Why is high cholesterol a problem?

Blood cholesterol is a fatty substance. The body uses it to make parts of your cells. It's also used for making hormones. Cholesterol travels through the bloodstream. It's used by the tissues so they work normally. When blood cholesterol is high, it forms plaque. Plaque builds up in the walls of arteries. Arteries carry blood from the heart to the body. The plaque narrows the opening for blood flow. Over time, your heart may not get enough oxygen. This can lead to coronary artery disease or a heart attack. It can lead to stroke.

3 steps for understanding your risks

Step 1. Get a blood test to check your cholesterol

High cholesterol has no symptoms. A blood test is the only way to know if your cholesterol levels are high. Have your cholesterol tested every 4 to 6 years after the age of 20. Test more often if you have other risk factors (see below). Cholesterol testing most often needs no preparation. Your healthcare provider will tell you if you need to not eat before the test. A blood sample is taken and sent to a lab. The amount of cholesterol and triglyceride in your blood is measured. There are 2 types of cholesterol in the sample. The first is HDL (good cholesterol). The second is LDL (bad cholesterol). Cholesterol test results are most often shown as the total of HDL and LDL cholesterol numbers. You may also be told the separate HDL and LDL results.

Your healthy level of LDL depends on your risk factors. Talk with your provider about what level is best for you. It's important to know your cholesterol numbers. Your healthcare provider will talk with you about your results and what they mean for your health.

What are your numbers?

Fill in your numbers below.

HDL cholesterol:                            LDL cholesterol:                          Total cholesterol:                          Triglyceride:                         

Note

We understand gender is a spectrum. We may use gendered terms to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

Step 2. Learn your other risk factors for heart disease and stroke

How your cholesterol affects your heart health depends on all of your risk factors. Mark each risk factor below that applies to you:

• Age. Are you a man age 45 or older or a woman age 55 or older?

• Blood pressure. Do you have high blood pressure? Do you take medicine to treat high blood pressure?

• Smoking. Do you smoke or use tobacco products? Do you use electronic cigarettes or other products with nicotine? These all cause inflammation in the body and the arteries. Inflamed arteries can become scarred or damaged. This can cause cholesterol deposits to build up. Quitting tobacco and nicotine can reduce this inflammation. This lowers the risk for heart disease and stroke.

• Diabetes. Do you have diabetes? Is your blood sugar level controlled well? You may be able to lower your risk for heart disease or a stroke by keeping your LDL level lower than what is advised for people who don't have diabetes.

• Exercise. Do you exercise very little or not very often? Experts advise at least 30 minutes of moderate-intensity exercise at least 5 days a week. You may be at higher risk for high cholesterol and heart disease if you're not exercising this much.

• Diet. Do you eat a diet that is high in saturated or trans fats, cholesterol, sugar, or alcohol? You may be at increased risk for heart disease. You may be at higher risk if you don't eat enough fruits, vegetables, or lean meats.

All of the things listed above can raise your risk for blockages in the arteries of your heart, neck, and legs. This can lead to heart disease and heart attack. They can lead to stroke and peripheral artery disease.

To help find your overall risk, your provider may use a risk calculator. It looks at your cholesterol level and other things that put you at risk. Ask your provider about your 10-year risk if you are over age 40. Ask about your lifetime risk if you are age 20 to 39.

Your provider may talk with you about other things that can affect your risk. These can affect your treatment decisions. They include:

• A family history of heart problems before the age of 55 in male relatives

• A family history of heart problems before the age of 65 in female relatives

• Primary high cholesterol

• Metabolic syndrome

• Chronic kidney disease

• Chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, or HIV/AIDs

• Menopause before age 40

• High blood pressure during pregnancy (preeclampsia)

• Ethnicity (for example, being from South Asia)

• Other blood lipid disorders

Step 3: Talk with your healthcare provider

Your provider will help you understand your risk and options for treatment. If your cholesterol levels are too high, your provider will advise how you can lower them. Steps may include a change in diet and more physical activity. If you smoke, you should quit. Make a plan that will work for you.

Your provider can assess your risks of heart disease or stroke. This can guide your decision to start medicine such as a statin to treat your cholesterol and lower your risks.

If you have high cholesterol, you may need a blood test more often. This is to make sure your medicine and lifestyle changes are working to reduce your cholesterol.

In some cases, you may need more testing. This might include a coronary artery calcium (CAC) scan. This scan measures the amount of calcium in the coronary arteries. If you have calcium deposits in an artery, it means plaque is starting to build up. The results of the test are given as a calcium score. This can help guide the decision to start cholesterol medicines such as statins.

Your risk factors, including cholesterol levels, can change over time. Talk with your provider at each wellness visit.