High Cholesterol

What is high cholesterol?

Cholesterol is a fatty substance your body needs in small amounts. Problems arise when there is too much of certain kinds circulating in the blood, because the excess contributes to plaque forming inside artery walls. Over years, that plaque narrows arteries and can trigger a heart attack or stroke.

Like high blood pressure, high cholesterol produces no symptoms. It is found with a blood test, not by how you feel.

What do the different numbers mean?

• LDL cholesterol — often called the "bad" cholesterol. This is the number most closely tied to plaque buildup, and the main target of treatment.
• HDL cholesterol — the "good" cholesterol, which helps carry cholesterol away from the artery walls. Higher is generally better.
• Triglycerides — another type of fat in the blood. High levels often travel with diabetes, obesity, and high alcohol intake.
• Lipoprotein(a) — an inherited particle that raises risk independently. It is not part of a standard panel but is worth checking in people with a strong family history of early heart disease.

What LDL level should I aim for?

There is no single number that applies to everyone. The target depends on your overall cardiovascular risk — someone who has already had a heart attack or stent needs a much lower LDL than someone with no other risk factors. Cardiologists estimate that overall risk using your age, blood pressure, cholesterol, smoking status, and diabetes status, and sometimes refine it with additional testing such as a coronary calcium score.

This is why two people with identical cholesterol numbers can appropriately receive completely different recommendations.

How is high cholesterol treated?

Diet and exercise matter and are always part of the plan. Reducing saturated fat, increasing fiber, staying physically active, and losing excess weight all improve the lipid profile. For many people, though, lifestyle alone is not enough — a substantial portion of your cholesterol level is determined by genetics rather than diet.

Statins are the best-studied medications for lowering LDL and reducing heart attacks and strokes, with decades of evidence behind them. Other options exist for people who cannot tolerate statins or who need further lowering, including ezetimibe and injectable PCSK9 inhibitors. Which is appropriate depends on your numbers, your risk, and how you respond.

When should I see a cardiologist about cholesterol?

Consider a cardiology evaluation if your LDL remains high despite treatment, if you cannot tolerate statin therapy, if you have a family history of heart attack at a young age, or if you want a more precise assessment of your actual risk before deciding about long-term medication.

This page is general health information, not medical advice. It cannot replace an evaluation by a physician who knows your history. Talk with your cardiologist or primary care physician about what applies to you.