High Cholesterol? Your Primary Care Doctor Can Help You

Because there are no symptoms associated with the condition, high cholesterol is known as a silent killer.  According to the NIH and the Centers for Disease Control and Prevention (CDC), just over a third of U.S. adults — 86 million — have high levels of “bad cholesterol,” or LDL-C, doubling the risk of heart disease and other chronic health conditions. Additionally, 43.8 million people — nearly one in five — have low levels of “good cholesterol,” or HDL-C, which studies show can increase the risk of cardiovascular disease and certain cancers.

Our cells need cholesterol to function, but not all cholesterol is created equal. In this guide, we’ll help you understand the difference between good and bad cholesterol, learn the optimal cholesterol levels for your age and learn how to work with your doctor to bring your cholesterol numbers into a healthy range. 

Cholesterol by the numbers

 Cholesterol levels are measured as milligrams of cholesterol per deciliter of blood, noted as mg/dL. When someone says their cholesterol is 187, they are using shorthand for 187 mg/dL. This means their cholesterol level is 187 milligrams per deciliter of blood. Generally, a cholesterol level of 200 mg/dL or more puts you at increased risk of heart disease, heart attack and stroke.  

U.S. high cholesterol fast facts

According to the most recent report by the Centers for Disease Control (CDC):

• While 31.7% of adults have high LDL levels of over 200 mg/dL, only 48.1% are receiving treatment or medication to help lower it.
• Worldwide, high LDL-C is more common in women than men. In the U.S., Hispanic males have the highest occurrence of high cholesterol in the U.S., followed by African Americans, then white males.  
• The healthy range of total cholesterol is 125-200 mg/dL. Between 2017 and 2020, 10% of adults aged 20 or older had total cholesterol levels above 240 mg/dL.
• Healthy levels of good cholesterol (HDL-C) are more than 40 mg/dL for men and more than 50 mg/dL for women; 17% have levels below 40 mg/dL.
• Approximately 7% of U.S. children and adolescents ages 6 to 19 have high cholesterol.

Role of cholesterol in the body

Found in the blood, cholesterol is a fat-like, waxy substance made up of lipoproteins. As the name suggests, lipoproteins are groupings of proteins and lipids (types of fat called triglycerides) that transport fatty acids and fat-soluble vitamins via our blood plasma to organs and cells that need it to function. All the cholesterol the body needs is made by the liver; additional cholesterol is absorbed from foods like dairy products and red meat.  

Cholesterol is one key to keeping our cells healthy and working optimally. Notably, it contributes to the cell’s membrane structure and fluidity. Cholesterol is also a component of bile salt, which is necessary for digestion and our ability to absorb vitamins A, D, E and K. It also functions in synthesizing steroidal hormones such as cortisol and adrenaline and the sex hormones estrogen, testosterone and progesterone. On a fundamental level, cholesterol is critical to life.

HDL vs. LDL Cholesterol

There are two main types of cholesterol: high-density lipoprotein cholesterol, referred to as HDL-C, and low-density lipoprotein cholesterol, known as LDL-C.

HDL-C is considered “good cholesterol” and LDL-C  is often referred to as “bad cholesterol.” Without treatment, a high level of bad cholesterol is often a precursor to or indicator of potentially life-threatening health issues, including heart disease due to plaque buildup in our arteries, stroke and peripheral vascular disease (PAD).

It’s critical to your overall health that your levels of both HDL-C and LDL-C fall into healthy ranges. Both types are also calculated into one overall total cholesterol number, which also has a healthy range and unhealthy parameters.

LDLs:  Low-density lipoproteins are considered the main form of transportation for cholesterol. Insoluble in blood, they travel around the body in blood plasma, delivering necessary cholesterol to organs that need it. Elevated LDL-C levels means there is too much LDL circulating, which can result in arterial plaque deposit blockages that can lead to stroke, heart attack, cardiovascular disease or PAD.

The healthy LDL-C range in the blood is less than 100 mg/dL for both men and women.

HDLs: High-density lipoproteins have the opposite function. They remove excess cholesterol from the body by returning it to the liver, where it is processed for secretion. That means the goal is to have higher HDL numbers.

Healthy HDL-C levels are above 40 mg/dL for men aged 20 years and up, and 50 mg/dL or higher for women of the same age range.

Total Cholesterol is the combined level of LDL-C, HDL-C and other fatty lipids. Both men and women need a range of 125-200 mg/dL range to be considered healthy.

 Understanding your cholesterol blood test results

To determine cholesterol concentrations in your blood, doctors order a test called a lipid panel, which is a lipid profile of your blood. This simple blood test determines your levels of total cholesterol, triglycerides, HDL-C and Non-HDL (your total cholesterol minus your HDL).  

A medical mathematical equation called the Friedewald Equation is used to calculate your LDL-cholesterol level; this type is the main component of cholesterol buildup and blockage in the arteries that can cause heart disease. Your doctor may order additional tests to measure other impacting factors, like a test that measures whether your arteries are inflamed.

 The healthy guidelines for cholesterol levels are:

Women 20 years and older:

 Men 20 years and older:

Though triglycerides are not a type of cholesterol, they are also measured in a lipid panel; healthy levels are below 150 mg/dL.

Your doctor may also look at your triglyceride to HDL ratio, which is a marker for insulin resistance and a key indicator of cardiovascular risk; this is especially true if your triglyceride level is high and your HDL-C level is low.

What is a fasting insulin test?

A fasting insulin test result may also be included in your lipid panel. Epidemiological studies have found a correlation between high levels of insulin and cholesterol and ischemic heart disease (IHD), which is heart weakening caused by decreased blood flow to the heart.  

Home cholesterol tests are also available, but experts warn that results vary and many home kits only test total cholesterol or HDL and triglycerides. Because many variables factor into how your cholesterol levels impact your risk for cardiovascular and other chronic diseases, the most reliable cholesterol test is a doctor-prescribed lipid panel.

High cholesterol and its impact on health

High cholesterol can have serious consequences, namely the risk of stroke and coronary artery disease, two leading causes of death. A high level of lipids circulating in the blood can lead to plaque buildup in the arteries, which can then cause blockages that increase your risk of developing atherosclerotic cardiovascular disease (CVD), strokes, or angina (chest pain).  

Arterial plaque buildup due to cholesterol can also block branches of arteries that supply oxygen and nutrients to the brain, causing mini-strokes (transient ischemic attacks). High LDL-cholesterol and low  HDL-cholesterol are also risk factors for erectile dysfunction and diabetes; diabetes can also be a cause of high cholesterol. Additionally, high triglyceride levels over 1,000 mg/dL can lead to an increased risk of pancreatitis.

If arterial plaque ruptures, it can cause a blood clot, leading to stroke or heart attack.

What causes high cholesterol?

Certain lifestyle factors — like a diet high in fats, particularly saturated fat and trans fats — are the primary causes of high cholesterol. Other lifestyle factors include too little exercise or a sedentary lifestyle, tobacco use, excess alcohol consumption and stress. Stress can trigger hormonal changes, causing your liver to produce more cholesterol than your body needs.  

Genetics can also play a role in cholesterol levels, like when familial hypercholesterolemia (highly elevated blood concentrations of bad LDL cholesterol) is passed down through generations. High cholesterol can also be a side effect caused by certain medications.

Options for managing high cholesterol

Because lifestyle factors and habits are the main causes of high cholesterol, the first line of treatment usually involves lifestyle changes. Depending on your individual health and cholesterol levels, your doctor may also prescribe medication.

Why diet may be the most important factor

A primary cause of high cholesterol is an unhealthy diet, especially one that contains high amounts of saturated fats and trans fats. These types of fat are commonly found in fast food, processed foods, dairy and red meat. Research shows that reducing or eliminating high-cholesterol foods and eating low cholesterol meals can have a significant impact on reducing bad cholesterol and increasing good cholesterol. The Mayo Clinic and Harvard Medical School recommend making the following adjustments to your diet. As with any major lifestyle or dietary change, you should always check with your doctor first.

Cut out trans fats completely: The Food and Drug Administration (FDA) banned trans fats — listed on food labels as partially hydrogenated vegetable oil — from being added to foods made or sold in the U.S. as of January 2020. Foods can still legally contain up to a half gram of trans fats per serving; these small amounts are not required to be noted on the label. Trans fats are found mostly in store-bought crackers, cakes, cookies and margarines. 

Reduce saturated fats: These types of fats are found primarily in full-fat dairy products and red meat. Doctors and experts often recommend a heart-healthy Mediterranean diet that is high in healthy fats, vegetables, legumes, nuts and seeds and low in saturated fats.

Eat more foods rich in omega-3 fatty acids: These include fish like salmon, herring and mackerel, as well as avocados, nuts such as almonds, and seeds such as flaxseeds.

Bulk up on more soluble fiber: Found in fruits, vegetables, legumes, oats and wholegrains — including apples, pears, strawberries, citrus fruits, Brussel sprouts, kidney beans, black-eyed peas, garbanzos and lentils — soluble fiber can help reduce cholesterol absorption into the bloodstream. Low cholesterol meals are typically high in fiber. Ask your doctor if you would benefit from taking a daily fiber supplement like psyllium.

Supplement with whey protein: Whey protein has been determined to be responsible for the healthy attributes of dairy. Studies have found that whey protein can help lower blood pressure, bad cholesterol and total cholesterol.

Consume soy: Studies show that consuming 25 grams of soy protein daily can lower bad LDL-C by 5-6%.

Favor foods fortified with stanols and sterols: These plant gum extractions help increase our ability to absorb cholesterol from food and can lower LDL-C by around 10%; they are used as an additive in a broad range of foods.

If your triglycerides level is high, your doctor may also recommend a triglycerides diet to help lower it. This typically entails cutting out or limiting high-sugar foods such as cakes, cookies, candy, ice cream, pies and some yogurts, and avoiding sugary drinks, sodas and energy drinks. 

Benefits of exercise in lowering cholesterol

Exercise is not directly proven to lower bad cholesterol, but it can potentially help increase good HDL-cholesterol when combined with other healthy lifestyle changes. Getting 20-30 minutes of moderate physical activity a day Aerobic exercise—such as a brisk daily walk, swimming, dancing or riding a bike—is recommended as it may help improve insulin sensitivity and lower triglyceride levels as well as increase HDL.

Smoking cessation and alcohol moderation

Research shows that a highly reactive compound found in cigarette smoke called acrolein inhibits good HDLs from transporting bad LDLs out of the arteries and to the liver for excretion. This means smoking can promote the accumulation of LDLs and potential blockages in your arteries and at the same time impair good HDLs from preventing and repairing any damage.  

The CDC also reports that our lungs absorb vapors from tobacco smoke that have been found to increase LDL levels; decrease HDL levels; promote narrowing and thickening of blood vessels; damage cells that line our arteries and blood vessels; and cause our blood to be stickier and thicker. This means LDL cholesterol gets stickier and is more likely to cling to artery walls or clot, increasing risk of heart disease and stroke.

Cholesterol-lowering medications

Statins are the most common medication proven to help lower (bad) LDL levels by blocking a substance our body needs to make cholesterol. They also stabilize arterial plaque and help lower the risk of cardiovascular events, heart disease and clotting that can cause a stroke.

Common prescription statins include: altorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo, Zypitamag), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor)

How your Primary Care Physician can support you  

When it comes to addressing high cholesterol and related symptoms, your primary care physician is your best advocate and collaborator. A primary care doctor has a baseline knowledge of cholesterol and can help guide you on your journey to making sustainable, healthier lifestyle changes. Your doctor also will know your health history and can order blood tests and other labs to monitor your cholesterol levels and other health conditions.

If appropriate, your doctor may prescribe cholesterol medications or recommend certain vitamins or supplements. Ask to schedule a regular check-in appointment so he or she can see how you’re doing and address any questions or concerns. If you want extra support around healthy eating, your doctor can also refer you to a registered dietician, a weight loss specialist trained in both the psychological and behavioral aspects of weight loss, a physical therapist regarding any exercise concerns and/or a psychologist to help maintain your mental health and wellbeing.

How to talk to your doctor about high cholesterol

Be open with your physician about your cholesterol-related concerns (e.g., risk of heart disease) and health goals (e.g. start exercising). Share your health history and any roadblocks that get in the way of good health (e.g. work stress, lack of knowledge about healthy eating). Accept your doctor's recommendations and timeframes for any needed lifestyle changes. The key is to be honest and transparent with your doctor so he or she can guide you to your goals.

Be completely honest with your doctor.

Sometimes, it’s tempting to be less than truthful with our doctors when it comes to fraught topics like diet, exercise and alcohol or tobacco. It’s understandable to feel embarrassed or even guilty if you struggle with things like smoking, drinking, unhealthy eating habits, weight gain or any type of addiction.  

Your doctor has seen it all: You won’t be their first patient to struggle with these issues (or the last!). You can also communicate to your doctor that you are anxious or embarrassed about these topics and let them know that you could use reassurance.  

Make a list of your questions and concerns.

It’s easy to forget important questions at the doctor, especially if your appointment is short or rushed. A simple solution is to write out your questions and concerns ahead of time. You could even keep a list on your phone or a pocket notebook and add to it whenever you think of something else you want to bring up.  

If you are planning to make (or have already made) major lifestyle changes, it’s recommended that you check with your doctor to ensure these changes are safe and appropriate for you. Good general questions to ask include:

• What first steps do you recommend for lowering my cholesterol?  
• Should I be tested for any diseases that my cholesterol levels put me at risk for?
• Do you have patients who successfully lowered their cholesterol and maintained it?
• Is there a cholesterol medication I should try?
• Are there cholesterol books, podcasts, or literature I should check out?
• What lifestyle changes do you recommend?

Bring a spouse or trusted friend.

Not everyone knows that you are allowed to bring someone with you when you go to the doctor. Having a confidante by your side can make you feel more secure and help you remember what you want to talk about with your doctor. It also shows your doctor that you have a strong support system and research has shown that strong social and emotional support are associated with better health.

Take notes.

Medical appointments can be overwhelming. In order to remember of your doctor’s recommendations, it can be helpful to take notes during your appointment. If you bring someone with you, you can ask them ahead of time to take notes for you. You should also get a visit summary from your doctor after each appointment. If you are not sure how to access this summary, ask your doctor or a member of his or her front desk staff.

FAQ about High Cholesterol

Does cholesterol medicine make you lose weight?

There is no evidence that cholesterol medicine in general causes weight loss. In fact, studies show that statins are more likely to cause weight gain. The risk of weight gain should not deter you from taking life-saving statin medications.

Can high cholesterol cause weight gain?

Gaining weight is a very common side effect of cholesterol medications, since they can increase sensations of hunger, leading to increased calorie intake. A UCLA Health study found that patients taking statins consumed more calories and ate more fat. It is theorized that people taking statins may feel less motivated to make healthy lifestyle changes, relying instead on the statins to do the work to lower their cholesterol.

What is a lipid panel?

A lipid panel — also referred to as a lipid test, a lipid profile, a cholesterol panel or a coronary risk panel — is a blood test that measures the concentration of lipids (fat molecules) in your blood. The panel typically measures five types of lipids:

• Low-density lipoprotein cholesterol (LDL-C)
• Very low-density lipoprotein cholesterol (VLDL-C)
• High-density lipoprotein cholesterol (HDL-C)
• Triglycerides
• Total cholesterol

 What is mixed hyperlipidemia?

Mixed Hyperlipidemia – also known as Familial Combined Hyperlipidemia – is a genetic predisposition of elevated lipid levels in the blood, including LDL (bad) cholesterol, triglycerides and other lipids, that is inherited from one’s parents. It is compounded by a sedentary lifestyle and a diet high in saturated fats and trans-fats.

Can stress cause high cholesterol?

Ongoing high levels of stress can increase stress hormones such as corticosteroids, which can incite the liver to make more cholesterol than your body needs, thereby increasing your cholesterol level. Managing stress levels is key to your overall health.

 At what cholesterol level is medication required?

Your doctor may prescribe cholesterol-lowering medication if you are age 40 or older and your LDL cholesterol level is 190 mg/dl or higher, or it’s over 170 mg/dl and you are over age 40 and have diabetes. It is typically also prescribed for those over 40 who are at risk for or already have peripheral arterial disease (PAD), or have suffered a stroke or heart attack.