High cholesterol is a silent but serious health concern that affects millions around the world. In its early stages, it frequently exhibits no symptoms, but it can subtly exacerbate major health issues like heart disease and stroke. Understanding its causes, recognizing potential signs, and exploring the best treatment options are crucial for prevention and management.

What is cholesterol, and why is it important?

Cholesterol is a waxy, fat-like substance found in our cells that helps build cell membranes. Synthesize various hormones, including estrogen, progesterone, cortisol, and vitamin D. Our bodies get cholesterol from our diet, and the liver also makes a significant amount for different bodily functions.

What are the functions of cholesterol?

Cholesterol plays an important role in various body functions, such as 

• Cell Membrane Structure: Cholesterol is an essential component of every cell membrane. It keeps them both flexible and stable. It also helps control what enters and exits the cells, ensuring proper function.
• Hormone Production: The synthesis of steroid hormones requires cholesterol. These include sex hormones such as estrogen, progesterone, and testosterone, as well as cortisol and aldosterone.
• Vitamin D Synthesis: Cholesterol is converted to vitamin D when the skin is exposed to sunlight. This vitamin regulates blood calcium levels, strengthens bones, and increases immunity.
• Production of Bile Acids (Digestion): Bile acids are made by the liver using cholesterol. These aid in the digestion of fats and the absorption of vitamins A, D, E, and K.
• Transport of Fats in the Blood: Lipoproteins are how cholesterol moves through the blood. LDL carries it to tissues (bad cholesterol), while HDL removes excess and takes it to the liver (good cholesterol).
• Overall Body Function and Balance: Cholesterol supports brain health, nerve function, and hormone production. However, too much LDL can raise the risk of heart disease. Maintaining a healthy body weight is important.

What are the types of cholesterol?

There are two main types of cholesterol.

Low-Density Lipoprotein (LDL) Cholesterol: also referred to as “bad” cholesterol, high levels of LDL can lead to a buildup of plaque that sticks to the artery walls, leading to blockage and narrowing of arteries, making them hard and less flexible. This condition is also called atherosclerosis.

High-Density Lipoprotein (HDL) Cholesterol: Also known as “good” cholesterol, HDL helps remove excess cholesterol from your arteries and transports it to the liver for removal from the body. A high level of HDL is generally preferred.

Triglycerides: It is a type of fat whose increased level raises the risk of cardiovascular disease.

What Causes High Cholesterol Levels?

Your cholesterol level depends on your lifestyle, and some genetic factors can also affect the cholesterol level in your blood. Some of the primary causes include

• Age and Gender: Cholesterol levels tend to rise with age due to the lowering of metabolism. Before menopause, women tend to have lower total cholesterol levels than men of the same age. After menopause, women’s LDL levels tend to rise.
• Unhealthy fats: Diets such as red meat, fat-rich dairy products, and processed and fried foods are rich in saturated and trans fats that can increase the level of bad (LDL) cholesterol, leading to high cholesterol levels in the body.

(Note: Some dietary cholesterol, such as organ meats or egg yolk, can also slightly raise the cholesterol level.)

• No physical activity: Regular exercise maintains cholesterol levels by regulating good cholesterol and lowering LDL cholesterol. A sedentary lifestyle can lead to weight gain and unfavorable cholesterol profiles.
• Obesity: Being overweight or obese can lead to excess belly fat, which can increase LDL cholesterol and triglycerides (another type of fat in the blood) and lower good (HDL) cholesterol.
• Smoking and Drinking: Smoking damages blood vessels, which makes arteries weak and prone to blockage. Drinking can affect liver function in regulating cholesterol levels.

Genetic History: Rare inherited disorders such as familial hypercholesterolemia (FH) can cause very high LDL cholesterol levels from birth, significantly increasing the risk of congenital heart disease.’

Other factors

Medical Condition:

Certain medical conditions can also lead to High cholesterol levels, such as

• Diabetes
• Hypothyroidism (underactive thyroid)
• Kidney or Liver disease
• Polycystic ovarian syndrome (PCOS)

Medications: Some medications, such as diuretics, beta-blockers, and corticosteroids, can sometimes raise cholesterol levels as a side effect.

What are high cholesterol symptoms?

High cholesterol has no clear symptoms in the majority of cases and is often referred to as a silent killer due to its late detection, but  in severe or advanced cases, or when complications arise, some of the signs and symptoms that can be seen associated with high cholesterol levels are 

Chest Pain (Angina): Occurs due to the narrowing of the arteries supplying blood to the heart; you might experience chest pain, especially during physical activity.

Stroke-like symptoms: Blockage of the arteries can lead to stroke. Symptoms can include 

• sudden weakness or numbness on one side of the body, 
• difficulty speaking, 
• vision problems or severe headaches.

Heart Attack Symptoms: Complete blockage of arteries can lead to symptoms of a heart attack, such as 

• severe chest pain & sweating, 
• shortness of breath, 
• pain radiating to the arm or jaw, and.

Xanthomas: A genetic condition in which cholesterol deposits may appear as yellowish bumps on the skin, especially around the eyelids (xanthelasma) or on tendons (tendon xanthomas).

Arcus Senilis: A bluish-white ring around the iris of the eye can sometimes indicate high cholesterol, especially in younger individuals. Or a normal sign of aging.

Diagnosis and tests

How is cholesterol level diagnosed?

High cholesterol level is often diagnosed through tests such as lipid profiles or lipid panels that measure the level of good (HDL) cholesterol and bad (LDL) cholesterol levels as per standards.

Lipid Profile (Fasting or Non-Fasting)

The most common test to test high cholesterol levels includes

If the diagnosis remains unclear, some other tests may be recommended. These include

• Apolipoprotein B (ApoB) Test: determines the number of LDL particles, particularly for atherosclerosis.
• Lipoprotein(a) test: A genetic cholesterol marker often linked to early heart disease in families.
• High-Sensitivity C-Reactive Protein (hs-CRP): Detects inflammation in blood vessels and helps predict heart attack or stroke.
  
• VLDL Cholesterol (Very Low-Density Lipoprotein): Indicates the level of triglyceride-rich lipoproteins; high levels may suggest metabolic problems.

What is the ideal cholesterol level in the body?

If your blood cholesterol levels fall within the recommended range, your heart health is on track. Examine your results using this cholesterol level chart, and if necessary, take appropriate action.

Key points:

• Values may change and differ slightly depending on the lab conditions.
• High LDL levels are directly linked to an increased risk of heart attack and stroke.
• Low HDL is a risk factor for heart disease. Higher HDL is protective.
• High triglycerides raise the risk of heart disease, particularly when paired with low HDL or high LDL.
• Adults aged 20 and older should have their cholesterol levels checked every 4 to 6 years, or more frequently if they have risk factors such as obesity, family history, or diabetes.

Management and Treatment 

What are the best treatment options for high cholesterol?

The only way to treat the high cholesterol level is to manage the primary cause as discussed above. In more severe cases, medication may be necessary to manage the condition.

Heart-healthy Lifestyle tip to lower cholesterol.

• Heart-Healthy Diet: Include fruits, vegetables,   and lean protein sources such as fish, legumes, and nuts. These are rich in soluble fiber, which helps reduce cholesterol absorption.
• Use Healthy Fats Wisely: Replace saturated and trans fats with monounsaturated and polyunsaturated fats found in avocados, olive oil, seeds, and nuts.
• Consider Plant Sterols and Stanols: Found in fortified foods, these compounds help block cholesterol absorption in the gut.
• Exercise daily: Aim for at least 150 minutes of moderate-intensity aerobic exercise (like brisk walking or cycling) or 75 minutes of vigorous activity per week.
• Maintain a Healthy Weight: Losing even 5–10% of your body weight can have a significant impact on your cholesterol profile.
• Quit Smoking: Help improve HDL (good cholesterol) and reduce your overall heart disease risk.
  Limit Alcohol Intake: Excessive alcohol can raise triglyceride levels. Stick to one drink per day for women and two for men, if at all.
• Stress Management: Chronic stress can impact cholesterol indirectly. Practice yoga, meditation, or deep breathing, or spend time in nature to lower stress levels.

Medications

When lifestyle changes aren’t enough, especially if genetic factors are at play. Doctors may prescribe medication. Always consult with your doctor about the dose before starting treatment and medications.

• Statins (e.g., atorvastatin, rosuvastatin): The most effective way to reduce LDL.
• Ezetimibe: Lowers cholesterol absorption in the intestine.
• PCSK9 inhibitors: Injectable drugs used for genetic cases or statin intolerance.
• Bile acid sequestrants: Help remove cholesterol from the body.

 What if you have a high cholesterol level?

Adults should check their cholesterol every 4-6 years, but those with risk factors—such as a family history of heart disease, obesity, or high cholesterol—may require earlier and more frequent screenings and regular monitoring.

What questions do I ask my doctor?

• How can I lower my cholesterol naturally?
• What level of cholesterol is dangerous?
• Do I have to take medication, or can I make lifestyle changes first?
• How often should I have my cholesterol tested?
• Is my high cholesterol due to a genetic factor?
• What foods should I avoid completely, and which ones should I eat more of?
• Can you recommend a personalized plan to lower my cholesterol?
• What are the side effects of cholesterol-lowering drugs such as statins?
• Should my family members also be tested for high cholesterol?
• How much exercise should I do each week to help manage my cholesterol?

Ready to take charge of your cholesterol? Consult your healthcare provider for a personalized treatment plan.

Key Thought:

Although silent, high cholesterol can be managed. You can take control of your health and significantly reduce your risk of heart disease by making appropriate decisions and being proactive with examinations and treatment. Your heart’s future is in your hands. Monitor your cholesterol regularly—it’s a simple step that can greatly improve your quality of life.

People may ask

How does high cholesterol affect my body?

Too much cholesterol, especially a high level of bad cholesterol (LDL), can lead to a condition called hypercholesterolemia, which is often present without symptoms and can lead to the excess formation of plaque in your arteries, leading to an increased risk of heart attack and strokes. Early detection is important for better treatment and management.

Are there any signs of high cholesterol?
Usually, there are no obvious symptoms. It is detected through a routine blood test, but severe cases may show signs such as fatty deposits under the skin.

How can I lower my cholesterol naturally?
You can effectively lower cholesterol levels by eating a heart-healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking, and limiting your alcohol consumption.

How often should cholesterol be checked?
Adults should monitor their cholesterol levels every 4 to 6 years. Those with risk factors may require more frequent testing and at a younger age.

Is medication always needed for high cholesterol?
No, not always. Mild cases can be managed with lifestyle changes, but more serious or genetic cases may require medication such as statins.