High Cholesterol: Symptom, Causes and Treatment

What is high cholesterol?

Let’s say your bloodstream is like a busy highway. Now imagine cholesterol as the trucks delivering essential building materials—great in moderation, but chaos if there are too many.

High cholesterol means you have too much of a fatty substance called cholesterol in your blood. This condition doesn’t cause symptoms by itself, which is why it’s often called a “silent threat.” But over time, it can clog your arteries and lead to serious problems like heart attacks or strokes.

Globally, high cholesterol is one of the major risk factors for cardiovascular disease (CVD), which accounts for nearly one-third of all deaths worldwide each year, according to the World Health Organization (WHO).

How does high cholesterol occur?

So, how does something so essential to your body become dangerous?

Cholesterol is made by your liver and also comes from the food you eat, particularly animal-based products like meat, eggs, and dairy. Your body uses it to build cells and hormones. But problems start when there’s too much “bad” cholesterol.

Here’s an analogy: imagine pouring grease down your kitchen sink every day. Eventually, it builds up, narrowing the pipes. That’s pretty much what low-density lipoprotein (LDL) does—it deposits cholesterol in your arteries, forming plaques. These plaques can eventually rupture and cause a blood clot—leading to heart attacks or strokes.

On the flip side, high-density lipoprotein (HDL) helps clean out the pipes. It carries cholesterol back to the liver, where it’s broken down and removed. A healthy balance between the two is vital.

What are the causes of high cholesterol?

High cholesterol can sneak up on anyone. In many cases, people don’t even know they have it until something serious happens.

The most common causes include:

• Unhealthy diet (over 50% of cases): Especially one high in saturated fats (found in red meat, butter, cheese) and trans fats (found in processed foods).
• Lack of physical activity
• Obesity or being overweight
• Smoking: It lowers HDL (good) cholesterol.
• Genetics (familial hypercholesterolemia): A rare inherited condition that affects 1 in 250 people globally and causes cholesterol levels to skyrocket, even in childhood.
• Medical conditions: Such as diabetes, kidney disease, and hypothyroidism.
• Age and sex: Cholesterol naturally rises as you age, and women’s levels often go up after menopause.

Who is at risk of high cholesterol?

Before you shrug this off, ask yourself—do you know your cholesterol level?

Many people at risk have no clue. A few things can quietly increase your risk over time:

• Poor diet (especially high in saturated and trans fats)
• Sedentary lifestyle
• Being overweight or obese
• Family history of heart disease or high cholesterol
• Age (men over 45 and women over 55 are at greater risk)
• Smoking
• Alcohol overconsumption
• Certain medical conditions, especially type 2 diabetes and hypothyroidism

Interestingly, even thin people can have high cholesterol if their diet is poor or they have a genetic tendency.

What are the symptoms of high cholesterol?

This is the tricky part: high cholesterol doesn’t cause any symptoms. Most people only find out after a heart attack, stroke, or through a blood test.

However, in rare genetic disorders like familial hypercholesterolemia, you might see signs such as:

• Xanthomas: Yellowish bumps under the skin or around the eyes (cholesterol deposits)
• Corneal arcus: A white or gray ring around the colored part of the eye

These are rare and usually only show up in extreme cases. For most people, the only way to know is through a blood test.

What conditions mimic high cholesterol (Differential Diagnosis)?

Since high cholesterol doesn’t cause clear symptoms, it often overlaps with or gets overlooked in favour of other issues. However, it’s essential to distinguish it from:

• Metabolic syndrome: A cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol.
• Hypothyroidism: Can lead to elevated LDL cholesterol.
• Nephrotic syndrome: A kidney disorder that also increases lipid levels.
• Diabetes mellitus: Often coexists with dyslipidemia.
• Liver disease: Can alter lipid metabolism and confuse the diagnosis.

A thorough clinical history and blood work help to rule out these conditions and pinpoint cholesterol as the culprit.

How is high cholesterol diagnosed?

The gold standard? A lipid panel or lipid profile test—a simple blood test that measures:

• Total cholesterol
• LDL (bad) cholesterol
• HDL (good) cholesterol
• Triglycerides (another fat that can increase heart risk)

To get the most accurate reading, the test is usually done after 9–12 hours of fasting.

Here’s what the numbers mean (in mmol/L):

• Total cholesterol: Less than 5.0 mmol/L is desirable
• LDL cholesterol: Less than 3.0 mmol/L
• HDL cholesterol: More than 1.0 mmol/L (men), 1.3 mmol/L (women)
• Triglycerides: Less than 1.7 mmol/L

Doctors will interpret your results based on your overall cardiovascular risk, not just the numbers alone.

How do we treat high cholesterol?

Treatment starts with one powerful word: lifestyle.

1. Lifestyle Changes (First-line treatment)

These are often enough to lower cholesterol significantly, especially in borderline cases:

• Eat a heart-healthy diet:
  • More fibre (e.g., oats, beans, fruits)
  • Less saturated fat and trans fats
  • More healthy fats (olive oil, avocado, nuts)
• Exercise: 30 minutes a day, 5 days a week
• Lose weight if overweight
• Quit smoking
• Limit alcohol

2. Medications (When lifestyle changes aren’t enough)

If your cholesterol is very high or you’re at high risk of heart disease, medication is usually needed.

• Statins (e.g., atorvastatin, simvastatin): Reduce LDL by blocking cholesterol production in the liver. This is the gold standard.
• Ezetimibe: Reduces cholesterol absorption in the intestines.
• PCSK9 inhibitors (e.g., evolocumab): Injectable drugs for very high-risk patients.
• Bile acid sequestrants: Help remove cholesterol via the bowel.
• Fibrates and niacin: Mostly used to target triglycerides.

Doctors will tailor the treatment based on your age, risk factors, and how you respond to the initial therapy.

Can High Cholesterol Be Prevented?

Yes—and often, it starts with what’s on your plate and how often you move your body.

Here’s how to lower your risk:

• Choose whole grains over refined carbs
• Load up on colourful vegetables and fruits
• Pick lean proteins like beans, tofu, or fish
• Move more—brisk walks, cycling, swimming
• Limit alcohol and avoid smoking

And most importantly? Know your numbers. Getting tested is the only way to truly know where you stand.

Complications of Uncontrolled High Cholesterol

Ignoring high cholesterol is like ignoring a ticking time bomb. Over time, it can lead to:

• Heart attack
• Stroke
• Peripheral artery disease (PAD)
• Chronic kidney disease
• Non-alcoholic fatty liver disease
• Cognitive decline and possible dementia link

The key takeaway? Even if you feel fine now, untreated high cholesterol lays the groundwork for serious disease down the line.

Cholesterol in Children and Teens

Think kids don’t get high cholesterol? Think again. Childhood obesity and poor diet are driving up cholesterol problems earlier than ever.

When to test kids:

• Between ages 9–11 and again at 17–21, especially with family history of heart disease.

Early intervention through nutrition, activity, and sometimes medications can help prevent lifelong complications.

Myths About High Cholesterol

Let’s bust a few common myths:

• ❌ “I’m thin, so I’m safe.” Truth: Thin people can still have high cholesterol.
• ❌ “If I eat healthy, I don’t need to get tested.” Genetics can override good habits.
• ❌ “Cholesterol meds are a life sentence.” Not always—some people normalize with lifestyle and taper off.

Conclusion

High cholesterol may be silent, but its impact on your health can be loud and life-altering. The good news? It’s largely manageable—and in many cases, preventable. With a mix of healthy habits, regular screenings, and proper treatment, you can take charge of your cholesterol before it takes charge of you.

References

1. World Health Organization – Cardiovascular Diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
2. NHS – High cholesterol. https://www.nhs.uk/conditions/high-cholesterol/
3. Mayo Clinic – High cholesterol. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
4. American Heart Association – Cholesterol. https://www.heart.org/en/health-topics/cholesterol
5. National Heart, Lung, and Blood Institute – Cholesterol levels. https://www.nhlbi.nih.gov/health/cholesterol