- High Cholesterol Glossary
- What You Should Know About Hyperlipidemia
- High blood cholesterol levels
- Know your numbers. And what to do about them.
High Cholesterol Glossary
Being an educated and informed patient will not only make you feel more in control of your health and your treatment, but will also help you make better decisions about taking care of yourself. Once you’re familiar with these cholesterol terms, you might feel more comfortable talking to your doctor and asking questions about your health and high cholesterol treatment.
- Angina. This term is used to describe chest pain, which may be caused by a buildup of cholesterol in the arteries from high cholesterol levels.
- Atherosclerosis. This condition, in which cholesterol builds up and forms plaque inside the arteries, can result from high cholesterol levels. Also called hardening of the arteries, it restricts blood flow to the heart and may result in a heart attack.
- Coronary artery disease. Also called coronary heart disease, this results when the arteries narrow because of atherosclerosis and high cholesterol levels. It can lead to an eventual heart attack.
- Cholesterol. A naturally-occurring substance that the body produces because cells need it to function. But too much of this waxy, fatty material can build up and cause heart problems. Cholesterol levels comes from the body and from your diet, and is found in foods like meat, eggs, and dairy foods made with whole milk and butterfat.
- HDL (high-density lipoprotein). HDL is one type of cholesterol, also known as the “good” or healthy cholesterol. A high HDL level can actually lower your risk of heart disease and cardiac events.
- Heart attack. A cardiac event that occurs when blood flow to the heart is decreased or stops because of a narrowed artery or a blood clot. A heart attack can result from untreated high cholesterol levels.
- Hyperlipidemia or hypercholesterolemia. These are the medical terms used to describe high cholesterol. High cholesterol significantly increases the risk of having a heart attack, heart disease, or a stroke.
- LDL (low-density lipoprotein). LDL is another type of cholesterol, also known as the “bad” or unhealthy cholesterol. A high level of LDL puts you at risk for heart disease.
- Lipids. Fats found in the blood. When lipid levels get too high, they can build up in the arteries and contribute to atherosclerosis.
- mg/dL. The measurement, milligrams per deciliter, used for cholesterol levels in the blood.
- Plaque. When cholesterol, triglycerides, and other fatty material levels are too high, they begin to build up in the arteries and form plaque, which narrows the passageway for blood to travel to the heart. Too much plaque buildup or a blood clot that forms from ruptured plaque can lead to heart attack.
- Saturated fats. Unhealthy fats that lead to high cholesterol levels. Your doctor may tell you to avoid saturated fats in your diet. These are found in animal products like meat, and dairy foods like milk (any type except skim), cheese, butter, and cream.
- Statins. These are some of the most commonly prescribed drugs available to treat high cholesterol. Statins work by inhibiting the production of cholesterol by the liver.
- Triglycerides. A type of fat found in the blood. High triglycerides, a condition called hypertriglyceridemia, often indicate high cholesterol levels as well, and contribute to atherosclerosis, heart disease, and heart attack. High triglycerides are often caused by negative lifestyle habits, such as smoking, overeating that leads to obesity, and poor diet.
- Trans fats or trans fatty acids. These unhealthy fats, found in processed foods like cooking oil and shortening, can cause very high cholesterol levels and plaque buildup. Your doctor may recommend eliminating trans fats from your diet.
- Unsaturated fats. Healthy fats that can actually lower LDL cholesterol levels. Your doctor may recommend that you get most of your daily fat from unsaturated fats, which can be found in olive oil, salmon, nuts, and seeds.
What You Should Know About Hyperlipidemia
Lifestyle changes are the key to managing hyperlipidemia at home. Even if your hyperlipidemia is inherited (familial combined hyperlipidemia), lifestyle changes are still an essential part of treatment. These changes alone may be enough to reduce your risk of complications like heart disease and stroke. If you’re already taking medications, lifestyle changes can improve their cholesterol-lowering effects.
Eat a heart-healthy diet
Making changes to your diet can lower your “bad” cholesterol levels and increase your “good” cholesterol levels. Here are a few changes you can make:
- Choose healthy fats. Avoid saturated fats that are found primarily in red meat, bacon, sausage, and full-fat dairy products. Choose lean proteins like chicken, turkey, and fish when possible. Switch to low-fat or fat-free dairy. And use monounsaturated fats like olive and canola oil for cooking.
- Cut out the trans fats. Trans fats are found in fried food and processed foods, like cookies, crackers, and other snacks. Check the ingredients on product labels. Skip any product that lists “partially hydrogenated oil.”
- Eat more omega-3s. Omega-3 fatty acids have many heart benefits. You can find them in some types of fish, including salmon, mackerel, and herring. They can also be found in some nuts and seeds, like walnuts and flax seeds.
- Increase your fiber intake. All fiber is heart-healthy, but soluble fiber, which is found in oats, brain, fruits, beans, and vegetables, can lower your LDL cholesterol levels.
- Learn heart-healthy recipes. Check out the American Heart Association’s recipe page for tips on delicious meals, snacks, and desserts that won’t raise your cholesterol.
- Eat more fruits and veggies. They’re high in fiber and vitamins and low in saturated fat.
If you’re overweight or obese, losing weight can help lower your total cholesterol levels. Even 5 to 10 pounds can make a difference.
Losing weight starts with figuring out how many calories you’re taking in and how many you’re burning. It takes cutting 3,500 calories from your diet to lose a pound.
To lose weight, adopt a low-calorie diet and increase your physical activity so that you’re burning more calories than you’re eating. It helps to cut out sugary drinks and alcohol, and practice portion control.
Physical activity is important for overall health, weight loss, and cholesterol levels. When you aren’t getting enough physical activity, your HDL cholesterol levels go down. This means there isn’t enough “good” cholesterol to carry the “bad” cholesterol away from your arteries.
You only need 40 minutes of moderate to vigorous exercise three or four times a week to lower your total cholesterol levels. The goal should be 150 minutes of exercise total each week. Any of the following can help you add exercise to your daily routine:
- Try biking to work.
- Take brisk walks with your dog.
- Swim laps at the local pool.
- Join a gym.
- Take the stairs instead of the elevator.
- If you use public transportation, get off a stop or two sooner.
Smoking lowers your “good” cholesterol levels and raises your triglycerides. Even if you haven’t been diagnosed with hyperlipidemia, smoking can increase your risk of heart disease. Talk to your doctor about quitting or try the nicotine patch. Nicotine patches are available at the pharmacy without a prescription. You can also read these tips from people who have quit smoking.
High blood cholesterol levels
Cholesterol is a fat (also called a lipid) that your body needs to work properly. Too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems.
The medical term for high blood cholesterol is lipid disorder, hyperlipidemia, or hypercholesterolemia.
Cholesterol – high; Lipid disorders; Hyperlipoproteinemia; Hyperlipidemia; Dyslipidemia; Hypercholesterolemia
There are many types of cholesterol. The ones talked about most are:
- Total cholesterol — all the cholesterols combined
- High density lipoprotein (HDL) cholesterol — often called “good” cholesterol
- Low density lipoprotein (LDL) cholesterol — often called “bad” cholesterol
For many people, abnormal cholesterol levels are partly due to an unhealthy lifestyle. This often includes eating a diet that is high in fat. Other lifestyle factors are:
- Being overweight
- Lack of exercise
Some health conditions can also lead to abnormal cholesterol, including:
- Kidney disease
- Polycystic ovary syndrome
- Pregnancy and other conditions that increase levels of female hormones
- Underactive thyroid gland
Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels. Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:
- Familial combined hyperlipidemia
- Familial dysbetalipoproteinemia
- Familial hypercholesterolemia
- Familial hypertriglyceridemia
Smoking does not cause higher cholesterol levels, but it can reduce your HDL (good) cholesterol.
Exams and Tests
A cholesterol test is done to diagnose a lipid disorder. Different experts recommend different starting ages for adults.
- Recommended starting ages are between 20 to 35 for men and 20 to 45 for women.
- Adults with normal cholesterol levels do not need to have the test repeated for 5 years.
- Repeat testing sooner if changes occur in lifestyle (including weight gain and diet).
- Adults with a history of elevated cholesterol, diabetes, kidney problems, heart disease, and other conditions require more frequent testing.
It is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer doctors away from targeting specific levels of cholesterol. Instead, they recommend different medicines and doses depending on a person’s history and risk factor profile. These guidelines change from time to time as more information from research studies becomes available.
General targets are:
- LDL: 70 to 130 mg/dL (lower numbers are better)
- HDL: More than 50 mg/dL (high numbers are better)
- Total cholesterol: Less than 200 mg/dL (lower numbers are better)
- Triglycerides: 10 to 150 mg/dL (lower numbers are better)
If your cholesterol results are abnormal, you may also have other tests such as:
- Blood sugar (glucose) test to look for diabetes
- Kidney function tests
- Thyroid function tests to look for an underactive thyroid gland
Steps you can take to improve your cholesterol levels and to help prevent heart disease and a heart attack include:
- Quit smoking. This is the single biggest change you can make to reduce your risk of heart attack and stroke.
- Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables.
- Use low-fat toppings, sauces, and dressings.
- Avoid foods that are high in saturated fat.
- Exercise regularly.
- Lose weight if you are overweight.
Your provider may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:
- Your age
- Whether or not you have heart disease, diabetes, or other blood flow problems
- Whether you smoke or are overweight
- Whether you have high blood pressure or diabetes
You are more likely to need medicine to lower your cholesterol:
- If you have heart disease or diabetes
- If you are at risk for heart disease (even if you do not yet have any heart problems)
- If your LDL cholesterol is 190 mg/dL or higher
Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190 mg/dL.
There are several types of drugs to help lower blood cholesterol levels. The drugs work in different ways. Statins are one kind of drug that lowers cholesterol and has been proven to reduce the chance of heart disease. Other drugs are available if your risk is high and statins do not lower your cholesterol levels enough. These include ezetimibe and PCSK9 inhibitors.
High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.
Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.
Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.
Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 48.
U.S. Preventive Services Task Force recommendation summary. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/statin-use-in-adults-preventive-medication1. Updated November 2016. Accessed March 21, 2018.
Review Date: 2/22/2018
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Know your numbers. And what to do about them.
When it comes to cholesterol, there are two terms worth knowing. Hyperlipidemia means your blood has too many lipids (or fats), such as cholesterol and triglycerides. One type of hyperlipidemia , hypercholesterolemia, means there’s too much LDL (bad) cholesterol in your blood. This condition increases fatty deposits in arteries and the risk of blockages.
Another way your cholesterol numbers can be out of balance? Your levels of HDL (good) cholesterol can also be too low. With less HDL to remove cholesterol from your arteries, your risk of atherosclerotic plaque and blockages increases.
If you’re diagnosed with hyperlipidemia, your overall health and known risks (such as smoking or high blood pressure) will help guide treatment. These factors can combine with high LDL cholesterol or low HDL cholesterol levels to affect your cardiovascular health. Your doctor may use the National Institutes of Health’s Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Score to assess your risk of a coronary event in the next 10 years.
The good news is, high cholesterol can be lowered, reducing the risk of heart disease and stroke. If you’re an adult 20 or older, have your cholesterol tested and work with your doctor to adjust your cholesterol levels as necessary.
Often, changing behaviors will go a long way toward bringing your numbers into line. (If lifestyle changes alone don’t improve your cholesterol levels, medication may be prescribed.) Lifestyle changes you may be asked to make are:
Eating a heart-healthy diet
From a dietary standpoint, the best way to lower your cholesterol is reduce saturated fat and trans fat. The American Heart Association recommends limiting saturated fat to 5 to 6 percent of daily calories and minimizing the amount of trans fat you eat.
Reducing these fats means limiting your intake of red meat and dairy products made with whole milk. (Choosing skim milk, low-fat or fat-free dairy products instead.) It also means limiting fried food and cooking with healthy oils, such as vegetable oil.
A heart-healthy diet emphasizes fruits, vegetables, whole grains, poultry, fish and nuts, while curbing sugary foods and beverages. Eating this way may also help to increase your fiber intake, which is beneficial. A diet high in fiber can help lower cholesterol levels by as much as 10 percent.
Many diets fit this general description. For example, the DASH (Dietary Approaches to Stop Hypertension) eating plan promoted by the National Heart, Lung, and Blood Institute as well as diets suggested by the U.S. Department of Agriculture and the American Heart Association are all heart-healthy approaches. Such diets can be adapted based on your cultural and food preferences.
To be smarter about what you eat, you’ll may need to pay more attention to food labels. As a starting point:
- Know your fats. Knowing which fats raise LDL (bad) cholesterol and which ones don’t is key to lowering your risk of heart disease.
- Cooking for lower cholesterol. A heart-healthy eating plan can help you manage your blood cholesterol level.
Becoming more physically active
A sedentary lifestyle lowers HDL (good) cholesterol. Less HDL means there’s less good cholesterol to remove LDL (bad) cholesterol from your arteries.
Physical activity is important. Just 150 minutes of moderate-intensity aerobic exercise a week is enough to lower both cholesterol and high blood pressure. And there are lots of options: brisk walking, swimming, bicycling or even a dance class can fit the bill.
Learn more about getting active.
Smoking lowers HDL (good) cholesterol.
Worse still, when a person with unhealthy cholesterol levels also smokes, his or her risk of coronary heart disease increases more than it otherwise would. Smoking also compounds the risk presented by other risk factors for heart disease, such as high blood pressure and diabetes.
By quitting, smokers can lower their cholesterol levels and help protect their arteries. Nonsmokers should avoid exposure to secondhand smoke.
Learn more about quitting smoking.
Being overweight or obese tends to raise LDL (bad) cholesterol and lower HDL (good) cholesterol.
Losing excess weight can improve your cholesterol levels. A weight loss of as little as 10 percent can help to improve your high cholesterol numbers.
Learn more about losing weight.
Most young adults might assume they have years before needing to worry about their cholesterol.
But new findings from researchers at the DCRI suggest that even slightly high cholesterol levels in otherwise healthy adults between the ages of 35 and 55 can have long-term impacts on their heart health, with every decade of high cholesterol increasing their chances of heart disease by 39 percent.
The findings are published in the American Heart Association journal Circulation. Lead author Ann Marie Navar-Boggan, MD, PhD, likens the cumulative effects of elevated cholesterol to the long-term impacts of smoking.
“The number of years with elevated cholesterol, or ‘lipid years,’ can affect you in a similar way to the number of ‘pack years’ you have had as a smoker,” Navar-Boggan said. “It shows that what we’re doing to our blood vessels in our 20s, 30s and 40s is laying the foundation for disease that will present itself later in our lives. If we wait until our 50s or 60s to think about cardiovascular disease prevention, the cat’s already out of the bag.”
For the study, Navar-Boggan and colleagues at Duke, Boston University and McGill University examined data on 1,478 adults who were free of heart disease at age 55 who were part of the Framingham Heart Study, which began in 1948.
“Few, if any, studies have gathered the quality of the cardiovascular data that the Framingham study has,” said Michael Pencina, PhD., director of biostatistics at the DCRI and a senior author of the paper. “That wealth of data collected over time made it possible to analyze the long-term effects of cholesterol in young people—a topic on which not enough is known because it requires decades of tracking.”
Researchers calculated the length of time each participant had high cholesterol by age 55 and they were followed for up to 20 years to see how cholesterol levels affected their risk of heart disease. Elevated cholesterol for this study was defined as non-HDL cholesterol of 160 mg/dL or higher. Researchers found similar results for patients with LDL cholesterol, or “bad cholesterol” of 130 mg/dL or higher.
At age 55, nearly 40 percent of participants had at least 10 years of exposure to high cholesterol. Over the next 15 years, their risk of heart disease was 16.5 percent, nearly four times the rate of 4.4 percent seen among those without high cholesterol. Each decade of high cholesterol raised the risk of heart disease by 39 percent, suggesting that the cumulative effects of even mild or moderate elevations in cholesterol pose a significant risk to heart health.
What was surprising, Navar-Boggan said, is that “the effect is perhaps even stronger among adults who are otherwise healthy. So even if you control everything else in your life—you don’t smoke, your blood pressure and weight are normal, and you don’t have diabetes—having elevated cholesterol over many years can still cause problems in the long run.”
The researchers also noted that most study participants with elevated cholesterol early in adulthood wouldn’t have met the criteria for treatment with statins, a class of medication that lowers blood cholesterol, under current guidelines endorsed by the American Heart Association and American College of Cardiology.
The study results suggest that otherwise healthy adults from age 35 to 55 may be a group of people who should consider cholesterol control sooner, Navar-Boggan said. She cites the need for more data on the long-term effectiveness and safety of statins in younger adults. The first step for young adults—a demographic known for missing regular check-ups—is to be tested.
“It’s never too soon for young adults to talk with their doctors about a comprehensive strategy for heart health, first and foremost focusing on diet and exercise,” Navar-Boggan said. “Our study suggests, though, that young adults who cannot control cholesterol with diet and exercise alone may benefit from medication earlier in life.”