Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 28, 2016

Hypercholesterolemia or high cholesterol is a condition in which a person has excessive amounts of cholesterol in their body. Having hypercholesterolemia increases the risk of heart attack, stroke, and other types of heart disease.


Definition & Facts

When a person has too much cholesterol in their bloodstream, it can form plaque, a sticky deposit, on the sides of the arterial wall, which is a condition called atherosclerosis. A buildup of plaque can then partially or completely block the flow of blood to important areas of the body like the brain, heart, and other organs. Blood cells can also get caught by the plaque and form a blood clot. If the clot breaks loose, it can also block the blood flow and cause a heart attack or stroke.

Cholesterol is a waxy, fatty material that is a natural part of any cell in the body. However, extra cholesterol we eat can become harmful. There are two types of cholesterol: HDL (high-density lipoproteins or the “good” kind of cholesterol) and LDL (low-density lipoproteins which is the “bad” kind of cholesterol).

A third kind of fatty substance called triglycerides can be found in the bloodstream, and they tend to rise when the good cholesterol falls. When a person has problems with high cholesterol, this means they have high levels of LDL and triglycerides and low levels of HDL.

Hypercholesterolemia is seen often more in people who are overweight or obese. People who have diets that are high in saturated fats are at greater risk of developing high cholesterol as well.

Symptoms & Complaints

Having high cholesterol typically does not cause symptoms and is only discovered when a person is found to have high cholesterol on a blood test.


There can be several causes of hypercholesterolemia including heredity (genetic factors, family history), liver disease, and inefficient LDL removal from the blood. However, the main reason most people have high cholesterol is because of diet and lack of exercising. The following are factors that increase one's risk of developing hypercholesterolemia:

  • An individual is overweight or obese
  • An individual has a diet that is high in saturated fats and trans fatty acids
  • An individual does not exercise 
  • An individual has a family history of heart disease
  • An individual has high blood pressure or diabetes
  • An individual smokes

Diagnosis & Tests

Since people with hypercholesterolemia won't typically have any symptoms, they will need to have periodic blood tests to check and see where their cholesterol levels are. If their total levels come back around 200 or higher or their HDL level comes back below 40, their doctor will do further testing including a fasting lipid profile. The following are a general range of what is considered high for an average person (all in milligrams per deciliter).

Total cholesterol level:

  • Good: under 200 mg/dL
  • Borderline: between 200 to 239
  • High: over 240

LDL cholesterol levels:

  • Good: under 100
  • Average to good: between 100 to 129
  • Borderline high: between 130 to 159
  • High: between 160 to 189
  • Dangerously high: over 190

HDL cholesterol levels:

  • Good: 60 and over
  • Acceptable: between 40 to 59
  • Risky: under 40

Triglyceride levels:

  • Average: below 150 mg/dL
  • Borderline: between 150 to 199
  • High: over 200
  • Dangerously high: 500 and above

Individuals with normal levels of HDL and overall total cholesterol should be tested every five years. If they already have high cholesterol, they should be tested every two to six months. They should also have tests on their liver function if they are taking a cholesterol medication. 

Treatment & Therapy

It is imperative for people with high cholesterol to lower their cholesterol levels in order to reduce their risks of heart disease and stroke. Those that are already at risk for heart disease have even more reason to watch and lower their cholesterol levels.

The first step in treating hypercholesterolemia is a change in one's lifestyle: changing the diet and getting more exercise. These are the most effective ways to treat less severe cases of high cholesterol. Medication is the next step if a person's overall cholesterol levels are more than 200. The most common medications for high cholesterol are statins as they have less interactions with other drugs. These statins include:

Other drugs that may be used include:

It is also common to use a combination of drugs if the patient does not respond to one of the drugs on its own. Besides eating a healthy, low fat diet, there are some specific foods that may help lower one's cholesterol such as fiber and soy. In addition, some proponents of alternative medicine recommend supplements. Many supplements marketed to treat cholesterol have not been proven to be effective through peer-reviewed studies, and individuals should speak with their health care providers before taking any of them. Nevertheless, they include:

Similar to supplements, herbs may be recommended to treat high cholesterol, though the efficacy of some may be controversial in the scientific community. People should always check with their doctors first to make sure herbs and supplements won’t have reactions with medications they are currently on. Pregnant women should also be highly cautious about any negative interactions. The following herbs are considered to be helpful in treating high cholesterol:

  • Hawthorn 
  • Garlic olive leaf extract 
  • Red yeast or red yeast rice
  • Psyllium 
  • Guggul

Prevention & Prophylaxis

Most people can prevent high cholesterol levels by eating a well-balanced diet and regularly exercising. The diet should include cutting down on saturated fats and trans fats, increasing high fiber foods, and eating more fruits and vegetables. Dietitians recommend eating a diet that mostly consists of vegetables and fruits.  

Getting regular exercise can lower one's LDL levels and reduce the risk of heart disease. Thirty minutes of reasonable exercise five times a week can help a person to reduce LDL and triglyceride levels, lose weight, and increase HDL. People should talk with their doctor about an exercise program that is right for them.