CARE GUIDE High Cholesterol

High Cholesterol

High cholesterol (hypercholesterolemia) is known as a “silent killer.” It is estimated that nearly one-quarter of the population has high cholesterol, according to the Centers for Disease Control and Prevention. Often, there are no symptoms or obvious signs that serve as a warning until it is too late. Left untreated, it can cause heart attacks, strokes, artery narrowing and heart disease. This is why it is crucial to be screened for high cholesterol once every five years.

High cholesterol tends to run in families. Other risk factors for the condition include:

  • Obesity
  • Drinking alcohol excessively
  • High blood pressure (hypertension)
  • Diabetes
  • Smoking
  • Lack of exercise

Cholesterol is a waxy substance similar to fat and made in the liver. It is needed by the body to create hormones, vitamin D and bile acids. There are two varieties of cholesterol: LDL (the “bad” cholesterol) and HDL (the “good” cholesterol). An excess of LDL can create obstructions or narrowing in artery walls, increasing the risk of cardiovascular problems.

While triglycerides are not actually a type of cholesterol—they are a type of fat in the blood--they are usually part of a cholesterol screening. High triglycerides, like cholesterol, can increase the risk of cardiovascular problems.

Doctors and Specialists

Your regular doctor will probably be the physician to detect high cholesterol from a routine blood test. Depending on your age and gender, that provider may be one of the following:

  • General practitioner: Treats all patient groups.
  • Gynecologist: Female health specialist.
  • Pediatrician: Specialist in infant, childhood and adolescent care.
  • Gerontologist: Doctor for senior or elder health.

Once high cholesterol is discovered, it can be helpful to consider a team approach to the problem, especially if you are in a high-risk category. These specialists deal with the prevention and treatment of high cholesterol:

  • Nutritionist: Formulates a diet plan that will lower LDL and triglycerides.
  • Personal trainer: Creates a personal workout program that will help get a person into shape safely.
  • Nurse educators: Assists individuals in understanding the condition and its significance along with the necessary treatment plans.
  • Psychologist: Helps individuals decrease stress, quick smoking and make any mental adjustments that contribute to the condition.
  • Cardiologist: Treats diseases affecting the heart and blood vessels. While high cholesterol itself isn’t a reason to see a cardiologist, it’s a good idea if other risk factors like diabetes, hypertension, obesity or a and/or family history of high cholesterol or heart problems.

Before Your Visit

Screening for high cholesterol involves a blood test. These are standard guidelines for preparing for this type of screening, but be sure to follow any additional instructions given to you by your doctor’s office.

  • Before a blood test, it is important to fast so that proper levels can be obtained.
  • No food or beverage (other than water) should be consumed for 12-hours before the test.
  • Abstain from alcoholic beverages for two days before the test.

You’ll probably have questions about high cholesterol as you are diagnosed and treated. Review this list of common concerns before your appointment, or print it out to bring with you.

Questions About My Diagnosis

  • If I have a high triglyceride count and the total cholesterol number is normal, do I have a cholesterol problem?
  • What does a lipid panel include?
  • Are lipids and cholesterol the same?
  • Do I have blocked arteries or plaque formation already? What is my risk for heart disease?
  • How often should I have my cholesterol tested? What tests do I need?

Questions About My Treatment

  • Is there a specialist for high cholesterol? Should I see one?
  • Do I need medication to lower my cholesterol? What are the side effects of these drugs?
  • Do I have to take the medication forever? Even if my values return to normal?
  • Can I lower cholesterol by taking supplements?
  • What risks do I have if I choose not to take medication?
  • Are there alternative therapies to lower my cholesterol?

Questions About My Lifestyle and Family

  • Does this run in families? Will my children get it?
  • At what age should my children be tested?
  • Will a special diet decrease my cholesterol? Will you recommend one or should I consult with a nutritionist?
  • Are there foods that I should avoid? Should I give up alcohol?
  • How much weight loss would change my cholesterol numbers?
  • Is there exercise that I can do?

Diagnosis and Treatment

A blood test is the only way to diagnose high cholesterol. It measures total cholesterol, LDL (“bad” cholesterol), HDL (“good” cholesterol) and triglycerides. The Centers for Disease Control and Prevention recommends adults have cholesterol levels checked every five years, but your doctor may want to check more frequently if you are high-risk. This is how the results are measured:

Total Cholesterol

  • Normal: Less than 200 mg/dL
  • Borderline: 200-239 mg/dL
  • High: 240 mg/dl and over

Low Density Lipoproteins (LDL)

  • Normal: Less than 100 mg/dL
  • Borderline: 100-159 mg/dL
  • High: 160-189 mg/dL

High Density Lipoproteins (HDL)(protective)

  • Normal: 60 mg/dL or higher
  • Borderline: 40-60 mg/dL
  • High: 40 mg/dL or less


  • Normal: Less than 150 mg/dL
  • Borderline: 150-200 mg/dL
  • High: 200 mg/dL and above

Once you are diagnosed with high cholesterol, it is important to begin treatment immediately. Early action can help to decrease your risk for strokes, heart attacks or heart disease.

Eating right, maintaining a healthy weight and getting plenty of exercise can help to decrease LDL and increase HDL. In addition to making lifestyle changes, many people with high cholesterol will need to take medication to control the condition. These drugs treat cholesterol problems by:

  • Decreasing cholesterol production
  • Lowering cholesterol absorption in the gastrointestinal tract
  • Promoting the rate of cholesterol elimination with bile acids
  • Preventing cholesterol build-up in the arteries

Types of Medications for Treating High Cholesterol

  • Statins (Lipitor, Lescol, Altoprev): Decreases production of cholesterol by blocking an enzyme the liver needs for making it
  • Bile acid sequestrants (Prevalite, Welchol, Colestid): Makes the liver use cholesterol to make bile acids, which lowers LDL; can be used alone or in combination with statins
  • Fibric acids (TriCor, Fenoglide, Lopid): Lowers triglycerides and raises HDL levels; often used in combination with statins to decrease LDL
  • Cholesterol absorption inhibitors (Zetia): Decreases the absorption of dietary cholesterol; often used in combination with statins
  • PCSK9 inhibitors (Praluent, Rapatha): Injectable drugs that help the liver absorb LDL; often used in people who can’t take statins or other cholesterol medications

Alternative Therapies for High Cholesterol

Drugs for high cholesterol have some serious side effects, including liver and muscle problems. To avoid potential complications, many patients are turning to more natural remedies to treat the condition, including:

  • Beta sitosterol (Found in soybeans, wheat germ and corn oil): Decreases cholesterol absorption
  • Green tea extract: Decreases LDL, decreases triglycerides, increases HDL
  • Guggulipid extract: An Indian herb that lowers all cholesterol types
  • Policosanol (Found in sugar cane wax): Decreases LDL, increases HDL