Effects of High Cholesterol - Risks, Tests, and What You Can Do Now

High cholesterol contributes to plaque buildup in arteries, increasing risk of heart attack, stroke, and peripheral artery disease. Screening with a lipid panel identifies LDL, HDL, and triglycerides. Clinicians use risk calculators plus LDL levels to decide on lifestyle changes and, if needed, medications such as statins, ezetimibe, or PCSK9 inhibitors. Key actions: improve diet, increase activity, quit smoking, and follow medical advice. Seek specialist care for very high or treatment-resistant cholesterol or suspected familial hypercholesterolemia.

Why high cholesterol matters

High cholesterol increases the risk of atherosclerosis - the buildup of fatty plaque in arteries. Over time that plaque can narrow or block blood flow, raising the chance of coronary artery disease, heart attack, stroke, and peripheral artery disease. Very high triglycerides can also trigger pancreatitis.

Cholesterol itself is carried in different particles. Low-density lipoprotein (LDL) is the primary driver of plaque buildup; high-density lipoprotein (HDL) helps remove cholesterol from arteries. Modern prevention focuses on lowering LDL and overall cardiovascular risk.

Who should be tested and how often

Adults should have their cholesterol checked as part of routine care. A standard lipid panel measures total cholesterol, LDL, HDL, and triglycerides. Nonfasting samples are generally acceptable for screening; clinicians sometimes request a fasting panel when triglycerides are very high or values need clarification.

Low-risk adults may only need screening every few years, while people with risk factors (smoking, diabetes, high blood pressure, family history of early cardiovascular disease) or those on treatment need more frequent monitoring. If you have a strong family history of very high cholesterol, ask about testing for familial hypercholesterolemia.

How clinicians decide treatment

Doctors assess your 10-year cardiovascular risk using validated calculators (for example, the ASCVD risk estimator) and combine that with LDL values and other factors. Lifestyle change is the first step for most people. When risk or LDL remains high despite diet and activity, clinicians commonly prescribe statin therapy. Other drug options include ezetimibe and PCSK9 inhibitors for selected patients, especially those with very high risk or familial conditions.

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Practical steps you can take now

• Improve diet: reduce saturated and trans fats, avoid industrial trans fats, eat more vegetables, whole grains, legumes, nuts, and fatty fish. Plant sterols and soluble fiber (oats, barley, beans) help lower LDL.

• Move more: aim for regular aerobic activity and strength work as advised by your clinician.

• Lose excess weight: modest weight loss lowers LDL and triglycerides.

• Quit smoking and limit excess alcohol.

• Follow prescribed medications and attend follow-up testing.

When to see a specialist

Ask for a lipid specialist or cardiologist referral if you have very high LDL despite treatment, suspected familial hypercholesterolemia, statin intolerance, or established cardiovascular disease.

Taking action now - screening, sensible lifestyle changes, and working with your clinician - reduces the long-term harms of high cholesterol and lowers your chances of heart attack and stroke.

1. Confirm current guideline recommendations for lipid screening frequency in low-risk adults (every few years vs specific interval).
2. Confirm the 10-year ASCVD risk thresholds clinicians use now to decide when to start statin therapy and whether thresholds have changed since 2018 ACC/AHA guidance.