High Blood Cholesterol: What Your Numbers Mean, Why It Matters, and How to Lower It
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
TL;DR
High cholesterol is a waxy buildup in your blood with no symptoms — a simple blood test is the only way to find it. Too much cholesterol forms plaque that can narrow or block arteries, raising the risk of chest pain, heart attack, and stroke. The three key numbers are LDL ("bad"), HDL ("good"), and triglycerides. Most people can lower cholesterol through a heart-healthy diet, regular exercise, weight loss, and quitting smoking — and when needed, medicines like statins work alongside lifestyle changes to protect your heart.
Quick Answer: What Is High Blood Cholesterol?
High blood cholesterol, or hypercholesterolemia, is a condition in which too much cholesterol — a waxy substance your body needs to build cells — builds up in your blood. It has no symptoms, so a blood test called a lipid panel is the only way to detect it. When levels stay high, plaque forms in arteries and can trigger heart attack or stroke. Doctors interpret your numbers using standard ranges for total cholesterol, LDL, HDL, and triglycerides. Most people lower it with diet, exercise, and weight loss; some also need cholesterol-lowering medicine such as statins. [1][2]
What the research says
Lowering LDL cholesterol lowers vascular risk. A meta-analysis of 26 randomized trials (about 170,000 participants) found that each 1.0 mmol/L reduction in LDL cholesterol with statin therapy reduced major vascular events by 22% (RR 0.78) and all-cause mortality by 10% (RR 0.90), with no threshold seen within the cholesterol range studied (CTT Collaboration, Lancet, 201061350-5) [3]).
Cutting saturated fat reduces cardiovascular events. In a Cochrane review of 15 randomized trials with 56,675 participants, reducing saturated fat intake for at least two years cut combined cardiovascular events by 17% (RR 0.83; 95% CI 0.70–0.98), with small reductions in total and LDL cholesterol and little or no effect on all-cause mortality (RR 0.96) (Hooper et al., Cochrane Database Syst Rev, 2020 [4]).
Exercise modestly raises HDL. A meta-analysis of 25 studies found that aerobic exercise training raised HDL cholesterol by 2.53 mg/dL on average; the minimum was about 120 minutes of exercise per week, and every extra 10 minutes per session was linked with about 1.4 mg/dL more (Kodama et al., Arch Intern Med, 2007 [5]).
What Is High Blood Cholesterol?
Cholesterol is a waxy substance found in the blood. Your body needs cholesterol to build healthy cells. But high levels of cholesterol can raise the risk of heart disease.
When cholesterol is too high, fats and other substances can build up in blood vessels called arteries. This buildup is called plaque. As more plaque forms over time, the arteries can become narrowed or clogged, which makes it hard for enough blood to flow through them.
Sometimes a piece of plaque can break loose and form a blood clot. The clot may cause a heart attack or stroke.
High cholesterol can be inherited, meaning it passes from parents to children through genes. But it is often the result of lifestyle choices such as not getting enough exercise, not eating a balanced diet, or consuming large amounts of saturated fat. You can make changes to help prevent it. And if you have high cholesterol, you can help lower it with a healthy diet, regular exercise, and sometimes medicine.
Why High Cholesterol Has No Symptoms
High cholesterol has no symptoms. A blood test is the only way to find out if you have it.
This is exactly why regular screening matters. You can have dangerously high cholesterol for years without feeling anything at all. That is why heart health organizations recommend checking your levels at set ages and intervals, described below.
When to Get Your Cholesterol Checked
Screening is a normal part of general health care. Recommended timing depends on your age and overall health.
Group | Recommended Screening |
Children | Once between ages 9 and 11; may start earlier with a family history of high cholesterol, heart attack, or stroke, or with conditions such as diabetes or obesity |
Ages 17–21 | Next cholesterol screening after the childhood check |
Adults | Every 4 to 6 years after the early adult screening |
People with high blood pressure or diabetes | More often, as recommended |
People taking cholesterol-lowering medicine | More often, as recommended |
People with family history of high cholesterol or heart disease | More often, as recommended |
Anyone with results outside the desirable range | More often, as recommended |
If you do not see a care provider regularly, ask about where to get a cholesterol screening. Because high cholesterol has no symptoms, waiting until you feel unwell means waiting too long.
What Causes High Cholesterol?
Lifestyle factors that are within your control are the most common cause of high cholesterol. These include eating a diet high in saturated and trans fats and not getting enough exercise.
Sometimes factors outside your control lead to high cholesterol. These include gene changes passed from parents to children, some health conditions, and some medicines.
Type of Cause | Examples | How It Works |
Lifestyle (controllable) | Diet high in saturated and trans fats, not enough exercise | Raises the amount of cholesterol circulating in your blood over time |
Inherited (genes) | Gene changes passed from parents to children | The body struggles to remove or break down LDL cholesterol in the liver |
Health conditions | Familial hypercholesterolemia, chronic kidney disease, chronic liver disease, diabetes, HIV/AIDS, hypothyroidism, lupus, overweight and obesity, sleep apnea | The condition itself raises cholesterol levels |
Medicines | Treatments for acne, cancer, high blood pressure, HIV/AIDS, irregular heartbeats, and organ transplants | The medicine makes cholesterol levels worse |
Understanding LDL, HDL, and Triglycerides
Cholesterol travels through the blood attached to proteins. This mix of proteins and cholesterol is called a lipoprotein. There are various types of cholesterol, based on what the lipoprotein carries.
Low-density lipoprotein (LDL) cholesterol is known as the "bad" cholesterol. LDL carries cholesterol particles throughout the body, and this "bad" cholesterol builds up in the walls of arteries. That makes the arteries hard and narrow. When a gene change causes high cholesterol, the body has trouble removing LDL cholesterol from the blood or breaking it down in the liver.
High-density lipoprotein (HDL) cholesterol is known as the "good" cholesterol. HDL picks up extra cholesterol and takes it back to the liver.
Most often, the blood test that checks cholesterol levels also measures a type of fat in the blood that is not a type of cholesterol, called triglycerides. Having a high triglyceride level can also raise the risk of heart disease. Lifestyle factors you may be able to control play a role in triglyceride levels.
Risk Factors You Can and Cannot Change
High cholesterol has many risk factors. Some you cannot change, but many are within your control.
Risk Factor | Type | How It Affects Cholesterol |
Too much saturated fat or trans fat | Controllable | Raises blood cholesterol; saturated fats are in fatty cuts of meat and full-fat dairy; trans fats appear in some packaged snacks or desserts |
Obesity | Controllable | Having too much body fat raises risk |
Lack of exercise | Controllable | Exercise boosts the body's "good" HDL cholesterol |
Smoking | Controllable | Cigarette smoking may lower HDL levels |
Heavy alcohol use | Controllable | Drinking lots of alcohol can raise total cholesterol |
Age | Not controllable | Much more common in people over 40; the aging liver becomes less able to remove "bad" LDL cholesterol |
Note that even young children can have high cholesterol. The condition is simply much more common as people get older.
Complications: What Untreated High Cholesterol Can Do
If there is too much cholesterol in the blood, the cholesterol and other substances may form deposits called plaque. Plaque can cause an artery to become narrowed or blocked. If a plaque ruptures, a blood clot can form. Plaque and blood clots can both reduce blood flow through an artery.
With high cholesterol, a dangerous amount of plaque can build up on the walls of arteries. This is called atherosclerosis. Over time, the plaque buildup narrows arteries and blocks blood flow, which can lead to serious complications.
Complication | What Happens |
Atherosclerosis | Dangerous plaque builds up on artery walls, narrowing them and blocking blood flow |
Chest pain (angina) | Arteries that supply the heart with blood are affected; may also cause other symptoms of coronary artery disease |
Heart attack | Plaques tear or break, forming a clot that blocks blood flow to part of the heart; a medical emergency requiring immediate treatment |
Stroke | A blood clot blocks blood flow to part of the brain; a medical emergency requiring immediate treatment |
How High Cholesterol Is Diagnosed
Diagnosis involves the steps your healthcare professional takes to find out if you have high cholesterol. You receive a blood test to check cholesterol levels. You might hear it called a lipid panel or a lipid profile.
The results usually show four numbers: total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
In general, you cannot have food or liquids other than water for around 9 to 12 hours before the test. This is called fasting. Some cholesterol tests do not require fasting, so follow your healthcare professional's instructions.
Interpreting Your Cholesterol Numbers
In the United States, cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. In Canada and many European countries, levels are measured in millimoles per liter (mmol/L).
Total cholesterol
Result (U.S.) | Result (Canada/Europe) | Meaning |
Below 200 mg/dL | Below 5.2 mmol/L | Desirable |
200–239 mg/dL | 5.2–6.2 mmol/L | Borderline high |
240 mg/dL and above | Above 6.2 mmol/L | High |
LDL ("bad") cholesterol
Result (U.S.) | Result (Canada/Europe) | Meaning |
Below 70 mg/dL | Below 1.8 mmol/L | Desirable for people with coronary artery disease or other atherosclerosis; optimal for people at high or very high risk |
Below 100 mg/dL | Below 2.6 mmol/L | Optimal for healthy people without coronary artery disease or atherosclerosis |
100–129 mg/dL | 2.6–3.3 mmol/L | Near optimal without coronary artery disease; high if disease is present |
130–159 mg/dL | 3.4–4.1 mmol/L | Borderline high without coronary artery disease; high if disease is present |
160–189 mg/dL | 4.1–4.9 mmol/L | High without coronary artery disease; very high if disease is present |
190 mg/dL and above | Above 4.9 mmol/L | Very high |
HDL ("good") cholesterol
Result (U.S.) | Result (Canada/Europe) | Meaning |
Below 40 mg/dL (men) / Below 50 mg/dL (women) | Below 1.0 mmol/L (men) / Below 1.3 mmol/L (women) | Low |
40–59 mg/dL (men) / 50–59 mg/dL (women) | 1–1.5 mmol/L (men) / 1.3–1.5 mmol/L (women) | Better |
60 mg/dL and above | Above 1.5 mmol/L | Best |
Triglycerides
Result (U.S.) | Result (Canada/Europe) | Meaning |
Below 150 mg/dL | Below 1.7 mmol/L | Desirable |
150–199 mg/dL | 1.7–2.2 mmol/L | Borderline high |
200–499 mg/dL | 2.3–5.6 mmol/L | High |
500 mg/dL and above | Above 5.6 mmol/L | Very high |
Guidelines in Canada and Europe differ slightly from U.S. guidelines. Always review your specific results and target numbers with your healthcare professional, because the "best" level depends on your overall health and risk.
Cholesterol-Lowering Medicines
Treatment choices to reach ideal cholesterol and triglyceride levels should be tailored to your needs. Talk with your healthcare professional about what levels are best for you. Treatment can include medicine. Together with healthy lifestyle changes, medicine can lower the risk of heart attacks and strokes.
You may benefit from one or more medicines depending on your risk factors, age, health, and possible side effects. Your healthcare professional helps choose the right treatments.
Statins
Statins block a substance the liver needs to make cholesterol. This causes the liver to make less cholesterol and to remove cholesterol from the blood. Statin choices include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo, Zypitamag), pravastatin, rosuvastatin (Crestor), and simvastatin (Zocor).
Other Cholesterol Medicines
Medicine Type | How It Works | Examples |
Cholesterol absorption inhibitors | Lowers the amount of cholesterol absorbed from food in the small intestine; may be prescribed with a statin | Ezetimibe (Zetia) |
Bempedoic acid | Works much like statins; used if statins cause serious side effects; can be combined with a statin to lower LDL | Bempedoic acid (Nexletol); combo pill with ezetimibe (Nexlizet) |
Bile acid sequestrants | Binds bile acids so the liver uses extra cholesterol to make more, lowering blood cholesterol | Cholestyramine (Prevalite), colesevelam (Welchol), colestipol (Colestid) |
PCSK9 inhibitors | Helps the liver absorb more LDL cholesterol; given as a shot under the skin; used for genetic very-high LDL or when statins fall short | Alirocumab (Praluent), evolocumab (Repatha), inclisiran (Leqvio) |
Medicines for High Triglycerides
If you also have high triglycerides, your provider may prescribe a different group of medicines.
Fibrates such as fenofibrate (Lipofen) and gemfibrozil (Lopid) speed the removal of triglycerides from the blood and also help lower LDL. Using a fibrate with a statin can raise the risk of statin side effects.
Niacin limits the liver's ability to make LDL cholesterol. However, niacin does not provide more benefits than a statin, and it has been linked with liver damage and strokes. Most healthcare professionals now recommend it only for people who cannot take statins.
Omega-3 fatty acids can help lower triglycerides. They are available with or without a prescription. If you choose non-prescription supplements, talk with your healthcare professional first, because omega-3s may interact with other medicines, and their effectiveness and cost vary.
Medicine Side Effects
Let your healthcare professional know if your cholesterol medicine causes side effects. Statin side effects can include muscle pains, muscle damage (very rare), and increased blood sugar. If you take cholesterol medicine, your provider may recommend liver function tests to check the medicine's effect on your liver.
Children and Cholesterol Treatment
For children age 2 and older with high cholesterol, diet and exercise changes are usually the first treatment. Children age 10 and older with very high cholesterol levels might be prescribed cholesterol-lowering drugs such as statins.
Lifestyle Changes That Lower Cholesterol
A commitment to a healthy lifestyle can help prevent and manage high cholesterol. Several heart-healthy habits have been shown to make a real difference.
Lifestyle Change | What to Do | The Payoff |
Lose extra weight | Reach and keep a healthy weight | Losing weight can help lower cholesterol |
Eat a heart-healthy diet | Focus on plant-based foods — fruits, vegetables, whole grains; limit added sugar and sodium; limit saturated and trans fats; choose healthy fats in olive and canola oils, avocados, nuts, and oily fish | Directly lowers the fats that raise cholesterol |
Exercise regularly | Work up to at least 30 minutes of exercise five times a week (talk to your provider if you are not active already) | Boosts protective HDL cholesterol |
Don't smoke | Ask your healthcare professional to help you quit | Protects blood vessel walls and supports better HDL levels |
Limit alcohol | No more than one drink a day for women, two for men — or none at all | Prevents alcohol-related cholesterol increases |
Manage stress | Exercise and meditation can help | Supports overall heart health |
Get enough sleep | Aim for about 7 to 9 hours each night for adults | Supports metabolic and heart health |
The same heart-healthy habits that lower cholesterol also help prevent it in the first place. Eating lean protein, fruits, vegetables, and whole grains while limiting saturated fat, trans fat, sodium, and added sugar gives your arteries the best possible protection.
About Supplements
Some supplements are promoted as heart-healthy. Researchers are studying options such as vitamin D and omega-3 fatty acids for their effect on cholesterol and triglycerides. If you choose to take supplements, talk with your care provider first, because supplements can interact with medicines, including cholesterol-lowering drugs. The effectiveness and cost of omega-3 products vary, and diet and exercise remain the best-proven ways to improve your numbers.
Coping With High Cholesterol
High cholesterol is not something you check once and ignore. It is a condition that requires regular health checkups.
Taking medicines as directed, scheduling regular checkups, choosing healthy habits, and asking for help from friends and family all make long-term control more achievable. Working with your provider to bring your numbers into a safe range — and keep them there — takes a team effort. The good news is that lifestyle changes can make a genuine difference, even when medicine is also part of the plan.
Preparing for Your Appointment
If you are an adult who has not had regular cholesterol checks, make an appointment with your healthcare professional. Here is how to get ready.
Before the test, you will likely need to stop eating and drinking for about 9 to 12 hours. You may be able to have water if your healthcare team says it is OK.
Make a list of your symptoms (if any), key personal information — including family history of high cholesterol, coronary artery disease, strokes, high blood pressure, or diabetes — and all medicines, vitamins, or supplements you take, including doses.
Some basic questions to ask your provider include what tests you need, what the best treatment is, how often you need a cholesterol test, and whether printed materials or websites are available.
Expect your healthcare team to ask about your diet, how much exercise you get, how much alcohol you drink, whether you smoke or are around other smokers, and when your last cholesterol test was and what the results showed.
The Bottom Line
High cholesterol is silent, common, and fixable. You will not feel it, but a routine blood test reveals it — and early action protects your heart, brain, and arteries for decades to come.
Know your four numbers: total cholesterol, LDL, HDL, and triglycerides. Then take the steps that are proven to work: eat a plant-forward, low-saturated-fat diet, move your body at least 30 minutes five times a week, lose extra weight, avoid tobacco, and limit alcohol. If lifestyle changes are not enough, today's medicines — from statins to PCSK9 inhibitors — are effective tools your provider can tailor to your situation.
Take action this week: if you have not had your cholesterol checked recently, schedule a lipid panel with your healthcare provider, and start one heart-healthy habit today. Your future self will thank you.
Frequently Asked Questions
What is considered high blood cholesterol?
High cholesterol means your blood contains too much of the waxy substance called cholesterol. On a U.S. lipid panel, total cholesterol of 240 mg/dL or above is considered high, and 200–239 mg/dL is borderline high. Because high cholesterol has no symptoms, a blood test is the only way to know your level.
Does high cholesterol cause symptoms?
No. High cholesterol has no symptoms. A blood test is the only way to find out if you have it, which is why regular screening at recommended intervals — and more often if you have risk factors — is essential.
What is the difference between LDL and HDL cholesterol?
LDL is "bad" cholesterol that carries cholesterol particles through the body and builds up in artery walls, making them hard and narrow. HDL is "good" cholesterol that picks up extra cholesterol and takes it back to the liver. Ideally, you want low LDL and high HDL.
What are triglycerides, and why do they matter?
Triglycerides are a type of fat in the blood that is not a type of cholesterol. High triglyceride levels can also raise the risk of heart disease. Desirable is below 150 mg/dL, while 500 mg/dL and above is very high. Lifestyle factors you can control influence triglyceride levels.
What causes high cholesterol?
The most common cause is lifestyle: eating too much saturated or trans fat and not exercising enough. It can also be inherited through gene changes, or caused by health conditions such as diabetes, hypothyroidism, kidney disease, obesity, and sleep apnea, and by certain medicines used to treat conditions like acne, cancer, and high blood pressure.
What are my cholesterol targets?
In general, total cholesterol below 200 mg/dL is desirable, LDL below 100 mg/dL is optimal for healthy people, LDL below 70 mg/dL is desirable for people with heart disease, HDL of 60 mg/dL or above is best, and triglycerides below 150 mg/dL are desirable. Your provider sets individual targets based on your risk.
How often should I get my cholesterol checked?
Children should be screened once between ages 9 and 11 and again between ages 17 and 21. Many adults are then checked every 4 to 6 years. More frequent testing is recommended for people with high blood pressure, diabetes, a family history of heart disease, those taking cholesterol medicine, or anyone whose results fall outside the desirable range.
Can I lower cholesterol without medication?
Yes. Lifestyle changes can lower cholesterol for many people: losing extra weight, eating a plant-based heart-healthy diet with healthy fats, exercising at least 30 minutes five times a week, quitting smoking, and limiting alcohol. When these are not enough, medicines can be added.
What is a statin, and how does it work?
A statin is a medicine that blocks the substance the liver needs to make cholesterol, causing the liver to make less and remove more from the blood. Common statins include atorvastatin, rosuvastatin, and simvastatin. Possible side effects include muscle pain, increased blood sugar, and very rarely muscle damage.
What happens if high cholesterol is left untreated?
Over time, excess cholesterol forms plaque that narrows and blocks arteries — a condition called atherosclerosis. This can cause chest pain (angina) and, if a plaque ruptures and forms a clot, can lead to a heart attack or stroke, both medical emergencies.
How is high cholesterol treated in children?
For children age 2 and older, diet and exercise changes are usually the first treatment. Children age 10 and older with very high cholesterol levels might be prescribed cholesterol-lowering drugs such as statins.
References
Mayo Clinic Staff. High cholesterol - Symptoms and causes. Mayo Clinic. March 7, 2025. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
Mayo Clinic Staff. High cholesterol - Diagnosis and treatment. Mayo Clinic. March 7, 2025. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/diagnosis-treatment/drc-20350806
Cholesterol Treatment Trialists' (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-1681. PMID 21067804. https://doi.org/10.1016/S0140-6736(10)61350-561350-5)
Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;8(8):CD011737. PMID 32827219. https://doi.org/10.1002/14651858.CD011737.pub3
Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167(10):999-1008. PMID 17533202. https://doi.org/10.1001/archinte.167.10.999
Further reading: Blood Cholesterol — National Heart, Lung, and Blood Institute · Cholesterol — Centers for Disease Control and Prevention · My Cholesterol Guide — American Heart Association · Lipid Panel Test — Testing.com.
This article is for general informational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about any medical condition.
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