If you have high cholesterol, you may not even know it, since there are no symptoms. But left untreated, high cholesterol can be a risk factor for heart disease, high blood pressure stroke and other conditions.

Not all blood cholesterol is bad. Some forms are actually helpful, but as the danger posed by the “bad” cholesterol has become more widely known, the phrase “high cholesterol” has come to refer to high levels of low-density lipoprotein (LDL) cholesterol.

Gradually, the waxy substance can build up in your blood vessels, narrowing them so your heart has to work harder to pump blood around your body. Once the cholesterol forms plaques on the walls of your arteries and veins, there’s a risk that it will break off and lodge in your brain causing a stroke or block blood flow in your heart, triggering a heart attack.

If you lower your LDL cholesterol, you’ll be adding less buildup to your blood vessels. But what’s already in your body won’t go away. That’s why knowing your risk for high cholesterol and monitoring it, even at a young age, can help you manage your health and lower your risk of serious illness.

The Centers for Disease Control and Prevention (CDC) recommends children get their first cholesterol check between the ages of 9 and 11. The CDC recommends most healthy adults can get their cholesterol checked every five years or so.

Staying on top of your cholesterol level is the first step in keeping high cholesterol — also known as hyperlipidemia — under control. A simple blood test is all that’s needed to perform what’s called a lipid panel that measures the level of fats, including saturated fat, in your blood.

Not all cases of high cholesterol are caused by poor diet and exercise. Many people are born with a predisposition to produce more of the dangerous cholesterol. Familial hypercholesterolemia is a medical term describing an inherited tendency to have high cholesterol. It is why your health care provider will ask about family members and any history of heart disease.

Talk to your health care provider at your annual checkup about a cholesterol blood test, or make an appointment to have an annual visit.

Before your test, your health care provider will ask you to avoid eating and drinking (except water) for 12 hours before the blood test. Fasting helps provides an accurate assessment of your baseline cholesterol measured as LDL and triglycerides and helps to standardize the conditions for the test.

What Is ‘Good’ vs. ‘Bad’ Cholesterol?

High cholesterol levels, high blood pressure and heart disease are all closely linked, so it is important to understand cholesterol and how it affects your body. At the right levels, cholesterol is an important part of how your body works. Produced by your liver, an appropriate cholesterol level serves useful purposes, like helping build cell membranes.

The cholesterol test checks your levels of:

• LDL cholesterol or “bad cholesterol,” since high levels can lead to plaque buildup in your arteries and result in heart disease or stroke
• High-density lipoprotein (HDL) cholesterol or “good cholesterol” that can lower your risk of heart disease and stroke
• Triglycerides, a type of fat in your blood that your body uses for energy

The combination of a high triglyceride level with low HDL cholesterol or a high LDL cholesterol level can increase your risk for heart attack and stroke.

Total cholesterol is the total amount of blood cholesterol based on your HDL, LDL and triglycerides numbers.

No race or ethnicity is immune from health issues, including unhealthy cholesterol levels, but research suggests Black individuals may have higher prevalence for factors that contribute to high blood cholesterol.

Questions to Ask a Medical Professional to Help Manage Your Cholesterol

Knowing your cholesterol level is an important part of managing your health and is one of several numbers that can help determine your heart disease risk. Your blood pressure, glucose (blood sugar) and weight are additional risk factor measures for heart disease.

When visiting your provider for a follow-up appointment after a lipid profile test, the following questions may be useful to discuss:

• What is my current cholesterol level?
• What is my overall coronary artery disease risk?
• What lifestyle changes can I make to lower my cholesterol?
• What is a heart-healthy diet, and should I consider it?
• What type and amount of exercise do you recommend?
• Should I consider weight loss?
• What medications might be appropriate to reduce cholesterol?
• What are the potential side effects of cholesterol-lowering medications?
• How often should I have my cholesterol checked?

While the cholesterol buildup doesn’t go away from your blood vessels, lifestyle changes to reduce the amount of LDL cholesterol circulating in your blood will help prevent more plaque development. The same changes likely will help you prevent other disease such as stroke and diabetes.

Dietary cholesterol comes from foods like egg yolk, shrimp, beef, pork, poultry, cheese and butter. Nicotine in tobacco causes LDL cholesterol to increase and reduces your HDL cholesterol levels. Nicotine also contributes to excess plaque buildup in your arteries (atherosclerosis).

Success in treating high cholesterol typically involves reducing cholesterol in your diet, exercising regularly, losing weight and quitting smoking. Even when making smart lifestyle choices, some people are genetically predisposed to higher cholesterol — which can make it challenging to manage through lifestyle alone.

If this is true for you, our team can help develop a personalized plan based on your specific health status. This plan may include medication to help lower your cholesterol.

Medication for Lower Cholesterol

If you are at risk for cardiovascular disease, heart attack or stroke, your health care provider may recommend a cholesterol-lowering medication or combination of medications.

Some of the more widely prescribed cholesterol medications, according to the American Heart Association, are:

• Statins (HMG-CoA reductase inhibitors). These are typically one of the first medications a provider will prescribe. They prevent cholesterol production in the liver. Lovastatin, pravastatin, simvastatin, fluvastatin and atorvastatin are examples of statins.
• PCSK9 inhibitors are new class of drugs. They inactivate a protein in the liver to lower LDL cholesterol. Examples include alirocumab and evolocumab.
• Bile acid sequestrants. These medications help the intestine get cholesterol out of your system. Examples include cholestyramine, colestipol and colesevelam.
• Cholesterol absorption inhibitors. Ezetimibe is a common nonstatin drug and prevents cholesterol from being absorbed in the intestine.