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a type of fat (lipid) in your blood. Your cells need
cholesterol, and your body makes all it
needs. But you also get cholesterol from the food you eat.
If you have too much cholesterol, it starts to build up in your arteries.
(Arteries are the blood vessels that carry blood away from the heart.) This is
called hardening of the arteries, or
atherosclerosis. It is the starting point for some heart and blood flow problems. The buildup can narrow the arteries and make it harder for blood to flow through them. The buildup can also lead to dangerous blood clots and inflammation that can cause heart attacks and strokes.
There are different types of cholesterol.
Your cholesterol levels can help your doctor find out your risk for having a heart attack or stroke. But it's not just about your cholesterol. Your doctor uses your cholesterol levels plus other things to calculate your risk. These include:
Many things can
affect cholesterol levels, including:
need a blood test to check your cholesterol.
A cholesterol test, also called a lipid panel, measures all of the fats in your blood,
total, LDL, and
High cholesterol levels don't make you feel sick. So the blood test is the only way to know your cholesterol levels.
A heart-healthy lifestyle along with medicines can help lower your risk.
The way you choose to lower your risk will depend on how high your
risk for heart attack and stroke is. It will also depend on how you feel about taking medicines. Your doctor can help you know your risk. Your doctor can help you balance the benefits and risks of your treatment options.
Heart-healthy lifestyle changes can help lower risk for everyone. They include:
Changing old habits may not be easy, but it is very
important to help you live a healthier and longer life. Having a plan can help.
Start with small steps. For example, commit to adding one fruit or one vegetable a day for a week. Instead of having dessert, take a short walk.
Statin medicine can lower the risk of heart attack and stroke.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about cholesterol:
Making lifestyle changes:
Cholesterol levels are affected by:
High cholesterol does not cause symptoms. It is usually found during a
blood test that measures cholesterol levels.
Some people with rare lipid disorders may have symptoms such as bumps in the skin, hands, or feet, which are caused by deposits of extra cholesterol and other types of fat.
cholesterol can lead to the buildup of plaque in artery walls. This buildup is called
atherosclerosis. It can lead to coronary artery disease
(CAD), heart attack, stroke or transient ischemic attack (TIA), and peripheral arterial disease.
Atherosclerosis can cause these problems because it:
For more information, see:
Some things that increase
your risk for
high cholesterol are things you can change, but some are
not. It's important to lower your risk as much as possible.
Things you can change include:
Each of these things can raise your LDL, lower your HDL, or both.
Things you cannot change include:
For more information, see Cause.
High cholesterol usually has no symptoms. Sometimes the first sign that you
have high cholesterol or other risk factors for heart disease is a
heart attack, a
stroke, or a
transient ischemic attack (TIA). If you have any
symptoms of these, call 911 or other emergency services.
Heart attack symptoms include:
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Stroke and TIA symptoms include:
Any of the following doctors,
nurses, or specialists can order a cholesterol test and treat high
registered dietitian can help you with a diet to lower
People who have rare
lipid disorders, which can be hard to treat,
may need to see a specialist, such as a lipidologist or an endocrinologist.
A blood test is used to check cholesterol levels.
cholesterol test measures the level of total cholesterol plus the level of different types of cholesterol and fats in your blood. These include LDL,
To learn about the test, see the topic Cholesterol and Triglyceride Tests.
For more information about risk, see the topic Heart Attack and Stroke Risk Screening.
Your doctor may order other tests or talk to you about other risk factors for heart attack and stroke. This helps you and your doctor decide what treatment to lower risk is right for you. You might talk about:
Most doctors recommend that everyone older than 20 be checked for high
cholesterol. How often you need to be checked depends on whether you have other
health problems and your risk of heart attack and stroke.
Your child's doctor may suggest a cholesterol test based on your child's age, family history, or a physical exam. A cholesterol test can help a doctor find out early if your child has a cholesterol level that could affect his or her health.
The goal of treatment is to reduce your chances of having a
heart attack or
stroke. The goal is not to lower your cholesterol numbers alone.
The two types of treatment are:
Lifestyle changes are always important, even if you take medicines to lower your risk.
Your doctor may suggest that you make
one or more of the following changes:
For more information, see Making Lifestyle Changes.
Some people also take medicines called statins, in addition to lifestyle changes, to reduce their risk.
Some people decide to start taking
a statin right away. That's because their chance of having a heart attack or stroke is
statins can reduce this risk.
For other people, it's not as clear if they need to take a statin. You and your doctor will need to look at your overall health and any other risks you have for heart attack and stroke.
A heart-healthy lifestyle can help you prevent heart and blood flow problems, such as heart attacks and strokes.
This lifestyle includes:
Heart-healthy diets include the DASH diet, the Mediterranean diet and the American Heart Association diet recommendations. This chart compares several heart-healthy diets(What is a PDF document?).
Remember that cholesterol is just
one of the things that increase your risk for
heart attack and stroke.
Controlling other health problems, such as
high blood pressure and
diabetes, can also help reduce your overall
Lifestyle changes are an important way to stay healthy and lower your risk of a heart attack or a stroke. They are always important, even if you take medicines too.
You can have a healthy lifestyle and still have a cholesterol level that puts you at risk for heart problems or stroke. Cholesterol problems can run in families. And cholesterol goes up as you age, no matter how healthy you are. But healthy habits are worth having because they can help you avoid some of the problems related to cholesterol, like heart disease, peripheral arterial disease, heart attack, and stroke.
One Man's Story:
"The walking was the easy part for me. I get out every evening for a walk. The food part took some thought. Each week, I added a food that was good for me and took something away that was bad for me."—Joe
Read more about how Joe is getting healthy by making one change at a time.
Making healthy eating habits a part of your daily life is one of the best things you can do to lower your risk. Your doctor may recommend that you follow the Therapeutic Lifestyle Changes (TLC) diet. The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat raises your cholesterol.
If you have questions about which diet to follow, talk to your doctor.
For more information about food and high cholesterol, see:
Losing weight if you need to, and staying at a healthy weight, can lower your risk. Losing weight can also help lower your blood pressure.
Exercise can help you lose weight, lower your blood pressure, and lower your risk. Aim for a total of at least 2½ hours each week. For example, you can do blocks of 10 minutes or more a few times each day to reach your goal. Getting active has many other benefits too.
Quitting smoking may be the best thing you can do to lower your risk of heart attack and stroke.
For more information, see:
One Woman's Story:
"Terri's heart attack scared me to death. I decided that this time, I'm doing the whole package. I'm quitting smoking for good."—Linda
Read more about Linda and how she quit.
"I'm just not that type of person who can change everything at once."—Joe
Read more about Joe and how he's changing his habits.
You can learn simple steps to help you make lifestyle changes, like setting goals. Work on one small goal at a time. Expect slip-ups. Get support from others. Reward yourself for each success. To find out more about making healthy lifestyle changes, see Change a Habit by Setting Goals.
When changing a lifestyle habit, barriers can sometimes get in your way. Figuring out what those barriers are and how you can get around them can help you reach your healthy eating goals.
For help, see:
"I've learned to not beat myself up [when I slip up]. Instead, I refocus on my plan and get right back to eating healthy food. What keeps me going is the results—I've lost weight and I feel younger every day."—Joe
Read more about how Joe is being heart-healthy.
Some people need to take medicines to reduce their risk of a heart attack or stroke. Your doctor may recommend that you take medicines called statins.
You and your doctor can work together to decide what treatment is best for you. Your doctor may recommend that you take statins
if the benefits outweigh the risks.
always used along with a plan for a heart-healthy lifestyle, not instead of it.
"I don't mind taking a pill a day. As long as it's doing me some good. And I no longer have any doubts about that."—Tony
Read more about Tony and how medicine helps lower his risk.
can lower the risk of a heart attack or a stroke.
Other medicines can improve cholesterol levels, but they have not been proven to lower the risk of a heart attack or a stroke. Your doctor may recommend these medicines if there is a reason you can't take a statin. These medicines include bile acid sequestrants, cholesterol absorption inhibitors, fibric acid derivatives, and nicotinic acid (niacin).
Some people find it hard to take their
medicines properly. If you do take medicine, it is important to use it the right way.
Some people don't see why they should take medicines every day
when they don't feel sick. Cholesterol doesn't make you feel sick. But it's important to take your statin medicine, because it can lower your risk of heart attack and stroke.
Some side effects are more likely and may be worse when you use higher
doses of statins. If you're having side effects, tell your doctor. You may be able to take a different statin.
Be sure to tell your doctor about all of the medicines that you take. This includes prescription and over-the-counter medicines, herbs, and supplements. Sometimes they can interact with other medicines and cause problems.
If you have trouble taking your medicine for any reason, talk to your doctor.
Some plant products can help lower cholesterol. But don't use them to replace your doctor's treatment. Research has not proven that they lower the risk of heart attacks and strokes. Whether
or not you use such products, be sure to continue your diet, exercise,
and prescription medicines.
As with any new form of treatment, make sure to talk with your doctor first. This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects.
Psyllium is an ingredient in some dietary supplements—Metamucil, for example. It's a fiber from fleawort and plantago seeds.
Doctors aren't sure how it helps cholesterol levels. It may make the small intestine absorb less cholesterol, so less of it enters your blood.
Psyllium is approved by the U.S. Food and Drug Administration (FDA). The main side effect is increased bowel movements. Products
containing psyllium aren't recommended to replace foods as a source of
Sterol and stanol esters are used in cholesterol-lowering margarine spreads.
Sterol esters might limit how much cholesterol the small intestine can absorb. These margarines are used along with a heart-healthy diet.
Red yeast rice contains a natural form of lovastatin, a statin medicine. This supplement may keep your body from producing too much cholesterol. But this supplement can cause dangerous side effects.
Talk to your doctor before you try red yeast rice. Serious side effects include rhabdomyolysis and hepatitis. Red yeast rice is not regulated by the U.S. Food and Drug Administration (FDA), so you cannot be sure of the amount of red yeast in a supplement. This means you cannot be sure of its dose and safety.
If you take red yeast rice, call your doctor right away if you have a bad reaction to it such as severe muscle pain or symptoms of hepatitis.
Do not take red yeast supplements if you are taking statins. Combining them can cause dangerous side effects.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
Other Works Consulted
Berthold HK, et al. (2006). Effect of policosanol on
lipid levels among patients with hypercholesterolemia or combined
hyperlipidemia. JAMA, 295(19): 2262–2269.
Brunzell JD (2010). Diagnosis and treatment of dyslipidemia. In EG Nabel, ed., ACP Medicine, section 9, chap. 6. Hamilton, ON: BC Decker.
Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
Genest J, Libby P (2008). Lipoprotein disorders and
cardiovascular disease. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 975–995. Philadelphia: Saunders.
Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.
Miller M, et al. (2011). Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 123(20): 2292–2333.
Mosca L, et al. (2011). Effectiveness-based guidelines for the prevention of cardiovascular disease in women 2011 update: A guideline from the American Heart Association. Circulation, 123(11): 1243–1262.
National Heart, Lung, and Blood Institute (2005). Your Guide to Lowering Your Cholesterol With TLC (NIH Publication No. 06-5235). Available online: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.
Pearson TA, et al. (2003). Markers of inflammation and
cardiovascular disease: American Heart Association and the Centers for Disease
Control and Prevention scientific statement. Circulation, 107(3): 499–511.
Raymond JL, Couch SC (2012). Medical nutrition and therapy for cardiovascular disease. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 742–781. St Louis: Saunders.
Red yeast rice (2009). Medical Letter on Drugs and Therapeutics, 51(1320): 71–72.
Sacks FM, et al. (2006). Soy protein, isoflavones, and
cardiovascular health: An American Heart Association science advisory for
professionals from the Nutrition Committee. Circulation,
113(7): 1034–1044. Also available online:
Stone NJ, et al. (2013). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437738.63853.7a. Accessed November 18, 2013.
U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.
U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
December 4, 2013
Kathleen Romito, MD - Family Medicine
& Robert A. Kloner, MD, PhD - Cardiology & Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
How this information was developed to help you make better health decisions.
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