High Cholesterol Symptoms and Signs

Contrary to what some people think, you cannot feel if your cholesterol levels are high. As with conditions like high blood pressure or diabetes, the lack of symptoms doesn't mean that you are inherently OK or have less to worry about. If left untreated, high cholesterol can place you at risk of serious complications, including a heart attack or stroke.

High cholesterol is one of the main risk factors for heart disease (alongside high blood pressure and obesity). To better reduce your risk, you need to get your cholesterol tested on a regular basis, particularly as you get older or if you have risk factors for heart disease.

What Is High Cholesterol?

Cholesterol is a waxy type of fat (lipids) produced by the liver that is essential to the digestion of food and also used in the production of certain hormones and vitamin D. However, when certain cholesterol levels are high, they can adversely affect blood circulation and contribute to the onset of heart disease.

There are two main types of cholesterol:

• Low-density lipoprotein (LDL) cholesterol: Often referred to as "bad" cholesterol, this is the type of cholesterol that can accumulate on the walls of arteries, causing plaques that narrow and harden blood vessels and increase blood pressure.
• High-density lipoprotein (HDL) cholesterol: Often referred to as "good" cholesterol, this is the type that transports cholesterol from the rest of your body to the liver so that it can be removed from the body.

In the broadest sense, high cholesterol (also known as hypercholesterolemia) can be described as having too much LDL cholesterol.

There is another form of LDL, called very low-density (VLDL) cholesterol, that is responsible for transporting triglycerides through the body. Triglycerides are another type of lipid that, when elevated, can increase the risk of heart disease.

Signs and Symptoms

There are generally no overt signs or symptoms of high cholesterol. If you do have symptoms, they are generally related to the consequences of the disease rather than the disease itself. You ultimately cannot "feel" high cholesterol if you have it.

For example, high cholesterol can lead to hypertension (high blood pressure). If your high blood pressure becomes severe enough, you may experience fatigue, difficulty breathing, headaches, vision problems, irregular heartbeats, and chest pains.

Only in severe cases might high cholesterol lead to a skin condition known as xanthoma. These are waxy deposits that develop under the skin, particularly around the eyes, eyelids, hands, elbows, and knees. Xanthomas are mainly associated with a genetic form of the disease known as familial hypercholesterolemia.

Ultimately, the only way to know if you have high cholesterol is to get a blood test.

Risk Factors

Because you cannot tell if you have high cholesterol, knowing your risk factors can help you determine your need for testing—even if you are otherwise young and healthy. The more risk factors you have, the greater the need and frequency of cholesterol testing.

Some risk factors for high cholesterol are things that we can change, such as diet and exercise. Others cannot be changed, such as your age, sex, or genetics.

If you have any of the conditions listed below, you are at risk of hypercholesterolemia and should be checked:

• A sedentary lifestyle with a lack of exercise
• A diet high in saturated and trans fats
• Family history of high cholesterol
• Obesity
• Smoking
  
• Type 2 diabetes

Complications

Some people don't ever think about having their cholesterol checked if they are feeling well. And this can be a mistake since untreated hypercholesterolemia can lead to a number of serious complications.

When cholesterol levels are high, fatty plaques can begin to form on the walls of blood vessels. The condition, referred to as atherosclerosis, causes the progressive obstruction of blood flow to the heart and rest of the body. This not only increases blood pressure but also raises the risk of a heart attack or stroke if a plaque breaks open, causing a clot that completely blocks blood flow.

In fact, many people do not even realize they have high cholesterol until they have had their first heart attack or stroke. To prevent this, you need to have your cholesterol checked regularly to not only diagnose hypercholesterolemia but determine when treatment is needed.

Diagnosis

The only way to tell if you have high cholesterol is through a lipid panel. This is a blood test that measures the level of different blood fats in a sample of blood, most specifically:

• LDL cholesterol
• HDL cholesterol
• Non-HDL cholesterol (including VLDL)
• Total cholesterol (the total amount of all types of cholesterol)
• Triglycerides

A lipid panel is used to establish whether the various levels are high or low based on a reference range of values. Anything between the high and low values is considered normal. Anything outside of the reference value is considered abnormal.

Ultimately, it's the relationship between the various values—which ones are high and which are low—that determine if your cholesterol levels are acceptable, if treatment is needed, or if you are responding well to treatment.

The current reference ranges for a lipid panel in the United States vary by age and sex. Here are what are considered healthy levels of cholesterol as measured in values of milligrams per deciliter (mg/dL):

Treatment

If your total cholesterol, LDL, or triglyceride levels are too high or your HDL is too low, your healthcare provider may recommend lifestyle changes, medications, or a combination of interventions to help bring your lipids back to a healthy range.

Lifestyle Modifications

Changes in lifestyle—including a healthy diet and routine exercise—are the first-line response to high cholesterol. In people with mild hypercholesterolemia, the changes may be all that is needed to bring the cholesterol levels under control.

The American Heart Association recommends the following lifestyle modifications:

• Limit your intake of saturated fat to less than 6% of daily calories
• Avoid trans fats
• Engage in at least 150 minutes of moderate-intensity aerobic exercise per week
• Quit smoking
• Lose weight if overweight or obese

Medications

If lifestyle modifications are not enough to bring your high cholesterol under control, your healthcare provider may prescribe cholesterol-lowering drugs. Options include:

• Statin drugs like Lipitor (atorvastatin) and Crestor (rosuvastatin)
• Bile acid-binding resins like Welchol (colesevelam) and Colestid (colestipol) 
• PCSK9 inhibitors like Praluent (alirocumab), Repatha (evolocumab), and Leqvio (inclisiran)
• Nexletol (bempedoic acid), an ATP citrate lyase (ACL) inhibitor
• Zetia (ezetimibe), a cholesterol absorption inhibitor

Other drugs may be prescribed if you have high triglycerides (hypertriglyceridemia).

A Word From Verywell

Feeling healthy is not necessarily the same thing as being healthy. Neither does having fewer risk factors mean that you won't develop heart disease in later life. In the end, cholesterol testing is considered a standard part of primary care and one of the tools healthcare providers routinely use to better reduce your risk of a heart attack or stroke.

The American Heart Association currently recommends that people over the age of 20 have their cholesterol checked at once at least every four to six years. Those with a family history of high cholesterol or a chronic condition like diabetes may need to get their lipids checked more frequently.