What Does It Matter If You Have High Cholesterol?

Illustration of atherosclerosis in a vein

PIXOLOGICSTUDIO / Getty Images

High cholesterol does not usually cause symptoms, so it may be tempting to ignore. However, having high blood cholesterol levels is strongly associated with an increased risk of heart attack, stroke, blocked blood vessels in the legs and kidneys, and may even contribute to dementia. Fortunately, diet, exercise, and medications help lower cholesterol levels and reduce your risk of these serious health problems.

High Cholesterol and Heart Disease

People who have high cholesterol have a much higher risk of developing heart disease than people with normal cholesterol levels.

For example, a cholesterol level of 250 increases the chances of developing coronary heart disease, and a level of 300 increases the risk even further. People with high cholesterol—with or without coronary heart disease—are more likely to die from heart disease than those who have a cholesterol level below 200.

Cholesterol is a sticky, waxy substance that circulates in the blood. Your body has a few different types of cholesterol.

The most common are low-density lipoprotein (LDL) and high-density lipoprotein (HDL):

  • LDL tends to stick to the walls of blood vessels to form atherosclerotic plaques that hinder normal blood flow and can lead to blood clots
  • HDL helps protect against heart disease.

LDL is what is usually referred to when the aim is to lower cholesterol. Ruptured plaques may block blood flow in the coronary arteries causing a heart attack.

Cholesterol Particle Size

Researchers have discovered that cholesterol chemistry is more complex than what was known just a few years ago. For instance, LDL cholesterol can reside in particles of different sizes: small, dense LDL particles, and large, fluffy LDL particles.

The small LDL particles appear to increase a person's cardiac risk more than the large particles. Similarly, small and large particles of HDL cholesterol have also been identified, and the two sizes also affect cardiovascular risk differently.

At this time, experts do not recommend measuring LDL and HDL particle size on a routine basis because collecting this information usually does not affect treatment options. Such measurements may become more routine as scientists learn more about cholesterol particle size, and in particular, learn ways to change cholesterol particle size to improve health outcomes.

Plaques

Atherosclerotic plaques can suddenly rupture, leading to blood clots and acute blockage of an artery. This sudden blockage can cause a heart attack or a stroke.

High Cholesterol and Strokes

Plaques may stick in the carotid arteries in the neck, or in the arteries in the brain.

When a piece of plaque dislodges from a carotid artery, it can travel to the brain causing a "brain attack" or stroke.

High Cholesterol and Dementia

There is mounting evidence to suggest that high cholesterol and a diet high in fat and saturated fat may contribute to dementia. This includes vascular dementia, which is caused by small strokes. And there is also a link with dementia caused by Alzheimer's disease, a degenerative neurological condition.

Taking Care of Your Cholesterol

The best way to keep cholesterol levels in check is by sticking to a low-fat diet. In particular, it is important to avoid saturated fats, which are fats from animal sources such as butter or lard. Saturated fats are the main contributor to higher total cholesterol and to high levels of LDL.

With heart-healthy diet changes, it may be possible to reduce cholesterol levels to a normal range or closer to a normal range.

It can be challenging to change years of eating habits. Rather than a complete diet overhaul, you can modify your diet gradually, easing your way into a healthier lifestyle.

For example:

  • Avoid fried foods.
  • Choose food that has been baked, grilled, broiled, or steamed.
  • Ask for sauces on the side.
  • Make vegetables the major part of your meal, rather than meat.
  • Choose lower-fat meats, such as fish, poultry (with the skin removed), or lean cuts of red meats.
  • Use spices for flavoring, instead of butter or oils.
  • Turn to fruits for snacks, desserts, and meals, while cutting back on high-fat pastries.

The best way to improve HDL is through​ ​exercise, such as walking, jogging, cycling, swimming, aerobics, or hiking. If fitness is new to your lifestyle, you may need to try several different exercises before finding a plan that works for you. Some people like to exercise at home, whereas others prefer a gym. Some people exercise in the morning and some prefer to exercise later in the evening.

If your doctor prescribes cholesterol-lowering drugs for you, be sure to tell them about any other medications, supplements, or herbs that you are taking and to take your medications as directed.

Sometimes these drugs may cause uncomfortable side effects, such as nausea, abdominal pain, or muscle cramps. Mention any side effects you are experiencing to your doctor right away. In most cases, there are treatments to relieve the symptoms, or your doctor may switch you to a different medication.

Statins

Many people use cholesterol-lowering medications such as statins, which can reduce the possibility of heart disease. Lipitor (atorvastatin), Zocor (simvastatin), and Crestor (rosuvastatin) are examples of commonly prescribed statins.

Statins are one of the only categories of cholesterol-lowering drugs that have been shown in many clinical trials to improve outcomes in people at high risk for cardiovascular events.

Statins have several properties that might reduce or stabilize plaques—it is not clear whether the cholesterol-lowering action of statins provides their chief benefit. This is why current guidelines recommend instituting statin therapy based on a person's overall cardiovascular risk, and not on their cholesterol levels.

Since cholesterol guidelines rely so heavily on statins, these drugs are recommended for many more people than they were just a few years ago—this fact has created much controversy.

Statins can also prevent strokes. And some studies suggest that taking statins may help prevent vascular dementia and possibly slow the progression of dementia that's related to Alzheimer's disease.

6 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.
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  3. Habchi J, Chia S, Galvagnion C, et al. Cholesterol catalyses Aβ42 aggregation through a heterogeneous nucleation pathway in the presence of lipid membranes. Nat Chem. 2018;10(6):673-683. doi:10.1038/s41557-018-0031-x

  4. Lardizabal JA, Deedwania PC. Benefits of statin therapy and compliance in high risk cardiovascular patients. Vasc Health Risk Manag. 2010;6:843-853.

  5. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002

  6. Schultz BG, Patten DK, Berlau DJ. The role of statins in both cognitive impairment and protection against dementia: a tale of two mechanisms. Transl Neurodegener. 2018;7:5. doi:10.1186/s40035-018-0110-3

Additional Reading
  • Furie, Karen L., Janet L. Wilterdink, and J. Philip Kistler. "Secondary prevention of stroke: Risk factor reduction" UpToDate.com. 2008. UpToDate.

  • Rosenson, Robert S. "Clinical trials of cholesterol lowering in patients with coronary heart disease or coronary risk equivalents." UpToDate.com. 2008. UpToDate.

  • Soliman GA. Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients. 2018;10(6).10.3390/nu10060780

  • Wilson, Peter WF. "Overview of the risk factors for cardiovascular disease." UpToDate.com. 2008. UpToDate.

  • Zhang X, Wen J, Zhang Z. Statins use and risk of dementia: A dose-response meta analysis. Medicine (Baltimore). 2018;97(30):e11304.10.1097/MD.0000000000011304

By Heather M. Ross
Heather M. Ross, PhD, DNP, FAANP is a nurse practitioner and PhD in Human and Social Dimensions of Science and Technology.