High Cholesterol - Diagnosis and Treatment

Diagnosis

A blood test, often called a lipid panel or lipid profile, checks cholesterol. This test finds out if you have high cholesterol, which can increase the risk of heart attack, angina, and other heart problems.

The test measures different types of fats in the blood, including:

Total cholesterol
LDL cholesterol (low-density lipoprotein, or “bad” cholesterol)
HDL cholesterol (high-density lipoprotein, or “good” cholesterol)
Triglycerides

Most people need to fast for 9 to 12 hours before the test, eating and drinking only water. Some tests do not require fasting. Always follow the instructions from your healthcare professional.

Understanding Cholesterol Test Results

Cholesterol test results in the United States are shown in milligrams per deciliter (mg/dL). Other countries use millimoles per liter (mmol/L).

These numbers help decide if your cholesterol levels are healthy or too high.

Type of Test	Measurement (U.S.)	Healthy Range	Borderline High	High	Very High
Total Cholesterol	Below 200 mg/dL	Desirable	200–239 mg/dL (5.2–6.2)	≥240 mg/dL (>6.2)	–
LDL Cholesterol	Below 70 mg/dL*	Ideal for heart disease	100–129 mg/dL (2.6–3.3)	130–159 mg/dL (3.4–4.1)	≥190 mg/dL (>4.9)
	70–99 mg/dL	Optimal for healthy people
HDL Cholesterol	<40 mg/dL (men)	Low	–	–	–
	<50 mg/dL (women)	Low	–	–	–
	60+ mg/dL	Best	–	–	–
Triglycerides	<150 mg/dL	Normal	150–199 mg/dL (1.7–2.2)	200–499 mg/dL (2.3–5.6)	≥500 mg/dL (>5.6)

People with heart disease often have a lower LDL goal.

What Each Number Means

LDL Cholesterol (Bad Cholesterol):
- Lower numbers are best. High LDL can cause plaque buildup in arteries and raise the risk of heart disease.
HDL Cholesterol (Good Cholesterol):
- Higher numbers are better. HDL helps clear cholesterol from the blood.
Triglycerides:
- High levels can raise the risk of heart attack and may signal other health issues like diabetes or obesity.
Total Cholesterol:
- This number combines LDL, HDL, and part of your triglyceride values. Doctors look at each part to judge heart risk.

Age, sex, and family history can change what counts as high or risky cholesterol. Sometimes, doctors also check extra numbers like VLDL or non-HDL cholesterol to understand your risk better.

Risk Factors and Symptoms

Most people with high cholesterol do not notice any symptoms. You may not know you have high cholesterol until you get a blood test.

Because high cholesterol does not cause symptoms, regular checks are important to find out your risk for heart problems.

Doctors also look at other risk factors:

Family history of heart disease or stroke
Diabetes or high blood sugar
Obesity
Smoking
High blood pressure
Low HDL cholesterol

Managing cholesterol helps lower the risk of serious health problems.

Cholesterol Checks for Kids and Teens

Children and teenagers can also have high cholesterol, especially if their family has a history of high cholesterol, heart attack, or stroke.

Some kids may develop high cholesterol if they are overweight or have health conditions like diabetes.

Recommended times for children to get a cholesterol check:

Ages 9 to 11: All children should have their cholesterol checked at least once.
Earlier Screening: Children with risk factors like diabetes, obesity, or a family history of heart disease may need to be tested sooner.
Ages 17 to 21: Another cholesterol test is recommended during these years.

Routine testing helps spot problems early. This allows families and doctors to manage cholesterol before it leads to heart disease.

Age Group	When to Test	Special Cases
9-11	Once during this age range
17-21	Once during this age range
Younger	If family or health history shows higher risk	Early signs or risk factors

Healthcare professionals use these checks to find children at risk and start steps to control cholesterol early. This can include changes in diet, more exercise, or medicine if levels stay high.

Treatment

Doctors often prescribe statins to lower LDL, the “bad” cholesterol. Statins block a process in the liver that makes cholesterol, so the liver removes more cholesterol from the blood.

Doctors usually suggest statins first for high cholesterol. Statins can help lower the risk of heart attack and stroke.

Drugs That Block Cholesterol Uptake

Cholesterol absorption inhibitors help reduce the amount of cholesterol absorbed from food in the small intestine. These medications lower blood cholesterol levels by limiting how much dietary cholesterol enters the bloodstream.

In some cases, doctors may combine a cholesterol absorption inhibitor with a statin to improve cholesterol control, especially when one medication alone isn’t enough to reach target levels.

Alternative Cholesterol-Lowering Medications

A cholesterol-lowering medication that works by blocking a key enzyme in the liver may be used to reduce LDL (bad) cholesterol levels.

This medication works similarly to statins but is activated in the liver rather than the muscles, which may make it a better option for people who experience side effects with statins.

In some cases, this type of medication is combined with a cholesterol absorption inhibitor to enhance cholesterol reduction when lifestyle changes or a single medication are not enough.

Bile Acid Binding Medications

Bile acid sequestrants bind to bile acids in the intestines. This makes the liver use up cholesterol to create more bile acids, lowering cholesterol in the blood.

Doctors sometimes give these medicines to people who cannot take statins or need extra help lowering cholesterol.

PCSK9 Blocking Medicines

PCSK9 inhibitors are shots that help the liver clear LDL cholesterol from the blood. Doctors use these medicines for people with genetic high LDL or when other medicines do not work well.

You get these injections under the skin, often every few weeks or months.

Medicines for High Triglyceride Levels

If tests show high triglycerides, doctors may suggest:

Fibrates: These drugs help remove triglycerides from the blood and can also lower LDL. Using a fibrate with a statin may increase the chance of side effects.
Niacin: This medicine limits how much LDL cholesterol the liver makes. Doctors use niacin less often now because it does not add extra benefits when combined with a statin, and it may cause liver problems or other serious side effects.
Omega-3 Fatty Acids: These are found in some fish oils and are available as pills or by prescription. Omega-3s can help lower triglycerides, but talk to your doctor first, since they can interact with other medicines. The quality and price of omega-3 products can vary.

Side Effects Linked With Cholesterol Medicines

Most cholesterol medicines are safe but can have side effects. Statins can sometimes cause muscle pain, rare muscle damage, and higher blood sugar levels.

If you have side effects, tell your healthcare professional. Doctors may order liver function tests to check for problems.

Medicine Type	Possible Side Effects
Statins	Muscle pain, rare muscle damage, higher blood sugar
Fibrates	Stomach upset, increased risk of muscle issues with statins
Niacin	Flushing, liver problems
PCSK9 inhibitors	Injection site reactions
Bile acid sequestrants	Stomach upset, constipation
Omega-3s	Fishy taste, upset stomach

Cholesterol Lowering in Kids

For children aged 2 and older with high cholesterol, doctors usually start with healthy eating and more exercise.

If these changes are not enough, doctors may recommend cholesterol-lowering medicines like statins for kids as young as 10. Each case is different, and doctors look at the full health picture before prescribing medicines for children.

Lifestyle and Home Remedies

Healthy changes at home can help manage cholesterol and lower the risk of heart problems.

These habits can also support better blood sugar, weight control, and may help with conditions like diabetes, kidney disease, and thyroid problems.

Healthy Eating Habits

Choose foods with less saturated and trans fats.
Eat more fruits, vegetables, nuts, and whole grains.
Add healthy fats from avocados, olive oil, and oily fish.
Limit sugar, sodium, and dietary cholesterol.

Staying Active

Aim for at least 30 minutes of physical activity most days.
Walking, biking, or swimming are good choices.
Regular exercise can help reduce obesity and improve blood pressure.

Avoiding Harmful Habits

Quit smoking to lower cholesterol and protect your heart and lungs.
Limit alcohol. Women should have no more than one drink per day; men, no more than two.
Manage stress with meditation, hobbies, or deep breathing.
Get enough sleep. Adults need about 7 to 9 hours each night.

Getting Ready for Your Visit

Steps You Can Take

Before your appointment, find out if you need to take any special actions.

For some cholesterol tests, your healthcare team may ask you not to eat or drink anything except water for 9 to 12 hours before the test. Always check with your healthcare team about what you are allowed.

Prepare the following before your visit:

Write a list of any symptoms, even if they seem unrelated.
Gather details about your family history of conditions such as high cholesterol, heart disease, stroke, high blood pressure, or diabetes.
Make a complete list of all medicines, vitamins, and supplements you take, including the amounts.
Note down questions to ask your healthcare provider.

Sample questions include:

Topic Area	Questions to Consider
Tests	What tests will I need?
Treatment	What are my treatment options?
Monitoring	How often should I get my cholesterol checked?

Ask about anything else that concerns you.

What Your Healthcare Provider Might Ask

The healthcare team may ask several questions to better understand your health.

What types of food do you eat most days?
How often do you exercise?

They may also want to know how much alcohol you drink, if any. They might ask if you smoke now or did in the past. They may also ask if you have been around smokers regularly.

Your provider could ask when you last checked your cholesterol and what the results were.

High Cholesterol – Diagnosis and Treatment