Cholesterol is a waxy material found in the blood which the body needs to build healthy cells. However, excess levels can raise the risk of heart disease, as one can develop fatty acid deposits in the blood vessels. When these deposits pile up, blood flow through the arteries is hampered. These deposits can sometimes break and form a blood clot, leading to a heart attack or a stroke. There are no symptoms that manifest because of high cholesterol. Only a blood test can detect it.

Types of Cholesterol

The combination of proteins and cholesterol is called a lipoprotein. There are mainly two types of cholesterol, based on what the lipoprotein carries. These are:

LDL or low-density lipoprotein: This is the “bad” cholesterol which builds up in your artery walls, rendering them hard and constricted.
HDL or high-density lipoprotein: This is the “good” or helpful cholesterol that mops up excess cholesterol and carries it back to your liver.

HDL and LDL

A lipid profile also gives you a quantum of triglycerides, a type of fat in the blood, which in excess can also increase your risk of heart disease.

What are the possible complications of a high cholesterol count?

High cholesterol can cause a dangerous condition called atherosclerosis (cholesterol and other deposits on the walls of your arteries). Such deposits or plaque can hinder blood flow through the arteries and lead to complications like:

Chest pain: You might experience chest pain or angina if your coronary arteries (the ones that supply blood to the heart) get clogged, together with other symptoms of coronary artery disease (CAD).
Heart attack: When plaques break up or rupture, a blood clot can form at the site, impeding blood flow or running loose to block an artery downstream. If flow of blood to the heart stops completely, the person might experience a heart attack.
Stroke: In a similar vein, when a blood clot blocks blood flow to a part of the brain, it can lead to stroke.

Certain diseases can cause unhealthy cholesterol levels like:

Chronic kidney disease (CKD)
Diabetes
HIV/AIDS
Hypothyroidism
Lupus

cholesterol levels

Medications for certain health conditions can also worsen cholesterol levels, like:

Acne
Cancer
Hypertension
HIV/AIDS
Arrythmia or irregular heart rhythms

How do you feel if your cholesterol is high?

Early on, you feel normal when you have high cholesterol. It doesn’t give you symptoms. However, after a while, plaque buildup (made of cholesterol and fats) can slow down or stop blood flow to your heart or brain. The symptoms of coronary artery disease can include chest pain with exertion, jaw pain and shortness of breath.

When a plaque of cholesterol ruptures and a clot covers it, it closes off an entire artery. This is a heart attack, and the symptoms include severe chest pain, flushing, nausea and difficulty breathing. This is a medical emergency.

Are there any warning signs of high cholesterol?

Most people don’t have symptoms when their cholesterol is high. People who have a genetic problem with cholesterol clearance that causes very high cholesterol levels may get xanthomas (waxy, fatty plaques on their skin) or corneal arcus (cholesterol rings around the iris of their eye). Conditions such as obesity have a link to high cholesterol, and this may prompt a provider to evaluate your cholesterol level.

Causes

What causes cholesterol to get high?

Various hyperlipidemia causes include:

Smoking.

Drinking a lot of alcohol.
Eating foods that have a lot of saturated fats or trans fats.
Sitting too much instead of being active.

Being stressed.

Inheriting genes that make your cholesterol levels unhealthy.
Medications that are helpful for some problems can make your cholesterol levels fluctuate, such as:
Beta-blockers.
Diuretics.
Hormonal birth control.
Steroids.

how much cholesterol you have

Antiretrovirals for HIV.

Medical problems can also affect how much cholesterol you have. These include:

Having overweight or obesity.
Liver disease.
Pancreas disease.
Multiple myeloma.
Polycystic ovary syndrome (PCOS).
Hypothyroidism.
Primary biliary cholangitis.
Chronic kidney disease.
Diabetes.
Lupus.
Sleep apnea.
HIV.

What are the risk factors for hyperlipidemia?

Several things can put you at a higher risk of hyperlipidemia, including:

Having a family history of high cholesterol.
Having hypothyroidism.
Having obesity.
Not eating a nutritious diet.
Drinking too much alcohol.
Having diabetes.
Smoking.
Diagnosis and Tests

How is hyperlipidemia (high cholesterol) diagnosed?

Your provider will want:

A physical exam.
Your medical history.
Laboratory testing of your cholesterol levels in your blood.
Your family’s medical history.
To calculate your 10-year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score.
A blood test called a lipid panel will tell you these numbers:

Type of cholesterol

Total cholesterol
Best number to have
Less than 150 mg/dL
Bad (LDL) cholesterol
Best number to have

Less than 100 mg/dL,less than 70 mg/dl in diabetes,less than 50 mg/dl in patients with atherosclerotic heart disease and less than 40 mg/dl in those with recurrent heart attacks.

For further coronary risk stratification one may also need to do these tests:

High sensitivity C-reactive protein (hs-CRP).

Lipoprotein (a).
Apolipoprotein B.
Coronary calcium scan.
Management and Treatment

How is hyperlipidemia (high cholesterol) treated?

Some people can just change their lifestyles to improve their cholesterol numbers. For other people, that’s not enough and they need medication.

Things one can do include:

Exercising.
Quitting smoking.
Sleeping at least seven hours each night.
Keeping your stress level well managed.
Eating healthier foods.
Limiting how much alcohol you drink.
Losing a few pounds to reach a healthy weight.

What medications are used for hyperlipidemia?

People who need medicine to treat their high cholesterol usually take statins. Statins are a type of medication that decreases how much bad cholesterol is circulating in your blood. Your provider may order a different type of medicine if:

If one can’t take a statin or cholesterol levels don't reach targets then one needs another medicine in addition to a statin. Currently available drugs include ezetemibe, Bempedoic acid and biogenomics like evolucomab and inclisiran

One may have familial hypercholesterolemia, a genetic problem that makes your bad (LDL) cholesterol number extremely high.

Are there side effects of hyperlipidemia (high cholesterol) treatment?

Any medication can have side effects, but the benefits of statins far outweigh the risks of minor side effects. Let your provider know if you aren’t doing well on your medicine so they can develop a plan to manage your symptoms.

How soon will the hyperlipidemia (high cholesterol) treatment start working?

The concerned Physician will order another blood test about two or three months after you start taking hyperlipidemia medication. The test results will show if the cholesterol levels have improved, which means the medicine and/or lifestyle changes are working. The risk of cholesterol causing damage to your body is a long-term risk, and people usually take cholesterol-lowering treatments for a long time.

How can I reduce my risk of hyperlipidemia?

Even children can get their blood checked for high cholesterol, especially if someone in the child’s family had a heart attack, stroke or high cholesterol. Children and young adults can get checked every five years.

Once you reach middle age, you should have your cholesterol checked every year or two. Your doctor can help you decide how often you should have a hyperlipidemia screening.

How can I prevent hyperlipidemia (high cholesterol)?

Changes you make in your life can keep you from getting hyperlipidemia. Things you can do include:

Stop smoking.
Stay active instead of sitting too much.
Keep your stress level down.
Get the right amount of sleep.
Eat healthy foods.
Cut back on eating fatty meats.
Don’t buy snacks that have “trans fat” on the label.
Stay at a healthy weight.
Outlook / Prognosis

What can I expect if I have hyperlipidemia?

If you have hyperlipidemia, you’ll need to keep using healthy lifestyle habits for years to come. You’ll also need to keep follow-up appointments with your doctor and continue to take your medicine. If you and your doctor are able to manage your cholesterol level, you may not have serious health problems as a result of it.

How long will you have hyperlipidemia?

Hyperlipidemia is a condition you’ll need to manage for the rest of your life.

What is the outlook for hyperlipidemia (high cholesterol)?

Although high cholesterol puts you at risk for heart attacks and stroke, you can protect yourself by living a healthier lifestyle and taking medicine if needed.

Living With

How do I take care of myself with hyperlipidemia?

Be sure to follow your doctor 's instructions for making your lifestyle healthier.

Here are things you can do yourself:

Exercise.
Stop smoking.
Sleep at least seven hours each night.
Manage your stress level.
Eat healthier foods.
Limit how much alcohol you drink.
Stay at a healthy weight.

Other things you can do:

If your doctor ordered medicine for you, be sure to keep taking it as the label tells you to do.

Talk to your doctor about estimating your risk of heart disease and stroke so they can manage your risk effectively.

Keep your follow-up appointments.

You should see Doctor if you have:
High blood sugar.
High blood pressure.
High cholesterol.

In summary:

Hyperlipidemia, or high cholesterol, can let plaque collect inside of your blood vessels and put you at risk of a heart attack or stroke. The good news is that you have the power to reduce your risk of heart attack and stroke. Exercising more and eating healthier are just two of the ways you can improve your cholesterol numbers. Taking medicine your provider orders makes a difference, too.

What are the known risk factors for unhealthy cholesterol levels?

Poor dietary habits: A diet overloaded with saturated or trans fats can lead to high cholesterol counts. The fat in the meat and full-fat dairy products contain saturated fats, whereas trans fats are very often found in packaged snacks or desserts.
Obesity: Those having a BMI (body mass index) of 30 or more are more prone to having wonky cholesterol levels.
Sedentary lifestyle: Regular exercise helps increasing the helpful HDL cholesterol count
Smoking: The levels of the “good” HDL cholesterol are often depleted by cigarette smoking
Drinking: Excessive alcohol consumption can raise the total cholesterol count
Ageing: The risk for unhealthy cholesterol usually increases with age, with those over 40 more vulnerable. With age, the liver’s capacity to remove the harmful LDL cholesterol decreases

Keeping these risk factors in mind, a few heart-healthy lifestyle changes can help anybody rationalize cholesterol count by doing simple things like, sticking to a healthy diet, exercising regularly, kicking smoking, limiting alcohol intake, etc.