks open, causing a clot that completely blocks blood flow.

In fact, many people do not even realize they have high cholesterol until they have had their first heart attack or stroke. To prevent this, you need to have your cholesterol checked regularly to not only diagnose hypercholesterolemia but determine when treatment is needed.

Diagnosis

The only way to tell if you have high cholesterol is through a lipid panel. This is a blood test that measures the level of different blood fats in a sample of blood, most specifically:

  • LDL cholesterol
  • HDL cholesterol
  • Non-HDL cholesterol (including VLDL)
  • Total cholesterol (the total amount of all types of cholesterol)
  • Triglycerides

A lipid panel is used to establish whether the various levels are high or low based on a reference range of values. Anything between the high and low values is considered normal. Anything outside of the reference value is considered abnormal.

Ultimately, it's the relationship between the various values—which ones are high and which are low—that determine if your cholesterol levels are acceptable, if treatment is needed, or if you are responding well to treatment.

Your lipid levels are assessed along with other factors, including your age, sex, race, blood pressure, and whether you have diabetes or smoke, to predict your 10-year risk of heart disease.

The current reference ranges for a lipid panel in the United States vary by age and sex. Here are what are considered healthy levels of cholesterol as measured in values of milligrams per deciliter (mg/dL):

Lipid Panel Normal Reference Range
LDL HDL Non-HDL  Total Triglyericide
People 19 and under Under 100mg/dL 45mg/dL or more Under
120mg/dL
Under 170mg/dL Under 150 mg/dL
Females 20 and over Under 100mg/dL 40mg/dL or more Under 130mg/dL 125 to 200 mg/dL Under 150 mg/dL
Males 20 and over Under 100mg/dL 50mg/dL or more  Under 130mg/dL 125 to 200 mg/dL Under 150 mg/dL

Treatment

If your total cholesterol, LDL, or triglyceride levels are too high or your HDL is too low, your doctor may recommend lifestyle changes, medications, or a combination of interventions to help bring your lipids back to a healthy range.

Lifestyle Modifications

Changes in lifestyle—including a healthy diet and routine exercise—are the first-line response to high cholesterol. In people with mild hypercholesterolemia, the changes may be all that is needed to bring the cholesterol levels under control.

The American Heart Association recommends the following lifestyle modifications:

  • Limit your intake of saturated fat to less than 6% of daily calories
  • Avoid trans fats
  • Engage in at least 150 minutes of moderate-intensity aerobic exercise per week
  • Quit smoking
  • Lose weight if overweight or obese

Medications

If lifestyle modifications are not enough to bring your high cholesterol under control, your doctor may prescribe cholesterol-lowering drugs. Options include:

  • Statin drugs like Lipitor (atorvastatin) and Crestor (rosuvastatin)
  • Bile acid-binding resins like Welchol (colesevelam) and Colestid (colestipol) 
  • PCSK9 inhibitors like Praluent (alirocumab) and Repatha (evolocumab)
  • Nexletol (bempedoic acid), an ATP citrate lyase (ACL) inhibitor
  • Zetia (ezetimibe), a cholesterol absorption inhibitor

Other drugs may be prescribed if you have high triglycerides (hypertriglyceridemia).

A Word From Verywell

Feeling healthy is not necessarily the same thing as being healthy. Neither does having fewer risk factors mean that you won't develop heart disease in later life. In the end, cholesterol testing is considered a standard part of primary care and one of the tools doctors routinely use to better reduce your risk of a heart attack or stroke.

The American Heart Association currently recommends that people over the age of 20 have their cholesterol checked at once at least every four to six years. Those with a family history of high cholesterol or a chronic condition like diabetes may need to get their lipids checked more frequently.

Frequently Asked Questions

  • What are the symptoms of high triglycerides?

    Most people will not experience any symptoms if they have high triglycerides. However, on rare occasions, levels over 1,000 milligrams per deciliter (mg/dL) can trigger acute pancreatitis, causing severe upper abdominal pain, fever, rapid pulse, and nausea or vomiting.

  • What are the signs of high cholesterol?

    Symptoms of high cholesterol are rare. The only exceptions are skin disorders called xanthoma in which fatty growths develop under the skin (most commonly around the eyes and on the knees, elbows, hands, and feet) or xanthelasmas in which waxy deposits appear on the skin surface. Both are more common in people with genetic forms of high cholesterol.

  • Can I check my cholesterol at home?

    There are an increasing number of home cholesterol test kits approved for use by the Food and Drug Administration. These include test strip kits that require a drop of blood, electronic devices that work like a glucose meter, and mail-in tests that are sent to a lab for processing. They are generally not as reliable as in-office tests but may be appropriate in some situations.

  • How can I lower my cholesterol?

    In addition to cholesterol-lowering drugs like statins, certain lifestyle changes can help lower your cholesterol whether you are on treatment or not. These include:

    • Eating a diet low in saturated fat and trans fat
    • Doing 150 minutes of moderate-aerobic exercise per week
    • Losing weight if you are overweight or obese
    • Quitting cigarettes
Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hill MF, Bordoni B. Hyperlipidemia. In: StatPearl [Internet]. Updated February 7, 2021.

  2. Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017 Jan-Dec;6:2048004016687211. doi:10.1177/2048004016687211

  3. Centers for Disease Control and Prevention. Heart disease facts. Updated September 8, 2020.

  4. Huff T, Boyd B, Jialal I. Physiology, cholesterol. In: StatPearls [Internet]. Updated March 2, 2021.

  5. Medline Plus. VLDL cholesterol. Updated February 27, 2019.

  6. Alves-Bezerra M, Cohen DE. Triglyceride metabolism in the liver. Compr Physiol. 2017;8(1):1-8. doi:10.1002/cphy.c170012

  7. American Heart Association. What are the symptoms of high blood pressure?  Updated October 31, 2016.

  8. Harada-Shiba M, Arai H, Ishigaki Y, et al. Guidelines for diagnosis and treatment of familial hypercholesterolemia 2017. J Atheroscler Thromb. 2018;25(8):751-70. doi:10.5551/jat.CR003

  9. American Heart Association. Heart-health screenings. Updated March 22, 2019.

  10. Centers for Disease Control and Prevention. Knowing your risk for high cholesterol. Updated January 31, 2021.

  11. Lu H, Daugherty A. AtherosclerosisArterioscler Thromb Vasc Biol. 2015;35(3):485–91. doi:10.1161/ATVBAHA.115.305380

  12. Adhyaru BB, Jacobson TA. New cholesterol guidelines for the management of atherosclerotic cardiovascular disease risk: a comparison of the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines with the 2014 National Lipid Association Recommendations for patient-centered management of dyslipidemia. Endocrinol Metab Clin North Am. 2016 Mar;45(1):17-37. doi:10.1016/j.ecl.2015.09.002

  13. MedlinePlus. Cholesterol levels: what you need to know. Updated October 2, 2020.

  14. Lloyd-Jones DM, Braun LT, Ndumele CE, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. Circulation. 2019;139:e1162–77. doi:10.1161/CIR.0000000000000638

  15. American Heart Association. Prevention and treatment of high cholesterol (hyperlipidemia). Updated November 11, 2020.

  16. Garg R. Rustagi T. Management of hypertriglyceridemia induced acute pancreatitis. Biomed Res Int. 2018;2018:4721357. doi:10.1155/2018/4721357

  17. MedlinePlus. High cholesterol. Updated February 10, 2020.