An Overview of Hyperlipidemia (High Cholesterol)

Symptoms, Causes, Diagnosis, and Treatment

In This Article

Table of Contents

High cholesterol—or hyperlipidemia, as your doctor might call it—is a very common condition that occurs when there are too many fats (called lipids) in your blood. Cholesterol is a type of fat that can build up in your arteries, restricting blood flow and increasing your chances of heart disease, stroke, or other health issues.

Many different factors can increase your chances of developing high cholesterol. While some can’t be helped (your family history, for instance), others can be controlled, like diet and exercise. Many people who are diagnosed with hyperlipidemia can lower their cholesterol levels by eating healthier, being more physically active, and maintaining a healthy weight.  

Lifestyle changes that reduce cholesterol
Illustration by Jessica Olah, Verywell

Symptoms

Having high cholesterol alone won’t make you feel sick, so many people do not realize their cholesterol is too high until their doctor diagnoses it from routine lab results. On rare occasions, high cholesterol can lead to yellowish fat nodules forming under the skin near the eyes, elbows, or knees. Other uncommon manifestations include an enlarged liver or spleen, or pale rings around the iris in the eye.

If left uncontrolled, however, high cholesterol can lead to other serious issues that are more noticeable like high blood pressure, heart attack, and blood clots.

Having high cholesterol doubles your risk for heart disease.

Causes

Cholesterol is a type of waxy fat that your body makes in the liver, or that you absorb from foods. Cholesterol is a critical building block for the body's cells and is important for a variety of functions like producing hormones and digestive fluids. However, excess cholesterol in the blood can become an important risk factor for cardiovascular disease. In particular, when too much circulating cholesterol becomes attached to low-density lipoproteins (LDL cholesterol, known as "bad cholesterol”), the risk of heart disease increases considerably. Excess LDL cholesterol can become deposited in the lining of the arteries—along with calcium, inflammatory cells, and other matter—to form atherosclerotic plaques. These plaques can limit blood flow through the arteries.

On the other hand, cholesterol attached to high-density lipoprotein (HDL cholesterol) represents excess cholesterol that is being removed from the tissues. For this reason, HDL cholesterol is known as "good cholesterol."

Hyperlipidemia happens when too much LDL cholesterol is in your blood. The excess cholesterol combines with calcium and other materials within the walls of arteries, forming plaques that can obstruct blood flow.

Over time, the build-up of cholesterol-laden plaques can lead to heart attacks, strokes, or blood clots.

High cholesterol isn't just about how much cholesterol you take in. It also has a lot to do with how your body processes and excretes cholesterol over time, and that can be influenced by a wide range of things. These risk factors include family history, age, medical conditions, medications, and health behaviors.

Family History

We share a lot with our family members. In particular, our genetic makeup is passed down through generations and can impact our risks for certain health conditions known to contribute to hyperlipidemia, such as obesity or diabetes. Families can also shape many of our behaviors and choices, especially when it comes to diet and exercise. As a result, people whose relatives have a history of high cholesterol are more likely to develop it, too. Certain genetic conditions can also leave us predisposed to having high cholesterol, including:

  • Familial combined hyperlipidemia: Familial combined hyperlipidemia is the most common genetic disorder that can lead to an increase in body fats. It causes high levels of cholesterol and triglycerides and is exacerbated by other chronic conditions like alcoholism, diabetes, and hypothyroidism.
  • Familial hypercholesterolemia: This inherited disorder prevents your body from being able to remove LDL cholesterol from your blood, resulting in abnormally high levels of the "bad" cholesterol in the body.
  • Familial dysbetalipoproteinemia: Those with familial dysbetalipoproteinemia have a genetic defect that leads cholesterol and triglycerides to build up in the blood. Like familial combined hyperlipidemia, certain health issues can make familial dysbetalipoproteinemia worse.

Age and Sex

Some risk factors you have control over, and others you don’t. As you age, it gets harder for your body to clear excess cholesterol from the blood, and easier for risky levels to build up. Someone’s sex can also play a role. Men, on average, tend to have less “good” cholesterol than women, while women (especially under 55 years old) often have less “bad” cholesterol. 

The older you get, the more likely you are to be diagnosed with high cholesterol, but younger generations aren’t immune.

In some cases, children with sedentary lifestyles and poor diets can develop hyperlipidemia. About 7.4 percent of all children ages nine to 10 years old met the criteria for high cholesterol between 2011 and 2014. The prevalence was higher among obese kids and teens: 11.6 percent. 

Medical Conditions

Having certain medical conditions has been shown to increase your risk of having abnormal cholesterol levels:

Having diabetes, in particular, can impact your risk for developing high cholesterol. While it's not exactly clear why this is, some research indicates that high levels of insulin may negatively affect cholesterol levels by upping the amount of "bad" cholesterol and reducing the amount of "good" cholesterol. This is especially true for those with type 2 diabetes.

Medications

Medications might also increase the likelihood of developing high cholesterol. Taking meds like beta-blockers, diuretics (water pills), certain birth control pills, or some anti-depressants may contribute to increased blood cholesterol levels.

Health Behaviors 

Certain lifestyle decisions can impact how much good and bad cholesterol is in your blood, including what you eat, how often you exercise, and whether you smoke.

  • Dietary choices: While your liver makes most of the cholesterol in your body, you also absorb cholesterol from certain foods, including products high in saturated fats. Foods containing higher levels of saturated fats include red meat, poultry skin, and full-fat dairy products. While there is some debate over the issue, most experts still recommend limiting saturated fats in the diet. All experts agree, however, that eliminating trans fats from the diet (found mainly in processed foods), eating plenty of fruits and vegetables, as well as making other sensible dietary changes can reduce your LDL cholesterol levels and your risk of cardiovascular disease.
  • Physical activity: Exercising regularly can help you stay at a healthy weight as well as lower your cholesterol levels. Low physical activity can result in weight gain and cause LDL cholesterol levels to increase.
  • Body weight: Being overweight or obese can change the way your body uses cholesterol, resulting in levels building up in your blood.
  • Smoking: Smoking won’t cause your LDL cholesterol to spike, but it can cause your HDL cholesterol levels (the good kind) to drop, as well as damage arteries and hasten how fast they harden.
  • Alcohol use: Drinking heavily increases levels of both cholesterol and triglycerides, another type of fat found in the blood.

Diagnosis

Hyperlipidemia doesn’t cause any physical signs or symptoms of the condition, so doctors must rely on blood tests to spot it. The most common way to diagnose high cholesterol is with a lipid panel. 

Lipid Panel

A simple blood test called a lipid panel can be used to check how much cholesterol is in your blood. The test uses a blood draw taken after fasting for roughly 12 hours.

Blood Levels That May Lead to Diagnosis

  • Total cholesterol is over 200 mg/dL (milligrams per deciliter)
  • LDL cholesterol is over 100 mg/dL
  • HDL cholesterol is under 40 mg/dL
  • Triglycerides are over 150 mg/dL

If your blood work comes back normal, your health care provider might want to run the tests periodically— every four to six years or so—to keep tabs on any trends signaling your cholesterol levels are on the rise.

While a total cholesterol count over 200 mg/dL generally indicates high cholesterol, your doctor might take other factors into consideration (like age and medical history) before making a diagnosis based on your results. Your doctor will then use your results to set cholesterol level goals with you, as well as formulate your treatment plan.

Treatment

Some people are able to lower their cholesterol levels by making some healthy lifestyle changes like improving diet and exercising more. Others might also need the help of medications. What your doctor recommends for you will depend a lot on your lab results, health history, and any other risk factors that might affect your cardiovascular health. 

Lifestyle Changes

Many people can lower their cholesterol levels on their own by making some lifestyle changes to eat better, exercise more, and maintain a healthy weight. These include:

  • Diet: Because some cholesterol is believed to come from food, health officials recommend those with hyperlipemia cut back on eating certain animal products, tropical vegetable oils (like palm oil), cheese, and other foods that are high in saturated or trans fats. You should stick to lower-fat and unsaturated-fat foods like fruits, vegetables, lean proteins (like fish), and nuts. The majority of blood cholesterol, however, is made by the liver—not taken in from food—so it's important to make other changes to your lifestyle.
  • Exercise: Staying physically active can help lower the amount of cholesterol in your blood. The American Heart Association recommends getting at least 40 minutes of moderate-to-vigorous intensity aerobic exercise three to four times a week, and some research shows that exercising for as little as 10 minutes at a time can help lower total cholesterol. This could mean walking during your lunch break, riding a bike, or taking part in group exercise classes—whatever gets you moving.
  • Weight Loss: Being overweight or obese can contribute to high levels of cholesterol in your blood. Getting down to a healthy body mass index (BMI) can put your body in a better position to excrete and process lipoproteins more efficiently and prevent them from building up in the bloodstream. Fortunately, the best path to losing weight is through a healthy diet and frequent exercise, both of which will also help to reduce cholesterol levels.
  • Quitting Smoking: Quitting smoking won’t necessarily roll back high cholesterol levels, but it can help lower your chances of other serious related health issues like heart attack or stroke. Smoking also accelerates the damage that can be done by excess cholesterol, so quitting can effectively remove a layer of risk from the equation.

Cholesterol-Lowering Medications

If you aren’t able to get your cholesterol levels down through lifestyle changes, your doctor might prescribe cholesterol-lowering medications. These drugs often need to be taken long-term and should only be used as directed by a physician. The most common medications used to treat high cholesterol are:  

  • Statins: Statin drugs are the most important drugs used to reduce LDL cholesterol and lower cardiovascular risk. These drugs lower LDL cholesterol by reducing the amount of cholesterol made by the liver. In addition, they have other important effects that reduce cardiovascular risk independent of their cholesterol-lowering capabilities. In fact, statins are the only class of cholesterol-reducing medications that, so far, have been clearly shown in clinical studies to reduce cardiovascular risk.
  • Bile Acid Sequestrants: These medications remove bile acids from the body. When the liver tries to compensate by making more bile, it uses up some of the cholesterol in the bloodstream.   
  • Niacin (Nicotinic Acid): Some prescription forms of this B vitamin increase HDL cholesterol while also lowering levels of LDL cholesterol and triglycerides. However, recent studies show that niacin fails to substantially reduce cardiac risk when combined with statins, and in addition, pharmaceutical niacin can cause serious risks. Most doctors no longer prescribe it for cholesterol in people who can take statins.
  • Fibrates: These medications primarily reduce the number of triglycerides in the blood.
  • PCSK9 Inhibitors: An injectable medication, this type of drug is a relatively new option available to treat people with familial hypercholesterolemia, which causes high levels of LDL cholesterol.

In general, these medications are typically only prescribed to individuals who have already had or are at an increased risk for heart attack or stroke, have very high LDL cholesterol levels (190+ mg/dL), or have certain risk factors like diabetes in combination with LDL cholesterol levels above 70 mg/dL. However, fewer than half of the individuals who need these medications actually get them.

A Word From Verywell

High cholesterol can significantly increase your chances of having serious heart issues, including heart attack and stroke. While some risk factors (like your genes or family history) are outside of your control, there are several things you can do to lower your risks of hyperlipidemia or lower your cholesterol levels if they are already high. Because people with hyperlipidemia often don't have any symptoms, it's important to ask your doctor about routine screening and about how often you should be tested for high cholesterol based on your current or past health history.

Was this page helpful?
Article Sources