Cholesterol is a fat-like substance found in the body’s cells. The body makes cholesterol, but it can also be found in foods. Too much cholesterol in the blood can lead to complications such as narrowing of the arteries and stroke. Treatments for high cholesterol include medication, supplements and lifestyle changes.
The body needs cholesterol to function optimally. For example, cholesterol helps the body make hormones, vitamin D and substances that help digest food. The body can make all the cholesterol it needs in the liver.
When a person eats foods with cholesterol, the body makes less to keep a balance. But if a person eats an unhealthy diet, smokes or doesn’t get enough exercise, too much cholesterol can build up in the blood.
LDL and HDL
Different types of fats and cholesterol move through the bloodstream as particles called lipoproteins. The two most common types are low-density lipoproteins, or LDL, and high-density lipoproteins, or HDL. Proper cardiovascular health depends on a good balance of these types.
Low-Density Lipoprotein (LDL)
Most people know LDL as the “bad” cholesterol. This is because it can contribute to waxy build-up in the arteries — a condition known as atherosclerosis. This increases the risk of serious conditions such as heart attack, stroke and peripheral artery disease, or PAD. PAD is narrowing of the arteries in the limbs or organs other than the heart and brain.
About 74 million American adults have high levels of LDL, according to pharmacist Emily M. Ambizas’ article in U.S. Pharmacist.
New studies are also finding that there are different types of LDL, and some may be more dangerous than others in people with normal cholesterol levels.
For example, Drs. Tadeusz Malinski and Jiangzhou Hua at Ohio University found that 75 percent of people who have heart attacks don’t have high cholesterol levels that signal a risk. They found that a type of LDL called subclass B is the real marker for risk.
“Our studies can explain why a correlation of total ‘bad’ cholesterol with a risk of heart attack is poor and dangerously misleading — it’s wrong three quarters of the time,” Malinski said. “These national guidelines may seriously underestimate the noxious effects of LDL cholesterol, especially in cases where the content of subclass B in total LDL is high (50 percent or higher).”
Very low-density lipoprotein, or VLDL, is also known as “bad” cholesterol because it also contributes to the buildup of plaque in your arteries. But unlike LDL, VLDL mainly carries a type of fat called triglycerides.
High-Density Lipoprotein (HDL)
In the case of HDL, also known as “good” cholesterol, higher numbers are better. HDL helps remove bad cholesterol from the blood and keeps it from building up in the arteries.
It doesn’t remove all LDL, but it removes about a third to a fourth of the bad cholesterol. Studies show that low levels of HDL increase the risk of heart disease, according to the American Heart Association.
Causes and Risks
According to the Centers for Disease Control and Prevention, nearly 1 in 3 American adults has high cholesterol. The only way for a person to know if they have high cholesterol is to get it checked because it has no symptoms. An unhealthy lifestyle is the most common cause of high cholesterol, but genetics may play a part too.
- Poor food choices
- Eating lots of bad fats such as saturated fat, trans fat and processed foods. Some meats, dairy, baked goods and deep-fried foods contain these fats that can raise LDL.
- Not getting enough exercise
- A sedentary lifestyle with plenty of sitting lowers HDL.
- Smoking lowers HDL and raises LDL.
- Taking certain medications
- Some medications may increase LDL cholesterol levels. These include beta-blockers, thiazide diuretics, some types of birth control, antivirals, anticonvulsants, retinoids and corticosteroids, and growth hormones.
- Family history
- People may inherit a type of cholesterol called familial hypercholesterolemia (FH).
- Cholesterol increases with age, even though younger people may also have high cholesterol.
- High cholesterol runs in families.
- Being overweight or obese raises cholesterol.
- Certain races are at risk for higher levels of cholesterol. For example, African Americans have higher cholesterol levels than whites.
Problems Caused by High Cholesterol
Having high cholesterol levels, especially LDL levels, increases the risk of blood vessels becoming narrowed or blocked. This can lead to serious health conditions.
- Coronary heart disease causes blood vessels to narrow and obstruct blood flow to the heart which can lead to heart attack.
- Stroke occurs when blood flow to the brain is blocked.
- Peripheral artery disease occurs when blood vessels outside the brain and heart narrow. This affects the blood supply to legs, feet and organs such as the kidney.
- High blood pressure occurs when blood vessels narrow, forcing the heart to pump harder to circulate blood through the body.
How to Test Levels
In order to test for cholesterol levels, health care providers order blood tests. All adults 20 or older should have their cholesterol checked every four to six years, according to the American Heart Association.
In addition to a primary health care provider’s office, people may opt to get their levels checked at public screenings.
Medication and Natural Treatments
The first line of treatment for many people is eating a better diet and getting more exercise. But some people might need additional help to get their cholesterol levels down. This can come in the form of medications and supplements.
People should work with their health care providers to develop a plan that is right for them.
The most common type of medication for high cholesterol is a statin. It’s the only type of drug linked to lower risk of stroke or heart attack, according to the American Heart Association. Others include PCSK9 inhibitors, selective cholesterol absorption inhibitors and bile acid-binding drugs.
|Drug Class||Brand (generic)||Common Side Effects|
|Statins work in the liver to prevent cholesterol from forming.||Lipitor (atorvastatin), Lescol (fluvastatin), Zocor (simvastatin), Crestor (rosuvastatin calcium)||Diarrhea, upset stomach, muscle and joint pain|
|PCSK9 inhibitors interact with a liver protein to lower LDL.||Repatha (evolucumab) and Praluent (alirocumab)||Back pain, symptoms of cold or flu|
|Selective cholesterol absorption inhibitors prevent cholesterol from being absorbed in the intestine.||Zetia (ezetimibe)||Diarrhea, tired feeling, headache, stomach pain, back pain|
|Bile acid sequestrants or bile acid-binding drugs work in the intestine to increase cholesterol disposal.||Questran (cholestyramine), Colestid (colestipol), WelChol(colesvelam)||Constipation, stomach pain, gas, indigestion, diarrhea|
A growing number of people are turning to non-medication ways to help lower cholesterol. About 34 percent of American adults use some form of alternative or complementary medicine. High cholesterol is one of the top 10 conditions that people have turned to complimentary medicine to treat, according to clinical professor and pharmacist Emily M. Ambizas.
Some of the most popular supplements include garlic, niacin, omega-3 fatty acids and fish oils, and soluble fiber.
Studies have shown garlic can lower total cholesterol by as much as 17 points and LDL by as much as 9 points. Most people have to take garlic for at least 2 months for it to work. The benefits of garlic may be short term because no significant benefit was seen after 6 months.
Niacin is also known as vitamin B3. It’s one of the most effective non-pharmaceutical agents to lower LDL by up to 25 percent and raise HDL by up to 35 percent. It also reduces triglycerides by up to 50 percent. The effect increases with the dose.
Niacin does have some side effects. These include higher levels of blood sugar, nausea, vomiting, diarrhea, and low blood pressure. Niacin flushing is one of the biggest side effects. It manifests as a red flush on the skin and may be itchy or uncomfortable. It usually subsides with continued use.
Over-the-counter long-acting formulations are not recommended because they are linked to abnormal liver enzymes that could lead to jaundice in severe liver toxicity cases.
Omega-3 Fatty Acids and Fish Oils
There are three kinds of omega 3’s: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). EPA and DHA are the most studied. They can lower triglycerides by up to 50 percent but may raise LDL and HDL.
Most people do well with omega 3 supplements, and the most common side effects include diarrhea, reflux and stomach upset. Some people may complain about a “fishy” taste. This is more likely to occur with higher doses.
People on antiplatelets or anticoagulants should be careful when using these supplements.
Some studies have shown that soluble fibers — including psyllium, oats, pectin and guar gum — may lower LDL and total cholesterol. The most effective fiber with the least amount of side effects is psyllium husk fiber.
Total cholesterol levels dropped by 4 to 15 percent and LDL dropped by 6 to 18 percent when people consumed 7 to 10 grams of this fiber daily.
Side effects include diarrhea, bloating, constipation and gas. People should make sure they drink plenty of water and increase fiber doses gradually. Take fiber supplements 2 hours before or after other medications to reduce interactions.
Diet & Lifestyle Changes to Lower Cholesterol
The National Institutes of Health and the National Health, Lung and Blood Institute recommend at least 30 minutes of moderate-intensity exercise, such as brisk walking, on most days of the week. Getting it in everyday is optimal.
In addition to exercise, the agency recommends a balanced diet. This includes less than 200 mg a day of cholesterol and only 7 percent of daily calories from saturated fat.
|Food Group||Servings a Day||Examples of Foods|
|Breads, Cereals, Grains||6 or more servings, adjust to calorie needs||Whole-grain cereals, pasta, rice, bread, low-fat cookies and crackers|
|Vegetables, Beans||3 to 5 servings||All vegetables fresh, frozen or canned without added fat or salt|
|Fruit||2 to 4 servings||Dried, fresh, canned, frozen without added sugar|
|Dairy||2 to 3 servings of low fat or fat free products||Yogurts, buttermilk, milk, sour cream, cottage cheese, cheese with no more than 3 grams of fat per ounce.|
|Eggs||2 yolks or fewer per week||2 whole eggs per week, egg whites and egg substitutes|
|Meat/Poultry/Fish||5 or less ounces a day||Lean beef, chicken, turkey, center cut pork loin or pork chops, all types of fish. Limit organ meats and shrimp.|
|Fats/Oils||Depends on daily calorie needs||Unsaturated fats and oils, nuts, seeds, salad dressings.|
|Soluble fiber||Depends on daily calorie needs, choose veggies and fruits and grains high in fiber for your daily servings||Barley, oats, psyllium, apples, bananas, berries, citrus fruits, nectarines, peaches, pears, plums, prunes, broccoli, Brussels sprouts, carrots, dry beans, peas, soy products (such as tofu, miso)|
How Much Fat Should I Eat?
|Calories per Day||Total Fat||Saturated Fat|
|1,500||42-58 grams||10 grams|
|2,000||56-78 grams||13 grams|
|2,500||69-97 grams||17 grams|
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