Hypercholesterolemia (High Cholesterol)

High cholesterol often doesn’t cause symptoms. You may not know your levels are high until they show up on routine blood work.

Hypercholesterolemia means you have too much cholesterol in your blood, especially low-density lipoprotein (LDL), or “bad” cholesterol. Over time, high LDL can lead to plaque buildup in your arteries and raise your risk of heart attack and stroke.

Diabetes & Glandular Disease Clinic provides care for high cholesterol and other metabolic conditions in San Antonio.

Cholesterol is a waxy substance your body needs to make cell membranes, hormones, and bile acids. Your liver makes cholesterol, and you also get some from food.

Hypercholesterolemia is a type of hyperlipidemia, a broader term for having high levels of cholesterol, triglycerides, or other fats in your blood.

Cholesterol travels through your blood in particles called lipoproteins. When you have too much LDL cholesterol, it can enter the walls of your arteries and contribute to plaque buildup.

Most people with high cholesterol feel no different, even when their LDL is high.

In rare cases, very high inherited cholesterol can cause fatty deposits around the tendons or skin or a pale ring around the colored part of the eye. These signs at a young age may point to an inherited form of high cholesterol.

Your genes can have a strong effect on your cholesterol levels. Familial hypercholesterolemia (FH) is an inherited condition that makes it harder for your body to remove LDL from your blood. People with FH can have very high LDL levels starting early in life.

Diet also affects cholesterol. Eating a lot of saturated fat can raise LDL levels.

Other conditions linked to abnormal cholesterol include:

• Hypothyroidism
• Diabetes
• Chronic kidney disease
• Obesity
• Polycystic ovary syndrome (PCOS)

Certain medications can also affect cholesterol levels, including corticosteroids, retinoids, and some drugs that suppress the immune system.

A blood test called a lipid panel measures:

• LDL cholesterol: Often called “bad” cholesterol because high levels can contribute to plaque buildup.
• HDL cholesterol: Often called “good” cholesterol because it carries cholesterol back to your liver.
• Triglycerides: Another type of fat in your blood.
• Total cholesterol: The total amount of cholesterol in your blood.

General adult cholesterol levels include:

• Total cholesterol below 200 mg/dL
• LDL cholesterol below 100 mg/dL
• HDL cholesterol above 40 mg/dL for men and 50 mg/dL for women
• Triglycerides below 150 mg/dL

Your numbers are only part of the picture. Your doctor will also consider your age, family history, blood pressure, diabetes, smoking, and existing heart disease. Your LDL goal may be lower if you have heart disease or other risk factors.

Most people don’t need to fast before a lipid panel. Your doctor may recommend fasting in some cases, especially if your triglycerides need a closer look.

Other tests may include:

• Lipoprotein(a), or Lp(a): A type of cholesterol particle that’s mostly determined by your genes.
• Apolipoprotein B, or ApoB: A test that measures the number of particles that can contribute to plaque buildup.

Treatment depends on your cholesterol levels and your overall risk of heart disease and stroke.

Lifestyle changes may include eating less saturated fat, getting regular physical activity, reaching a healthy weight, and avoiding tobacco.

Some people also need medication. Statins are usually the first medications used to lower LDL cholesterol. They reduce cholesterol production in the liver and can lower the risk of heart attack and stroke.

If a statin doesn’t lower LDL enough, other options include:

• Ezetimibe, which reduces cholesterol absorption
• Bempedoic acid, an oral LDL-lowering medication
• PCSK9 inhibitors, which can significantly lower LDL

You can’t tell whether you have high cholesterol based on how you feel. A blood test can show where your levels stand and whether you may need treatment.

If you have hypercholesterolemia, Diabetes & Glandular Disease Clinic can help you understand your results and treatment options. Schedule an appointment with our San Antonio team.

1. What cholesterol level is considered too high?

There isn’t one LDL number that’s right for everyone. Someone with heart disease or diabetes may need a lower LDL level than a younger person with few risk factors.

2. Can you have high cholesterol even if you eat a healthy diet?

Yes. Your liver makes cholesterol, and your genes affect how well your body removes LDL from your blood. People with inherited high cholesterol may need medication even if they eat a healthy diet.

3. Does a high HDL level cancel out a high LDL level?

No. A high HDL level doesn’t cancel out the risks of high LDL. Your doctor will consider your LDL and other risk factors when deciding whether you need treatment.