The Facts About High Cholesterol

There are no telltale symptoms that indicate you may have high cholesterol. Around 94 million Americans ages 20 and older have a cholesterol level of more than 200 milligrams per deciliter (mg/dL), according to the Centers for Disease Control and Prevention (CDC). This level is considered borderline high.

Of that number, it's estimated that around 28 million have cholesterol levels above 240 mg/dL, which places them at high risk for developing cardiovascular disease.

Around 47 million American adults who might benefit from cholesterol medicine are not currently taking it.

Cholesterol is a substance produced within the liver that travels through the blood to target different organ systems for various physiological functions. Waxy and fat-like, different types of cholesterol are needed for generating hormones and processing certain fatty foods. One category of cholesterol is lipoproteins, which are used to move cholesterol throughout the body. The "good" type is high-density lipoprotein (HDL) and the "bad" is low-density lipoprotein (LDL).

HDL transports cholesterol back to the liver post-absorption, then removes it from the body. High levels of HDL have been associated with lowering the risk of stroke, coronary artery disease and other cardiovascular diseases. LDL, by contrast, when excessively high has been associated with the opposite impact on cardiovascular health.

People with high cholesterol often show no obvious signs early and, thus, are usually unaware of climbing or already elevated levels. The only way high cholesterol can be detected is through a blood test, which is why doctors recommend healthy adults have one every four to six years. However, if cholesterol has become so excessive that it has begun to affect important cardiovascular structures, patients may begin to experience symptoms such as chest pain; pain, numbness or weakness in the limbs; headache or other symptoms, particularly with physical exertion.

Adults with preexisting conditions—especially those related to cardiovascular health and diabetes—should be tested more frequently. Having a family or medical history indicative of high cholesterol is another risk factor, so these patients also should have more frequent screenings.

A common cause of high cholesterol is related to lifestyle. Lack of exercise or a sedentary lifestyle, poor diet and certain medications have been linked to increased LDL and total cholesterol levels. There is also the possibility of an inherited condition that makes it harder for your body to process and remove LDL from your liver and bloodstream, often compounded by related conditions such as diabetes, kidney disease and cardiovascular disease.

When LDL builds up in the blood, it hardens into artery-clogging plaque; this is known as atherosclerosis. Plaque buildup eventually causes narrowing and stiffness of important arteries in the extremities, heart, neck and/or brain. This can create a barrier that restricts or impedes adequate blood flow/circulation to vital organs, leading to serious health consequences or conditions.

Cholesterol is measured in milligrams per deciliter of blood (mg/dL). For both men and women, the total level should approximate 150 mg/dL and the LDL around 100 mg/dL. However, there is variation in target HDL: Women should aim for greater than or equal to 50 mg/dL, and men should aim for 40 mg/dL. This is because men and women process cholesterol differently.

Along with ideal goal ranges, doctors have thresholds for higher total cholesterol levels. Borderline high is between 200 and 239 mg/dL, while anything above 240 mg/dL is considered high. At these levels, there is a significantly increased risk of heart disease.

Of course, these are estimates for the general population, and a discussion with your doctor is important to assess your individual risk.

Screening for high cholesterol can be done through a blood test called a lipid profile, for which you can expect to fast for about eight to 12 hours prior. Along with total, HDL and LDL cholesterol levels, the screening also covers triglycerides. The ideal threshold for triglycerides is less than 150 mg/dL.

High and very high levels of triglycerides—200 to 499 mg/dL and 500-plus mg/dL, respectively—may also have adverse impacts on cardiovascular health. Triglycerides are a type of fat that is used for energy production and travels through the bloodstream to target organs. The problem is that the body continuously produces triglycerides even when they aren't being used, particularly with certain types of diets, and a buildup in the bloodstream can have similar effects or compound the cardiovascular effects of high cholesterol.

The best ways to lower cholesterol levels are through diet and lifestyle changes. Dietary cholesterol is found in animal products, such as meats, poultry, dairy, seafood and eggs, so cutting back on those products can lower cholesterol levels in many people, particularly when combined with exercise. Any reduced consumption of animal products, combined with an increase in healthy fruits and vegetables, also may help.

Physical activity is paramount, too. Doctors recommend getting at least 30 minutes of exercise a day to lower cholesterol. Cessation of cigarette or tobacco use has also shown to be greatly beneficial, because nicotine products are notorious for causing blood clots and furthering arterial obstruction, along with LDL plaque deposits.

Monitoring nutritional content is important for managing cardiovascular conditions. Aim for a variety of vegetables and fruits, healthy sources of protein, foods low in added sugar, salt and saturated fat, unprocessed foods, and limited or no alcohol consumption. Aside from plant-based diets, the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diets have been shown to be helpful in some patients. Talk to your doctor and/or nutritionist to find a diet that works best for you.

Make sure to check ingredients and nutritional facts before making your selections.

Engaging in physical activity is one of the best things you can do to improve cardiovascular health. Experts typically recommend at least 30 minutes a day, or 150 minutes a week, of moderate to vigorous exercises, such as yoga, strength training and running. Walking is good, too. Aerobic activities in particular are formulated specifically for heart health and cardiorespiratory capability.

Exercise strengthens the heart by promoting steady circulation and blood flow: "Get your heart pumping" is a well-known maxim for a reason. Exercise also lowers the chances of cardiac events and/or diseases, increases HDL levels and supports a healthy weight.

Ideally, the first approaches to lower cholesterol should be improving your diet and getting more exercise. This conjunction of lifestyle modifications alone has been shown to be effective in reducing cholesterol to healthy levels in many individuals. However, if this approach is ineffective or damage has progressed to serious conditions such as coronary heart disease, a thorough evaluation by your doctor is recommended and medication is likely required to help reduce cholesterol and treat associated cardiovascular issues. Medicine is often recommended in combination with a healthy lifestyle to be most effective.

Many combinations of medications have been shown to lower cholesterol levels. Statins and cholesterol absorption inhibitors work by blocking cholesterol-producing substances and limiting the absorption of dietary blood cholesterol, respectively.

All medications have potential side effects, and those effects vary from drug to drug, so consult your doctor.

Statins have a few side effects that tend to be consistent:

• Drowsiness and/or fatigue
• Gastrointestinal disturbances such as diarrhea, constipation and cramps 
• High incidence of muscle aches and pains
• Trouble falling or staying asleep

Rarely documented side effects include diminished libido and erectile dysfunction (ED)

Additionally, any medication metabolized by the liver and/or kidneys poses a risk for damage, toxicity or failure. The danger is elevated for long-term use or high dosages.

High cholesterol is detrimental to sexual health because it leads to inadequate blood flow. This phenomenon affects both men and women, as circulation is needed throughout the process of sex. Men with high cholesterol can get ED because there is a deficit of penile blood flow, which can prevent them from getting and maintaining an erection.

For women, inhibited blood flow affects the vagina and vulva. They, too, can experience difficulties with arousal, such as the production of lubrication, which further leads to painful and/or unsatisfying intercourse. Anorgasmia, when orgasms are delayed, infrequent, absent or significantly less intense, has also been noted.

There are infinite departments, organizations and programs concerned with encouraging people to reduce high cholesterol levels. Among them are:

• Centers for Disease Control and Prevention (CDC)
• American Heart Association (AHA)
• National Heart, Lung and Blood Institute (NHLBI)

They offer a litany of literature, recommendations and tools to educate both patients and doctors on how to manage and treat both high cholesterol and other associated conditions, such as cardiovascular diseases.

How can I reduce high cholesterol?

The best ways to lower cholesterol are through diet and lifestyle changes. Cutting out unhealthy foods and alcohol, quitting the use of nicotine or tobacco products, and getting the recommended 30 minutes of daily exercise are the best initial approaches. If these methods are still ineffective or damage has progressed to conditions such as coronary heart disease, medications can be prescribed to reduce cholesterol levels.

What is the main cause of high cholesterol?

The primary reasons for high cholesterol are lifestyle-related. Lack of exercise or a sedentary lifestyle, poor diet and certain medications have been linked to increased LDL and total cholesterol levels. There is also the possibility of an inherited condition, such as diabetes, kidney disease or cardiovascular disease, that makes it harder for your body to process and remove LDL from your liver and bloodstream.

What foods should I avoid if I have high cholesterol?

A plant-based diet, the Mediterranean diet and the DASH diet are examples of diets that have shown to be useful for patients with high cholesterol.

In general, stay away from the following:

• Added sugars
• Alcohol
• Fried foods
• Full-fat dairy products
• Foods with high salt content
• Meats (but if you must eat meat, choose lean and unprocessed cuts)
• Processed foods
• Unhealthy or saturated oils/fats