What you need to know about high cholesterol

Cholesterol is one of the major markers of heart health. In the U.S., roughly 11.3 percent of adults—some 25 million people—have high total cholesterol, which can lead to hardening of the arteries, increasing the risk of heart attack and stroke. And about 86 million more have cholesterol levels that are high enough to put them at higher risk for heart disease. Being screened for high cholesterol, knowing your cholesterol levels, and adopting a healthy lifestyle can help you protect your long-term health.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that’s in every cell. Everyone ages 20 years and older should have their cholesterol measured at least once every four to six years. The best way to know what your cholesterol levels are is with a blood test called a lipid profile. The test will measure the following:

• Low-density lipoproteins (LDL) or “bad” cholesterol
• High-density lipoproteins (HDL) or “good” cholesterol
• Triglycerides (a type of fat in the blood that the body uses for energy)
• Total cholesterol (LDL, HDL, and very low density lipoproteins (VLDL)—a type of cholesterol that carries triglycerides through the blood)

If you have too much LDL cholesterol and triglycerides, they can stick to the walls of your arteries in the form of plaque, a condition called atherosclerosis. This restricts blood flow to the arteries. If a piece of plaque breaks off the walls and blood cells clot around it, the clot can partially or completely block blood flow to the heart or brain, leading to heart attack or stroke.

A total cholesterol level of 240 mg/dL (milligrams per deciliter) or greater is considered high. But a “borderline” level between 200 to 239 mg/dL means you are at higher risk for heart disease, especially if you have other risk factors such as high blood pressure.

So, the rule of thumb is to keep your:

• Total cholesterol less than 200
• “Bad” LDL less than 130 (depending on your individual health history and risk factors, your LDL goal may be 70 mg/dL, or even 55 mg/dL)
• “Good” HDL (it absorbs cholesterol in the blood) more than 60
• Triglycerides less than 150

More than the numbers

In addition to your cholesterol levels, it’s important to consider your 10-year risk for heart disease. “You can be a person with cholesterol numbers that look normal, but if you have other risk factors, cholesterol becomes a factor to calculate your risk,” says Scott Joy, MD, Chief Medical Officer of the Continental Division of HCA Physician Service Group’s (PSG) Continental Division.

The 10-year risk is a calculation of your chance of developing heart disease—heart attack, stroke, peripheral artery disease and heart failure, among others—within the next 10 years. It takes cholesterol into account, but also age, blood pressure and treatment for high blood pressure, diabetes, and smoking.

For some people, their 30-year risk for heart disease should also be considered. Guidelines about the use of cholesterol-lowering drugs called statins were updated in March 2026 to protect younger patients who may be considered low risk for the next decade but face a high lifetime risk of cardiovascular events. So, if you are between 39 and 59 years old and have a low 10-year risk, your healthcare provider (HCP) will also calculate your 30-year risk to determine what treatment plan (if any) is best for you.

High cholesterol symptoms and diagnosis

High cholesterol usually has no symptoms, but chest pain is a common symptom of severe atherosclerosis. “High cholesterol is not something you usually feel,” says Joy. “The only symptom of very high cholesterol is xanthomas, little plaques of cholesterol that develop on the skin. But routine patients won’t develop those.”

Cholesterol is checked by a blood test in your healthcare provider’s office. Adults at average risk for heart disease should have their cholesterol checked every four to six years, but those at higher risk should have it checked more frequently. Talk to your HCP about what screening schedule is best for you.

Additional tests, which may not be necessary for everyone, are used in some cases to more clearly define heart-related risks, including:

Coronary calcium (CAC) scan: This is a special CT scan of the heart. It looks for calcium deposits in the arteries. A buildup of calcium can narrow the arteries and reduce blood flow to the heart. This helps estimate the chances that those arteries may someday become blocked, which could lead to a heart attack or stroke.

Lipoprotein (a): Lp(a) is a mostly inherited type of lipoprotein that carries cholesterol. Adults should undergo this blood test at least once. High Lp(a) (50 mg/dL or greater) is linked to a higher long-term risk for heart attack or stroke.

Apolipoprotein B: ApoB is a protein that may contribute to the buildup of cholesterol in artery walls. This blood test may be used as a third "goal" if LDL and total cholesterol goals are met.

Medication and lifestyle

You may be at risk for high cholesterol if you:

• Are a man older than 45 or a woman older than 55
• Consume high levels of saturated fat
• Don’t exercise regularly
• Have overweight or obesity
• Have a family history of high cholesterol

Statins, which reduce the liver’s ability to produce cholesterol, are the standard treatment for high cholesterol, according to Joy. “They’ve been shown to reduce the risk of heart attack or stroke by 20 to 35 percent,” he says. Statins are generally considered safe, but muscle soreness and aches can be a problem for some people.

Medication can help control your cholesterol, but it shouldn’t be your only line of defense.

“Lifestyle changes are always included in treatment,” says Joy. You can reduce your risk by doing at least 150 minutes of moderate exercise a week (the more you move, the better), keeping your weight down and your body mass index (BMI) under 25 kg/m2 and eating a diet low in saturated fat.

“There’s no side effects to a healthy lifestyle,” Joy adds.