Symptoms of Hypercholesterolemia

Cholesterol is a vital substance that is produced by the liver to help support an immeasurable number of bodily functions. Cholesterol is most important for its role in making up the cell wall. It also serves as a precursor substance for many hormones and different coatings around special cells. 

Our body makes up all or most of the cholesterol we need to stay healthy, so we don’t need to consume too much in our diet. Too much cholesterol, or hypercholesterolemia, which may occur with or without a family history, may increase your risk of heart attack and stroke.

Learn more about the symptoms of hypercholesterolemia and when you should see a healthcare professional.

Frequent Symptoms

High cholesterol levels are usually detected by a blood test in the absence of symptoms. 

Familial hypercholesterolemia, an inherited genetic condition, is the one exception. This condition—which is present at birth—causes persistently high cholesterol levels.

Without prompt treatment for familial hypercholesterolemia, you may develop:

• Chest pain or angina; high cholesterol levels can cause atherosclerotic plaque formation and vessel narrowing
• Fatty deposits around the body called xanthomas
• Cholesterol deposits on the eyelid called xanthelasmas
• Fatty, yellow deposits of cholesterol on the skin, elbows, knees, under the eyes, or around the eyelids

The upper limit of normal for triglycerides is generally considered to be 1.7 mmol/l (151 mg/dl). Much higher levels—generally > 10 mmol/l (886 mg/dl)—are associated with acute pancreatitis.

Rare Symptoms

Abnormal levels of triglycerides and cholesterol can lead to accelerated rates of atherosclerotic cardiovascular disease (ASCVD). This can lead to an increased risk of heart attack and stroke.

High triglyceride or LDL levels can be toxic to the pancreas causing pancreatitis, a potentially life-threatening inflammatory reaction that destroys pancreatic tissues.

Complications

Complications of hypercholesterolemia and atherosclerosis include:

• Myocardial infarction
• Ischemic cardiomyopathy
• Sudden cardiac death
• Ischemic stroke
• Erectile dysfunction
• Claudication
• Acute limb ischemia

Leading a heart-healthy lifestyle and taking statins, or cholesterol-lowering drugs, are two primary preventive strategies that are central to preventing complications from hypercholesterolemia. Statin therapy is divided into three categories of intensity:

High-intensity, aiming for at least a 50% reduction in LDL-C. 

• Atorvastatin 40–80 mg daily
• Rosuvastatin 20–40 mg daily

Moderate-intensity, aiming at a 30% to 49% reduction in LDL-C. 

• Atorvastatin 10–20 mg
• Fluvastatin 80 mg daily
• Lovastatin 40–80 mg
• Pitavastatin 1–4 mg daily
• Pravastatin 40–80 mg daily
• Rosuvastatin 5–10 mg
• Simvastatin 20–40 mg daily

Low-intensity, aiming at a LDL-C reduction of less than 30%.

• Fluvastatin 20–40 mg daily
• Lovastatin 20 mg daily
• Pravastatin 10–20 mg daily
• Simvastatin 10 mg daily.

Muscle pain and an increase in the enzyme levels that signal liver damage are two common side effects, but generally, statins should not be discontinued unless your symptoms persist or otherwise specified by a healthcare professional.

Nonstatin drugs such as ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be added to statin therapy or used alone to lower cholesterol levels.

PCSK9 inhibitors lower LDL-C by 50% to 60% by binding to PCSK9, inhibiting labeling of LDL receptors for degradation, thus prolonging LDL receptor activity at the cell membrane.

Several studies have shown that the addition of ezetimibe trials or PCSK9 inhibitors to moderate or high-intensity statin therapy reduces cardiovascular risk in patients with stable atherosclerotic cardiovascular disease or recent acute coronary syndromes and lowers LDL-C levels by as much as 20%.

When to See a Healthcare Professional

The Centers for Disease Control and Prevention (CDC) recommends that adults more than 20 years old get their cholesterol levels checked out every five years. If you have cardiovascular risk factors—like a family history of heart disease or diabetes—you may want to get your cholesterol levels checked more often. 

Common risk factors for hypercholesterolemia include:

• Genetics and family history: Genetic mutations may cause familial hypercholesterolemia or an increase in the production of LDL cholesterol.
• Diabetes: Type 2 diabetes and insulin resistance raise levels of LDL or “bad” cholesterol.
• Age: The body does not clear cholesterol as efficiently the older we get.
• Biological male gender: Men tend to have higher LDL cholesterol levels and lower HDL levels than women, especially after 55.
• Overweight and obesity: Poor eating habits, lack of exercise, and a sedentary lifestyle can dramatically increase LDL cholesterol levels.
• Prior history of high cholesterol levels

If you are feeling any of the aforementioned symptoms seek immediate medical attention. Knowing the signs can lead to early diagnosis and treatment.

Summary

Hypercholesterolemia is too much cholesterol, which may occur with or without a family history and may increase your risk of heart attack and stroke. If you experience symptoms of hypercholesterolemia, see a healthcare provider.

A Word From Verywell

High cholesterol doesn’t spell doom, but it is a reminder that you can take control of your health with a few small changes. If possible, talk to your healthcare provider about your numbers and develop a plan with reasonable heart health goals.

Remember that high cholesterol is just one of many factors that impact heart health.

What you eat, how much you eat, your activity level, and health negative habits like smoking and drinking alcohol all play a role. Your risk of disease depends on other factors, too, in combination with high cholesterol. To keep your cholesterol levels low, eat a balanced diet, stay physically active, and take medicine if necessary.

For many people, preventing or mitigating high cholesterol is a major factor in living a happy and healthy life.