High cholesterol usually doesn't cause obvious symptoms. However, here are a few possible signs you should watch for—including some you can see in the mirror.
4 Signs of High Cholesterol You Should Know About
Updated on Sep. 20, 2024
How does your body feel when you have high cholesterol?
More than 40% of Americans with high cholesterol don’t realize they have it, according to 2023 research published in JAMA Cardiology—and this is a trend that worries heart health experts. “People often talk about blood pressure as a silent killer, but cholesterol can be as well,” says cardiologist Donald Lloyd-Jones, MD, chair of preventive medicine at Northwestern University and former president of the American Heart Association.
That’s because there aren’t generally signs of high cholesterol. Excess cholesterol in your blood quietly sticks to the inside of your blood vessels, creating deposits called plaques. And if you think you’re too young to worry about cholesterol and heart disease, think again. It’s not uncommon for these plaques to build up in the blood vessels of people in their 20s and 30s, explains Gordon Huggins, MD, cardiologist and Director of the Molecular Cardiology Research Institute at Tufts Medical Center. “They can be there for a very long time, just sort of smoldering and growing” until, one day, they potentially trigger a life-threatening situation.
Yet you’re unlikely to feel any physical symptoms as this atherosclerosis process unfolds—the deposits silently narrow or block blood flow until a major problem occurs, such as a heart attack or stroke. This begs the question: If you can’t feel that anything is wrong, how do you know if you have high cholesterol (and what can you do about it)?
Get The Healthy by Reader’s Digest newsletter
What is cholesterol?
Cholesterol is a type of blood fat, or lipid, that serves important roles throughout the body, explains Alon Ronen, MD, a cardiology specialist with Yale New Haven Hospital, Bridgeport Hospital, and Northeast Medical Group Cardiology in Trumbull, Connecticut.
Specific proteins carry cholesterol through our bloodstream to where they’re needed, creating a substance called a lipoprotein. There are various forms, but the main players include:
- High-density lipoproteins (HDL cholesterol): “good” cholesterol that scavenges excess cholesterol, sending it to our liver where it’s cleared.
- Low-density lipoproteins (LDL cholesterol): “bad” cholesterol which, in excess, attaches to our artery walls.
Are there signs of high cholesterol?
“In general, there are no physical findings that indicate your cholesterol level is elevated,” says Eugene Yang, MD, MS, FACC, a double-board-certified cardiologist, clinical professor at the University of Washington School of Medicine, and co-director of the UW Medicine Cardiovascular Wellness and Prevention Program. “So unless it’s checked, you won’t know if something is wrong.”
Yet the experts say some signs and situations suggest a person is at a higher risk.
Skin conditions
While high cholesterol typically has no obvious physical signs, there’s one caveat.
“Certain types of skin rashes might be a symptom of very, very high cholesterol levels,” Dr. Lloyd-Jones says.
He explains that when too much LDL cholesterol is floating around in the bloodstream, it can start to deposit in the skin in rash-like lesions and can even show up on your face.
These signs of high cholesterol can include:
- Xanthelasmas, or yellow dots around the eyes
- Arcus senilis, a gray ring around the iris of the eyes
- Xanthomas, cholesterol deposits in the tendons
Dr. Lloyd-Jones says that these types of skin rashes are more likely to occur in someone who has had a lifelong predisposition to high cholesterol.
“If you’ve got a family history of very high cholesterol and start to develop these skin lesions, it’s critically important that you get to the doctor immediately for treatment,” he says.
Breathing problems
Have you been experiencing chest pain or shortness of breath? Both are potential warnings of an artery blockage due to high cholesterol levels, says Dr. Yang.
Because these signs of high cholesterol can mean you’ve already started to develop heart disease, it’s important to seek urgent medical attention to lower your risk of experiencing a heart attack or stroke.
Chronic health conditions
“There are some conditions that can raise cholesterol as a sort of side effect,” says Dr. Lloyd-Jones. If you have one of them, it’s a sign you need to keep a close watch on your cholesterol with regular testing.
He explains that cholesterol levels can unexpectedly rise in people with kidney diseases, for example. This is because kidney conditions cause people to lose protein in their urine, which the body tries to replace by creating extra LDL cholesterol.
Thyroid abnormalities and diabetes can affect cholesterol metabolism as well, leading to potentially higher-than-normal levels.
Dr. Yang adds that chronic inflammatory conditions like lupus, rheumatoid arthritis, and psoriasis can raise someone’s risk for heart attacks and strokes. In these cases, cholesterol levels should be screened regularly and addressed aggressively if they get too high.
“Patients with HIV are also at an elevated risk of heart attack and stroke, and the medication they use to treat their HIV often raises cholesterol levels,” says Dr. Yang. “We tend to be more aggressive in not only screening but treating them.”
Family history
Dr. Yang says that about one in 250 people have a genetic mutation that causes their cholesterol levels to be naturally higher than average.
According to the Arkansas Medical Society, this condition—called familial hypercholesterolemia—puts someone at 100 times the risk for cardiovascular death due to the artery-clogging effects of high cholesterol levels.
The biology of this genetic condition is very well understood, Dr. Huggins says—and, in general, dietary and exercise interventions are not effective for people with genetically elevated LDL cholesterol levels. “As a result, we recommend medical therapy starting with statins in that setting, irrespective of [someone’s] age or [health status].”
This Hidden Oatmeal Benefit Could Lower Your Cholesterol, According to Research
How can you prevent high cholesterol?
While cholesterol is important, the amount our body needs for day-to-day housekeeping is pretty low, Dr. Yang says. In fact, “Generally, the liver makes all the cholesterol we need,” says Dr. Ronen. The excess cholesterol that can clog arteries tends to be heavily influenced by our diet.
“Foods high in saturated fats and trans fats may cause the liver to overproduce cholesterol at unhealthy levels,” he explains. Limiting animal products, sugar, fried foods, and these other cholesterol-boosting foods from your diet—while prioritizing cholesterol-lowering foods—can help keep your levels in a healthy range.
Tobacco use also contributes to high cholesterol and atherosclerosis, Dr. Huggins says. Smoking encourages LDL cholesterol to cling to your artery walls while lowering the amount of HDL cholesterol in your blood that can help clear the deposits away.
Yet exercise works to raise this “good” HDL cholesterol. “We recommend 150 minutes of moderate-intensity aerobic exercise for our patients,” Dr. Huggins says.
What are risk factors for high cholesterol?
A poor diet, smoking and lack of exercise are major risk factors for developing high cholesterol. Yet even if you exercise, having a more sedentary lifestyle is associated with high cholesterol, too, Dr. Huggins explains. This is the main reason that age is also considered a risk factor, “As people who are older are more sedentary and in general become more obese than their younger counterparts.”
However, familial hypercholesterolemia—the genetic predisposition to high cholesterol—plays a significant role in someone’s risk. It affects around 5% of people in the general population, Dr. Huggins says. “So it’s not very common, but it’s also not rare.”
What medical problems affect my cholesterol levels?
Other situations can enhance someone’s cholesterol risk as well, according to Dr. Yang. He says that certain groups of people may require more aggressive monitoring or treatment to keep their levels in a healthy range, including:
- Women who have pregnancy-related disorders, including preeclampsia (high blood pressure).
- People of South Asian descent, a group that carries a greater risk of heart disease.
- People with prediabetes.
- As described above, people with chronic health conditions such as kidney disease, diabetes, or chronic inflammatory conditions.
The Important Blood Test Your Doctor Should Be Doing—Your Heart Might Need It
How can I check if my cholesterol is high?
Some signs, conditions, and lifestyle factors can point to a greater risk for high cholesterol, “But we just don’t know unless we measure it directly,” says Dr. Lloyd-Jones. This involves a simple blood test called a lipid panel or lipid profile that measures four components: Total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, a type of blood lipid that, at high levels, is associated with heart disease.
In general, adults aim for the following targets:
- Total cholesterol: less than 200 mg/dl
- LDL cholesterol: less than 100 mg/dl
- HDL cholesterol: 50 mg/dl or higher for women; 40 mg/dl or higher for men
- Triglycerides: less than 150 mg/dl
Still, cholesterol goals are dependent on someone’s health situation. For example, Dr. Yang says that for people in a high-risk category—like those with heart disease or diabetes—the target LDL cholesterol level should be below 70 mg/dl.
“That’s a firm recommendation in the U.S. guidelines,” he explains. “But the European guidelines are even more aggressive.”
In its 2019 guidelines, the European Society of Cardiology set its LDL cholesterol target for high-risk patients at less than 55 mg/dl.
When should I get my cholesterol checked?
Clinical guidelines (and the American Heart Association) recommend that children get a lipid panel between the ages of 9 and 11—this is to try and identify those who have familial hypercholesterolemia. “[They] need to be treated very early in life. Otherwise, those are the people who could have heart attacks in their 20s and 30s,” Dr. Lloyd-Jones says.
“After that, if you’ve got cholesterol levels that are appropriate for your health status, then we usually recommend [testing] every five years throughout adulthood,” he explains. “Once it’s determined that you have extra risks, we do start to accelerate that, particularly once we put you on medication.”
Doctors recommend that people taking cholesterol medication get their levels checked at least every year. This is to make sure that you’re on the correct dose and that the drug is doing its job: Reducing your risk for heart attack and stroke.
Remember, getting your cholesterol levels tested on schedule is so important because most people experience no physical signs or symptoms of high cholesterol—and elevated levels can unknowingly put you at a higher risk of heart disease.
Long-term research confirms this relationship. A study of nearly 400,000 people published in The Lancet found a strong link between LDL cholesterol levels and heart disease across all age groups. The researchers also found that someone’s risk of heart attacks and strokes decreases as their LDL cholesterol lowers.
How can I lower my cholesterol?
“The lower the LDL, the better,” Dr. Huggins explains. While 100mg/dl or lower is ideal for your LDL, he says that under 130 is generally considered okay.
For people with higher LDL cholesterol, “We really try to emphasize dietary interventions and exercise,” he says. “[There’s] a profound beneficial impact of lifestyle changes to long-term heart health.” (Here are 8 things you can do right now to lower your LDL cholesterol.)
But if your LDL cholesterol levels exceed 190, “There’s a very strong recommendation to use medical treatment and close monitoring.” Statins are the gold standard for treating high cholesterol, with the strongest and most consistent evidence of benefit, Dr. Huggins says. They work by blocking a key step in the process of the body making cholesterol and are generally well-tolerated. (But here’s what a Cleveland Clinic doctor says you should do if you experience statin intolerance.)
About the Experts
|
For more heart-healthy updates delivered daily, subscribe to The Healthy @Reader’s Digest newsletter and follow The Healthy on Facebook and Instagram. Keep reading:
Sources
- Donald Lloyd-Jones, MD, cardiologist, chair of preventive medicine at Northwestern University in Evanston, Illinois, and former president of the American Heart Association
- Gordon Huggins, MD, Cardiologist and Director of the Molecular Cardiology Research Institute at Tufts Medical Center
- Eugene Yang, MD, MS, FACC, a double-board-certified cardiologist, fellow of the American College of Cardiology, and clinical professor at the University of Washington School of Medicine
- Alon Ronen, MD, a cardiology specialist with Yale New Haven Hospital, Bridgeport Hospital, and Northeast Medical Group Cardiology in Trumbull, Connecticut
- JAMA Cardiology: “Prevalence, Awareness, and Treatment of Elevated LDL Cholesterol in US Adults, 1999-2020”
- The Lancet: "Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium"
- The Journal of the Arkansas Medical Society: "Cholesterol and family history: when genetics matters"
- Circulation: "AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines"
- Centers for Disease Control and Prevention: "High Cholesterol Facts"
- Centers for Disease Control and Prevention: "Getting Your Cholesterol Checked"
- U.S. National Library of Medicine: "Cholesterol Levels: What You Need to Know"
- Cardiology News: "European cholesterol guidelines push LDL targets below 55 mg/dL"
