It has no warning signs. But left unchecked, high cholesterol can set off a heart attack or stroke
You can feel perfectly fine and still have dangerously high cholesterol. That’s what makes it so tricky. There are no symptoms, no pain, no warning. It just quietly builds up inside your arteries until something goes wrong.
The good news is that high cholesterol is largely preventable and treatable. Understanding what it is, where it comes from, and how to manage it puts you in control of your heart health.
What Is Cholesterol?
Cholesterol is a waxy, fat-like substance that travels through your blood. Your body needs it to build healthy cells, but too much causes trouble. It clings to the walls of your arteries, slowly narrowing them over time. Less blood gets through, and your heart and brain get less oxygen. That’s when a heart attack or stroke can happen.
Cholesterol travels through your body attached to proteins. Together, they form particles called lipoproteins. You’ve probably heard of the two main types:
- LDL (“bad” cholesterol) carries cholesterol through your body and deposits it on artery walls, making them hard and narrow.
- HDL (“good” cholesterol) sweeps excess cholesterol out of your blood and brings it back to your liver.
- VLDL carries a fat called triglycerides through your blood. High VLDL causes LDL particles to grow larger, which narrows your blood vessels even more.
What Raises Your Cholesterol?
Some people inherit genes that make their liver produce too much cholesterol or stop their cells from clearing it from the blood. But for most people, lifestyle plays the biggest role. These habits drive cholesterol up:
- Cigarette smoke damages artery walls and lowers your HDL cholesterol.
- A body mass index of 30 or higher raises your risk of high cholesterol.
- A poor diet. Red meat, full-fat dairy, and foods with saturated or trans fats all push cholesterol levels higher.
- Not exercising. Physical activity raises HDL and lowers LDL. Skipping it does the opposite.
- High blood pressure. Damaged artery walls attract fatty deposits faster.
- High blood sugar raises LDL, lowers HDL, and damages the inner lining of your arteries.
- Family history. If a parent or sibling developed heart disease before age 55, your own risk is higher than average.
What Happens If You Ignore It?
Over time, cholesterol deposits harden into plaques along your artery walls. Doctors call this atherosclerosis. As the plaques grow, less blood flows through. If a plaque tears or ruptures, a blood clot forms. That clot can block an artery entirely.
The consequences depend on where the blockage happens:
- Chest pain (angina). When the arteries feeding your heart narrow, you may feel pressure or tightness in your chest.
- Heart attack. A ruptured plaque blocks blood flow to your heart muscle.
- A clot cuts off blood flow to part of your brain.
Medications That Lower Cholesterol
If diet and exercise haven’t brought your cholesterol down far enough, your doctor may prescribe medication. The right choice depends on your age, overall health, and other risk factors.
- Statins are the most commonly prescribed cholesterol drugs. They block your liver from making cholesterol and may even help dissolve plaques already built up on artery walls. Options include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).
- Bile-acid resins (cholestyramine, colesevelam, colestipol) work by binding to bile in your gut. Your liver then uses up extra cholesterol to make more bile, pulling it out of your blood.
- Cholesterol absorption inhibitors like ezetimibe (Zetia) reduce how much cholesterol your small intestine absorbs from the food you eat.
If you also have high triglycerides, your doctor may add fibrates (TriCor, Lopid), niacin (Niaspan), or prescription omega-3 fatty acids (Lovaza).
Side effects vary from person to person but often include muscle aches, stomach pain, nausea, and changes in bowel habits. Your doctor may check your liver function periodically while you’re on these medications.
Five Foods That Lower Cholesterol
These five foods actively work to bring cholesterol down. They are also central to the diet for depression.
- Oatmeal and high-fiber foods
Oatmeal contains soluble fiber, which blocks cholesterol from entering your bloodstream. Aim for 5 to 10 grams of soluble fiber a day. A bowl and a half of cooked oatmeal gets you 6 grams. Other good sources include kidney beans, apples, pears, barley, and prunes.
- Fatty fish
Salmon, mackerel, sardines, herring, albacore tuna, lake trout, and halibut are all rich in omega-3 fatty acids. Omega-3s lower blood pressure, reduce the risk of blood clots, and cut the risk of sudden death in people who have already had a heart attack. The American Heart Association recommends two servings of fish a week. Bake or grill it rather than fry it.
- Walnuts, almonds, and other nuts
A handful of nuts a day (about 1.5 ounces) lowers blood cholesterol and keeps blood vessels healthy. Almonds, hazelnuts, peanuts, pecans, pistachios, and walnuts all qualify. Choose unsalted, uncoated varieties. Because nuts are calorie-dense, use them to replace higher-fat foods rather than add on top of them. Toss a handful into a salad instead of cheese or croutons.
- Olive oil
Olive oil lowers LDL cholesterol without touching your HDL. Use about 2 tablespoons a day in place of butter or other fats. Drizzle it on vegetables, mix it into a marinade, or use it as a salad dressing with vinegar. Extra-virgin olive oil is less processed and packs more antioxidants, so it gives you a bigger benefit.
- Foods with plant sterols or stanols
Plant sterols and stanols are natural substances that block cholesterol absorption in your gut. Some margarines, orange juices, and yogurt drinks are fortified with them. Two 8-ounce servings of sterol-fortified orange juice a day can cut LDL by more than 10 percent.
Cut the Foods That Hurt You
Adding heart-healthy foods only goes so far if you’re still eating plenty of the bad ones. Saturated fats, found in meat and full-fat dairy, raise your total cholesterol. Trans fats, which show up in some store-bought cookies, crackers, and cakes, are worse. They raise LDL and lower HDL at the same time. Read labels and cut them where you can.
Lifestyle Changes That Make a Difference
Exercise
Regular exercise raises HDL and lowers LDL. Work up to 30 to 60 minutes most days. Walk briskly, ride a bike, swim laps, or find whatever keeps you moving. You don’t have to do it all at once. Three 10-minute walks throughout the day count.
Lose a little weight
Even a small amount of weight loss helps. Dropping just 5 to 10 percent of your body weight can meaningfully reduce cholesterol levels.
Quit smoking
If you smoke, stopping is one of the fastest things you can do for your heart. Within 20 minutes of quitting, your blood pressure drops. Within 24 hours, your heart attack risk falls. Within a year, your heart disease risk is half that of a smoker. After 15 years, your risk is about the same as someone who never smoked.
The Bottom Line
High cholesterol is quiet, common, and treatable. A blood test is the only way to know where you stand. If your numbers are high, diet and exercise are the first tools to reach for. And if those aren’t enough, effective medications are available. Talk to your doctor about where you are and what steps make sense for you.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
