What Is Dangerously High Cholesterol?
You may be diagnosed with borderline-high or high cholesterol if your blood test results show:
Total cholesterol higher than 200 milligrams per deciliter (mg/dL)LDL (“bad”) cholesterol higher than 100 mg/dLTriglycerides over 150 mg/dLHDL (“good”) cholesterol lower than 40 mg/dL
But what do these numbers really mean for your health? While having high cholesterol isn’t something you’ll notice day to day, it does mean you’re at risk for — or may already have — heart disease, the leading cause of death for both women and men in the United States. Want to know more? Here are answers to 11 frequently asked questions about high cholesterol.
1. What Does High Cholesterol Do to the Body?
Having high cholesterol can lead to stiffening and narrowing of the arteries. A buildup of plaque — a combination of cholesterol, fats, your cells’ waste products, calcium, and fibrin (a protein that helps blood clot), explains the American Heart Association (AHA) — can reduce or block blood flow through the arteries. That’s why cholesterol matters: Lack of sufficient blood flow to your brain or heart can lead to a stroke or heart attack.
2. Why Do I Have High Cholesterol?
For many people, lifestyle plays a big role in the development of the condition. “It’s often due to a combination of diet and how active you are, as well as your genetic capacity to produce cholesterol,” says Raj Khandwalla, MD, cardiologist and director of digital therapeutics at Smidt Heart Institute at Cedars-Sinai in Los Angeles. Being overweight and smoking can also increase your chances of developing high cholesterol.
3. What Causes High Cholesterol If I Eat Healthy? Can It Be Genetic?
If you eat a healthy diet and get regular exercise but still have high cholesterol, your DNA may be a bigger factor than your lifestyle. About 1 in 250 people in the United States live with familial hypercholesterolemia (FH), a life-threatening inherited disorder that causes high cholesterol. Unfortunately, 90 percent of people who have it don’t know it, according to the FH Foundation, a national nonprofit organization based in Pasadena, California. Screening for high cholesterol is the only way to identify people who have FH. Because of this, all children should have a cholesterol screening once between ages 9 and 11, recommends the American Academy of Pediatrics. If your LDL is above 100, it’s already considered high. If it’s higher than 190, you may have FH, according to leading heart groups, such as the AHA, the American College of Cardiology, and the National Lipid Association. If a parent has FH, their child has a chance of having it, too. Finding out if you have FH — and getting treated if you do — is vital, because having FH means your risk of heart disease is 20 times higher than that of people who don’t have inherited high cholesterol, according to the FH Foundation.
4. How Can I Lower My Cholesterol Naturally?
For many people, revamping everyday habits can go a long way toward lowering cholesterol without medication. “There are a number of lifestyle changes that can be made, and they fall under the categories of diet and exercise,” says Dr. Khandwalla. Eating heart-healthy foods is a great place to start. This means reducing your intake of red meat and full-fat dairy products, both of which contain saturated fats that raise cholesterol. Instead, focus on eating lean proteins — chicken, turkey, seafood — and adding more soluble fiber to your diet from fruits, vegetables, and oatmeal, according to the National Heart, Lung and Blood Institute (NHLBI). Getting aerobic exercise most days of the week can also help lower cholesterol.
5. Can High Cholesterol Make Me Tired?
No, high cholesterol doesn’t usually cause fatigue, but it can lead to heart diseases, such as coronary artery disease, that do. With this heart condition, excess LDL builds up as plaque in your heart’s small arteries, causing them to narrow and stiffen. This reduces blood flow, which can make you feel tired or short of breath and cause chest pain, notes the NHLBI. If you’re taking a statin to treat high cholesterol, possible side effects could come with fatigue, such as memory loss, forgetfulness, and confusion, according to the U.S. Food and Drug Administration. However these are very rare. Mayo Clinic describes this as mental fuzziness. Be sure to discuss any similar symptoms with your doctor.
6. Can High Cholesterol Cause a Stroke?
Yes, if you have high cholesterol, you’re at risk of stroke due to the excess cholesterol circulating in your blood, according to the AHA. LDL builds up in your arteries, where it slows or blocks the flow of oxygen- and nutrient-rich blood to your body, including your brain. As arteries narrow and stiffen, blood clots may form a blockage, which can cause a stroke if it travels to the brain. Stroke is the fifth leading cause of death in the United States and one of the main causes of disability, according to the American Stroke Association. But it can be mostly preventable; keeping your cholesterol levels down is one way to cut your risk.
7. Will High Cholesterol Make Me Feel Bad?
No. For most people, high cholesterol has no symptoms at all, according to the AHA. But when it causes plaque buildup in larger arteries in your heart, coronary artery disease can result, which can involve angina (tightness in the chest), chest pain, arrhythmia (irregular heartbeat), and shortness of breath that can leave you low on energy, notes the NHLBI. Coronary artery disease is the most common heart disease, but many people have no idea they have it until they suffer a heart attack, according to the Centers for Disease Control and Prevention (CDC). For them, a heart attack is the first sign that they’d been living with high cholesterol. The AHA advises having your cholesterol checked every four to six years — or more frequently, if you’re at risk — starting at age 20. If your numbers are too high, you can take steps to lower your risk for both heart disease and stroke. Besides following a healthy diet and getting regular exercise, take medications as instructed if your doctor prescribes them.
8. Can High Cholesterol Cause Erectile Dysfunction?
High cholesterol alone is not thought to cause erectile dysfunction (ED), but plaque-clogged arteries can, because blood flow is essential to an erection, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Too much cholesterol may also affect the body’s ability to produce the hormone testosterone, as well as nitric oxide, which helps relax the penile tissue. Both of these factors can lead to ED as well. The good news is that in older men with both high cholesterol and ED, taking statins — medications used to treat high cholesterol — is associated with a significant improvement in ED, according to research presented at the American College of Cardiology’s 63rd Annual Scientific Session.
9. Does Stress Cause High Cholesterol?
While stress is not a primary cause of high cholesterol, it may still have an effect on cholesterol levels. A study published in May 2017 in the journal Medicine found that in people who experienced stress due to work or personal conflict, higher stress was a risk factor for high cholesterol. And when you are feeling stressed and pressed for time, you may be less likely to follow heart-healthy lifestyle measures, such as eating a nutritious diet and getting exercise. The 2017 study found that regular physical exercise had a strong protective effect against cholesterol.
10. When Should High Cholesterol Be Treated With Medication?
If you’ve had a heart attack, stroke, or have diabetes or been diagnosed with inherited high cholesterol, you’ll need to take one or more cholesterol-lowering medications, in addition to being careful with your diet and staying active. “Statins can have a tremendous impact for lowering LDL cholesterol,” says Khandwalla. Statins decrease your risk of illness and dying if you’re in one of these high-risk groups. In addition to statins, which should always be used first, other cholesterol-lowering drugs include fibrates, niacin, PCSK9 inhibitors, bile-acid sequestrants, and cholesterol absorption inhibitors, according to the CDC. If you found out your cholesterol was high after a routine checkup, discuss your test results with your doctor. Your doctor will calculate your individual risk of heart attack or stroke to decide if you should be on a statin. In some cases, the doctor may recommend giving a healthy diet and active lifestyle a try first. However, if your cholesterol levels remain high, you may need a heart scan to look for plaque buildup in your arteries, and your doctor may prescribe cholesterol-lowering drugs to lower your heart-disease and stroke risk.
11. Can I Live Long With High Cholesterol?
Untreated or undertreated high cholesterol is associated with a lower life span due to the risk of heart attack and stroke, but it’s still possible to live a long life with high cholesterol, provided you follow a heart-healthy lifestyle and take medication if needed. According to a study published in April 2018 in the journal Circulation, a healthy lifestyle — defined as not smoking, doing moderate exercise, maintaining a healthy weight, and following a healthy diet — was associated with an average of 14 more years of life for women and 12 for men. Additional reporting by Erica Patino
