Understanding High Cholesterol and Borderline High Cholesterol

If you have high or borderline high cholesterol, you may be wondering how to keep yours low. Sometimes lifestyle modifications like getting more exercise or managing stress can effectively improve your numbers. Other times, a statin or other prescription medication may be needed to get cholesterol at a desirable level.

High cholesterol can harm your health. It's important to keep track of your cholesterol levels because you may not have any symptoms until a serious problem occurs—like a heart attack or a stroke.

This article explains the causes of high cholesterol. It also discusses how to treat and prevent it.

Understanding Cholesterol

Cholesterol is needed to produce hormones, digest food, and make vitamin D. Your body has two main types of cholesterol: LDL and HDL.

• Low-density lipoprotein (LDL) is sometimes called "bad cholesterol" because high LDL levels can contribute to cholesterol buildup in the arteries, which is a risk factor for heart disease and stroke.
• High-density lipoprotein or HDL is often known as "good cholesterol" because it works like a cleanup crew in the bloodstream. It ferries excess cholesterol from the tissues back to the liver, where it is broken down. Higher HDL levels are good for the heart.

Your body also has other types of cholesterol in small amounts.

Your healthcare provider can measure your total cholesterol level, as well as individual types.

The target level for a healthy adult is below 200 mg/dL. It's much more common to have high levels than it is to have very low levels.

The American Heart Association recommends that healthy adults aged 20 years and older with a low risk of high cholesterol have their cholesterol levels checked at least once every four to six years. People at high risk may need to have it checked more often.

Borderline High Cholesterol

A total cholesterol level between 200 mg/dL and 239 mg/dL is considered borderline high. Having borderline high cholesterol means you have slightly higher levels than normal, which increases your risk of cardiovascular problems.

Some health conditions like diabetes, kidney disease, and hypothyroidism can alter cholesterol levels, as can medications like birth control pills and diuretics (aka water pills). If you have borderline high cholesterol, talk to your provider about what you can do to lower it. Factors you can control include following a diet low in saturated fat, exercising regularly, and not smoking.

High Cholesterol

High total cholesterol is any reading over 240 mg/dL. It increases the risk of heart attacks, strokes, and other serious problems.

High cholesterol can cause hardening of your arteries, the blood vessels that carry blood away from the heart. Cholesterol, fat, and other substances build up in the artery walls, forming a hard substance called plaque. As the plaque builds up, the arteries get narrower and can even become blocked, which can lead to heart disease, stroke, and other problems.

Diagnosis

A lipid profile test measures several types of cholesterol. The simplest is total cholesterol, which includes the combined levels of LDL, HDL, and other types such as very-low-density lipoprotein (VLDL).

The lipid profile also gives a detailed breakdown of cholesterol levels by lipid (fat) type: LDL, HDL, and triglycerides. Triglycerides are the main type of fat that circulates in your blood. High levels of triglycerides are linked to health problems like heart disease and diabetes.

According to current guidelines, target levels are:

• LDL: Levels below 100 mg/dL for most adults, though levels above 70 mg/dL may be too high for people with diabetes, a prior history of heart disease, or high risk of heart disease
• HDL: Levels above 40 mg/dL for males, levels above 50 mg/dL for females
• Triglycerides: Levels below 150 mg/dL

If you've already had a lipid test and you're not sure what the numbers mean, you can use our lipid test analyzer. Type your test results into the tool below. It can help you understand what your levels may mean for your health, so you can follow up with your healthcare provider if needed.

Causes

Your genes, your diet, and how much you exercise can all influence your cholesterol levels.

• Diet: High-fat, processed foods can raise your LDL levels. So can obesity. Excess body fat can increase the amount of cholesterol and triglycerides in the blood.
• Lack of exercise: Not getting enough physical activity can raise your LDL level. It can also cause your HDL level to be too low.
• Genetics: Sometimes the way your body naturally processes fat and cholesterol can cause your levels to be unhealthy.
  
• Age: Cholesterol levels rise with age in males and females. Before menopause, females have lower cholesterol levels than males of the same age. After menopause, females usually see an increase in LDL cholesterol.
  

About 1 in every 200 to 500 people have a condition called familial hypercholesterolemia. This genetic condition can raise cholesterol levels to twice the normal level or even higher.

Treatment

Bringing your cholesterol level into a healthy range is important for heart health. According to the National Heart, Lung, and Blood Institute, high total cholesterol levels are especially dangerous for people who smoke or have a family history of heart disease.

High cholesterol can also make some health conditions worse, including:

• Obesity
• Diabetes
• High blood pressure

You may be able to lower your cholesterol naturally by making some adjustments to your lifestyle:

• Quit smoking: This is the absolute best thing you can do to lower your risk of heart attack and stroke.
• Avoid foods that are high in saturated fats: Saturated fats are found in animal meat, dairy products, processed meats, and pre-packaged snacks and desserts.
• Seek out foods low in fat: Foods naturally low in fat include whole grains, fruits, and vegetables. Opt for low-fat varieties of toppings, sauces, and dressings.
• Exercise regularly.

In most cases, changes in diet and increased exercise are the first steps for lowering high cholesterol levels. Health experts recommend at least 150 minutes of moderate-intensity exercise per week.

Diet

Roughly 80% of the cholesterol in your blood is produced by your liver and intestines. The rest comes from your diet. It's important to avoid fried foods, foods high in saturated fats, and refined carbohydrates if you have high cholesterol, such as:

• Fatty meats, particularly red meat
  
• Whole-fat dairy products
• Processed foods
• White bread
• White potatoes
• White rice
  
• Highly processed sugars or flours

Foods proven to reduce cholesterol, on the other hand, include:

• Fatty fish such as salmon
• Walnuts and other nuts
• Oatmeal
• Soluble fibers such as psyllium
• Foods fortified with plant sterols or stanols, which are plant-based extracts added to a variety of foods including margarine, granola bars, orange juice, and chocolate

Medications

If lifestyle changes don't lower your levels enough, your healthcare provider may prescribe a type of drug called a statin. Statins are the first-line medications used to reduce LDL and triglyceride levels and increase HDL levels.

Statins are the most widely prescribed class of cholesterol-lowering drugs. They limit the liver's ability to make cholesterol.

These are examples of statin medications:

• Lipitor (atorvastatin)
• Zocor (simvastatin)
• Mevacor (lovastatin)
• Lescol (fluvastatin)
• Crestor (rosuvastatin)
• Pravachol (pravastatin)

In addition to statins, some people with high cholesterol are also prescribed other cholesterol-lowering medications such as PCSK9 inhibitors like Praluent (alirocumab), Repatha (evolocumab), and Leqvio (inclisiran); fibrates such as Antara (fenofibrate) and Lopid (gemfibrozil); or bile acid sequestrants like Welchol (colesevelam) and Colestid (colestipol).

Statins can cause several uncomfortable side effects. Myalgia is the most common side effect, better known as muscle aches and pains. Statins can also cause altered liver enzymes and increase the risk of diabetes in some people.

If you take a statin and experience side effects, ask your doctor if switching to a different statin may help. People who experience side effects on one type of statin may not have side effects on a different one.

Summary

Your body needs cholesterol to carry out important functions. But if your total or LDL cholesterol levels are too high, you're at risk of heart disease, stroke, and other health problems.

A blood test can tell you how high your levels are. Desirable total cholesterol is less than 200 mg/dL. Aim for an LDL level under 100 mg/dL and an HDL level of 40 mg/dL or higher. Your triglyceride level should be under 150 mg/dL.

If your test shows that you need to bring these numbers down, try to get 150 minutes of exercise each week and cut out high-fat, highly processed foods. Your healthcare provider may recommend medication if these steps aren't effective enough.