Hypercholesterolemia

What is hypercholesterolemia?

Hypercholesterolemia is a lipid disorder in which your low-density lipoprotein (LDL), or bad cholesterol, is too high. This makes fat collect in your arteries (atherosclerosis), which puts you at a higher risk of heart attack and stroke. Atherosclerosis is the main cause of cardiovascular disease, which is the reason for more deaths than anything else in the world.

What is considered hypercholesterolemia?

What your provider considers hypercholesterolemia depends on your other risk factors for cardiovascular disease.

Providers classify all of these as high levels of low-density lipoprotein cholesterol:

• 190 mg/dL or higher without other risk factors.
• Higher than 160 mg/dL with another major risk factor.
• Above 130 mg/dL with two risk factors.

Depending on your risk of a cardiovascular event, your target LDL-C level can range from 116 mg/dL to less than 70 mg/dL.

Risk factors include:

• Age.
• High blood pressure.
• Family history of premature atherosclerotic heart disease.
• Diabetes.
• Low levels of HDL (“good cholesterol”).

Are hypercholesterolemia and hyperlipidemia the same thing?

No. Hypercholesterolemia is a type of hyperlipidemia that focuses on high LDL-C. Hyperlipidemia includes various disorders that feature high levels of fat in your blood — not just LDL.

Who does hypercholesterolemia affect?

You’re more likely to have a high level of LDL-C if you’re:

• Older than 40.
• Asian Indian, Filipino or Vietnamese.
• Post-menopausal.
• A woman or person assigned female at birth (AFAB).

How common is hypercholesterolemia?

Hypercholesterolemia is very common. About 1 out of every 20 people has hypercholesterolemia. Nearly 1/3 of American adults have high LDL-C.

How does hypercholesterolemia affect my body?

Hypercholesterolemia can lead to cardiovascular issues, such as:

• Stroke.
• Coronary artery disease.
• Peripheral artery disease.

What are the symptoms?

There are no symptoms of hypercholesterolemia in most people. However, if you have severe hypercholesterolemia, you may have cholesterol deposits on your eyelid skin (xanthelasma) or connective tissue (xanthoma). Also, you may have cholesterol in your eye. This is called a corneal arcus.

What causes hypercholesterolemia?

Hypercholesterolemia causes include:

• Your genes (pure or familial hypercholesterolemia).
• A diet that includes a lot of saturated and/or trans fats.
• A lack of exercise.
• Tobacco products.
• Obstructive liver disease.
• Diabetes.
• Hypothyroidism.
• Anorexia nervosa.
• Chronic kidney failure.
• Nephrotic syndrome.
• Amiodarone (Pacerone® or Cordarone®).
• Rosiglitazone.
• Cyclosporine (Neoral® or Gengraf®).
• Hydrochlorothiazide (Oretic® or Microzide®).

How is hypercholesterolemia diagnosed?

Usually at your annual physical exam, your healthcare provider will:

• Ask you about your medical history and your family’s health.
• Do a physical exam.
• Order a lipid panel blood test, which you usually do after a period of fasting.

What tests will be done to diagnose hypercholesterolemia?

Once your provider rules out other causes of your hypercholesterolemia, they can do genetic testing. If you have pure hypercholesterolemia (familial hypercholesterolemia), your provider may suggest genetic testing for your family.

How is hypercholesterolemia treated?

Hypercholesterolemia treatment involves bringing down your LDL level to prevent heart disease.

You can do this in several ways:

• Exercising more.
• Staying at a healthy weight.
• Eating foods low in saturated fat.
• Lowering your stress level.
• Taking cholesterol-lowering medications.
• Avoiding tobacco products.
• Controlling high blood pressure and blood sugar.
• Having lipoprotein apheresis (using a device to take lipoproteins out of your blood and then putting your blood back into your body). This is only for people with severe hypercholesterolemia.

What can/can’t I eat/drink with hypercholesterolemia?

To lower the amount of LDL in your blood, you can:

• Drink less alcohol.
• Eat more fruits, vegetables and whole grains.
• Eat less saturated fat, like those in dairy products, some meats (like red meats) and desserts.

What medications are used?

Hypercholesterolemia medications include:

• Statins.
• PCSK9 inhibitors.
• Ezetimibe.
• Bile acid sequestrants.
• Niacin.
• Bempedoic acid.

Providers prescribe other medicines for people with familial hypercholesterolemia.

Side effects of the treatment

Every medicine has side effects, but the benefits of cholesterol-lowering drugs make them worth taking.

Side effects may include:

• Constipation or diarrhea.
• Pain in your muscles or joints.
• Upset stomach.
• Headache.

How soon after treatment will I see results?

Once you’ve taken medicine for 8 to 12 weeks, your provider will do another lipid panel test to see if your results improve. If your numbers don’t improve, they may increase your dose, switch you to a different cholesterol-lowering medicine or prescribe a second medicine for you.

How can I reduce my risk of hypercholesterolemia?

You can lower your risk with a healthy lifestyle that includes:

• Exercising.
• Staying at a healthy weight.
• Eating low-fat foods.
• Not using tobacco products.

What can I expect if I have hypercholesterolemia?

You’ll need to manage your high LDL for the rest of your life. However, once you make healthy habits part of your routine, you won’t need to give them much thought.

You can start small, like having one meatless dinner a week or taking a daily walk after dinner. You can buy foods that are low in saturated or trans fats so you always have healthy food on hand. Also, you can add variety to your plant-based diet by trying vegetables you’ve never eaten before.

Outlook for hypercholesterolemia

If you don’t treat your hypercholesterolemia, you can develop atherosclerosis. This is an artery-blocking issue that can cause a heart attack or stroke.

If you start living a healthier lifestyle, you can bring down your LDL. Doing this also lowers your risk of heart attack and stroke. Many medical studies have found that people have a good outcome when they manage their hypercholesterolemia.

How do I take care of myself?

Since managing cholesterol is a lifelong effort, you’ll need to keep up your lifestyle changes and continue taking your medicine.

Remember to:

• Exercise most days of the week.
• Avoid tobacco products.
• Avoid foods that have saturated or trans fats.

When should I see my healthcare provider?

Keep going to regular checkups with your provider. They’ll want to know if:

• Your cholesterol-lowering medicine is working.
• You’re having any side effects from cholesterol-lowering medicine.
• You’re following their recommendations.

Your provider can switch you to a different medication if you’re having a bad side effect. Also, they may want to check your cholesterol regularly to make sure it’s at a normal level.

What questions should I ask my doctor?

• What kinds of exercise should I do to improve my cholesterol?
• Can you recommend a program to help me stop using tobacco products?
• Can you refer me to a dietitian to help me with my diet?

A note from Cleveland Clinic

You’re not alone if you have a high level of LDL, which many call the “bad” cholesterol. Many people are dealing with this common problem. Your provider can be your ally in helping you get your LDL to a normal level. They can recommend ways to do it. If lifestyle changes don’t work, you can join the millions of people who take medicine to lower their cholesterol.