The Call-On-Doc Guide to High Cholesterol

High cholesterol typically does not cause noticeable symptoms on its own. It is often referred to as a "silent" condition because individuals may not experience any specific signs or symptoms. However, over an extended period of time, high cholesterol can contribute to the development of serious health problems such as:

• Heart disease with symptoms including chest pain or angina.
• Stroke with symptoms including weakness or numbness in one side of the body and difficulty speaking.
• Peripheral artery disease manifests as leg pain or cramping during physical activity as well as slow-healing wounds.

High cholesterol does not have one direct cause but develops over time due to a number of genetic, lifestyle, and dietary factors. The most common include: 

• Genetics: Family history plays a significant role in determining cholesterol levels. Some individuals may inherit genetic conditions that cause high cholesterol, such as familial hypercholesterolemia (FH), which leads to elevated levels of LDL cholesterol. 
• Diet: Consuming a diet high in saturated fats, trans fats, and cholesterol can contribute to elevated LDL cholesterol levels. Foods like fatty meats, full-fat dairy products, fried foods, processed snacks, and baked goods made with hydrogenated oils can raise cholesterol levels. (7)
• Lack of Physical Activity: Sedentary lifestyles and lack of regular physical activity can lead to lower levels of HDL cholesterol and higher levels of LDL cholesterol, increasing the risk of high cholesterol.
• Obesity and Weight Gain: Being overweight or obese is associated with higher LDL cholesterol and triglyceride levels and lower HDL cholesterol levels, contributing to an unhealthy lipid profile.
• Smoking: Tobacco smoke contains chemicals that can damage blood vessels and lead to atherosclerosis, increasing the risk of high cholesterol and related cardiovascular problems.
• Age and Gender: Cholesterol levels tend to increase with age, particularly LDL cholesterol. Women generally have lower LDL cholesterol levels than men before menopause, but their levels may rise after menopause. (8)
• Medical Conditions: Certain medical conditions and medications can influence cholesterol levels. For example, diabetes, hypothyroidism, liver disease, and kidney disease can affect lipid metabolism and lead to high cholesterol. Some medications, such as corticosteroids, diuretics, and certain antipsychotics, can also contribute to elevated cholesterol levels.
• Alcohol Consumption: Excessive alcohol consumption can raise triglyceride levels and contribute to high cholesterol, especially when combined with an unhealthy diet and sedentary lifestyle.

High cholesterol levels, particularly elevated levels of LDL cholesterol, can lead to the accumulation of cholesterol and other substances in the walls of arteries. This buildup forms plaques, which is a condition known as atherosclerosis. Over time, these plaques can narrow and stiffen the arteries, reducing blood flow to organs and tissues throughout the body. Happening slowly and often taking years to develop, conditions that arise from this process can affect critical parts of the body. 

In the coronary arteries supplying blood to the heart, atherosclerosis can lead to coronary artery disease (CAD). Reduced blood flow to the heart muscle can cause chest pain or angina, and if a plaque ruptures, it can trigger a blood clot that blocks blood flow to part of the heart, resulting in a heart attack. (4)

In the carotid arteries supplying blood to the brain, atherosclerosis increases the risk of stroke. A blood clot or a piece of plaque that breaks off can travel to the brain, blocking a blood vessel and causing a stroke. Symptoms of a stroke include sudden weakness or numbness in the face, arm, or leg (usually on one side of the body), difficulty speaking or understanding speech, vision problems, severe headache, and unexplained dizziness or loss of balance. (5)

High cholesterol levels can also contribute to peripheral artery disease (PAD), where arteries in the legs become narrowed or blocked, reducing blood flow to the lower extremities. Symptoms of PAD may include leg pain or cramping during physical activity (intermittent claudication), slow-healing wounds on the legs or feet, coldness or numbness in the extremities, and weak or absent pulses in the legs. (6)

While considered distinct conditions, a 60% majority of Americans with high blood pressure have high cholesterol. (9) Both affect arteries in the human body, with high cholesterol building up plaque on the artery walls while high blood pressure elevates the level of pressure pumped through arteries throughout the body, as mentioned in The Call-On-Doc Guide to Hypertension. While not necessarily confirmed as being related, it’s clear that having both increases a person’s chances of developing a problem arising from an artery blockage, burst, or strain. 

Like high blood pressure and high cholesterol, type 2 diabetes has the capacity to increase a person’s chances for heart disease and conditions linked to a person’s arteries. While there’s no direct link between the two conditions from the outset, type 2 diabetes can lower levels of good cholesterol in the body, making it easier for bad cholesterol to go unchecked and develop into high cholesterol. (10) Learn more about type 2 diabetes from The Call-On-Doc Guide to Type 2 Diabetes. 

For a high cholesterol diagnosis, a healthcare provider will normally conduct a blood test measuring the following: 

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides

Alongside a risk assessment, doctors are normally able to tell you whether you have high cholesterol, on the path of developing it, or at normal levels. It’s recommended to get this test every four to six years if your cholesterol is at normal levels and you have no family history. However, those with a family history of high cholesterol or other chronic conditions should be checked annually. (11) Annual checkups are additionally recommended for men at 45 and women at 55.

When it comes to high cholesterol treatment, doctors generally advise for dietary and lifestyle changes before offering medications. In the event that medications are needed, the following examples have proven the most effective: 

• Statins: Statins are considered the most effective at treating high cholesterol, inhibiting an enzyme in the liver called HMG-CoA reductase, which plays a key role in cholesterol production. By blocking this enzyme, statins reduce the liver's ability to produce cholesterol, leading to lower levels of LDL cholesterol ("bad" cholesterol) in the bloodstream. Additionally, statins may modestly increase levels of HDL cholesterol and have anti-inflammatory effects that can benefit cardiovascular health.
• Bile Acid Sequestrants: Bile acid sequestrants work by binding to bile acids in the intestines, preventing them from being reabsorbed into the bloodstream. This process forces the liver to use cholesterol to produce more bile acids, thereby lowering cholesterol levels in the blood. Bile acid sequestrants primarily reduce levels of LDL cholesterol. 
• Cholesterol Absorption Inhibitors: Cholesterol absorption inhibitors work by blocking the absorption of dietary cholesterol from the intestines into the bloodstream. Specifically, they target a protein called NPC1L1 (Niemann-Pick C1-Like 1 protein) in the intestines, which plays a role in cholesterol absorption. By inhibiting NPC1L1, these medications reduce the amount of cholesterol absorbed from food, leading to lower levels of LDL cholesterol in the bloodstream.

Yes, it is possible to lower and even reverse high cholesterol levels through lifestyle changes and, if necessary, medication prescribed by a healthcare provider. Adopting a heart-healthy diet rich in:

• fruits 
• vegetables 
• whole grains 
• lean proteins 
• healthy fats 

Such a diet can help lower LDL cholesterol and triglyceride levels while increasing HDL cholesterol. Additionally, when used in conjunction with a healthy diet, the following will help balance a person’s cholesterol: 

• Regular physical activity
• Maintaining a healthy weight 
• quitting smoking 
• limiting alcohol consumption  
• managing stress 

Each is important in managing cholesterol levels. In some cases, a healthcare provider may prescribe medications to further reduce cholesterol levels and lower cardiovascular risk. Regular monitoring and medical evaluation are essential for effective cholesterol management and overall heart health.

Alongside high cholesterol treatment, management can be applied in multiple ways and has proven effective for most of those who stick to the changes. These can include: 

• Heart-Healthy Diet: Adopt a diet rich in fruits, vegetables, whole grains, lean proteins (such as fish, poultry, beans, and legumes), and healthy fats (such as olive oil, avocados, and nuts). Limit saturated fats found in red meat, full-fat dairy products, and processed foods. Avoid trans fats often found in fried and packaged foods.
• Increase Fiber Intake: Include fiber-rich foods such as oats, barley, fruits, vegetables, beans, and legumes in your diet. Soluble fiber can help lower LDL cholesterol levels.
• Limit Dietary Cholesterol: Limit foods high in dietary cholesterol, such as egg yolks, organ meats, and shellfish. However, moderate egg consumption is generally acceptable for most people.
• Regular Physical Activity: Engage in regular aerobic exercise such as walking, jogging, cycling, or swimming for at least 30 minutes most days of the week. Physical activity can help raise HDL cholesterol ("good" cholesterol) and lower LDL cholesterol.
• Maintain a Healthy Weight: Achieve and maintain a healthy weight through a combination of balanced diet and regular exercise. Losing excess weight can help lower LDL cholesterol levels.
• Quit Smoking: If you smoke, quit smoking. Smoking can lower HDL cholesterol and increase the risk of cardiovascular disease.
• Limit Alcohol Consumption: Limit alcohol intake to moderate levels, as excessive alcohol consumption can raise triglyceride levels and contribute to high cholesterol.
• Manage Stress: Practice stress-reducing techniques such as meditation, yoga, deep breathing exercises, or mindfulness to help manage stress levels, which can impact cholesterol levels.

While there are conditions that can make a person more susceptible to developing high cholesterol, like diabetes, an underactive thyroid, and kidney disease, preventing high cholesterol early on is entirely possible. High cholesterol prevention starts in childhood, being largely dependent on a lifestyle that includes exercise and a healthy diet. If you’re concerned about high cholesterol, regular testing will help you get the best idea of where your levels are and where they need to be based on recommendations from your healthcare provider. 

Call-On-Doc can help those with high cholesterol, offering high cholesterol treatment and effective medications so you can gain control of the condition and improve your quality of life. Alongside same day prescriptions, Call-On-Doc offers an easy way to get prescription refills or labs to help you manage and monitor your overall health.

1. “Cholesterol | cdc.gov.” Centers for Disease Control and Prevention, https://www.cdc.gov/cholesterol/index.htm.
2. Berg, Sara. “What doctors wish patients knew about high cholesterol.” American Medical Association, 25 February 2022, https://www.ama-assn.org/delivering-care/hypertension/what-doctors-wish-patients-knew-about-high-cholesterol.
3. Corliss, Julie. “How it’s made: Cholesterol production in your body.” Harvard Health, 6 February 2017, https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body.
4. “Coronary Artery Disease | cdc.gov.” Centers for Disease Control and Prevention, https://www.cdc.gov/heartdisease/coronary_ad.htm.
5. “High cholesterol.” Stroke Association, https://www.stroke.org.uk/stroke/managing-risk/high-cholesterol.
6. “Peripheral Artery Disease - Causes and Risk Factors.” NHLBI, https://www.nhlbi.nih.gov/health/peripheral-artery-disease/causes.
7. “Cholesterol Diet: How Nutrition & Foods Impact Levels.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/16867-cholesterol--nutrition-tlc.
8. Oen, Joyce. “High Cholesterol in Women: Heart Disease, Risk Factors, and More.” Healthline, 25 January 2021, https://www.healthline.com/health/high-cholesterol/high-cholesterol-and-heart-disease-in-women.
9. Davis, Julie. “High Cholesterol and High Blood Pressure.” WebMD, 9 July 2023, https://www.webmd.com/cholesterol-management/high-cholesterol-and-high-blood-pressure.
10. “Cholesterol and Diabetes.” American Heart Association, 4 May 2021, https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cholesterol-abnormalities--diabetes.
11. “Get a Cholesterol Test | cdc.gov.” Centers for Disease Control and Prevention, https://www.cdc.gov/cholesterol/cholesterol_screening.htm.