Hyperlipidemia
Cholesterol is a natural substance produced by the liver and also found in the food we eat. Your body uses it to build healthy cells and hormones. But when there’s too much of the wrong kind—especially LDL (low-density lipoprotein) cholesterol—it can build up in the walls of your arteries like rust inside pipes.
A raw egg yolk presented simply on a white dish
The Silent Risk: A Heart Doctor’s Guide to Understanding and Managing High Cholesterol
When I first meet patients in my clinic—many of them busy professionals, parents, or retirees—the conversation often begins with something unexpected on their blood test: high cholesterol.
“No symptoms,” they tell me. “I feel perfectly fine.”
And yet, hidden in those numbers is a silent signal—a warning that the heart may be working under strain, and that arteries may be quietly narrowing. As a cardiologist and vascular medicine specialist, I’ve seen how this seemingly simple lab result can shape a person’s long-term risk of heart attack, stroke, and peripheral artery disease. But here’s the good news: High cholesterol is not a life sentence. With the right steps—starting today—you can take control of your numbers and protect your heart.
What Is Cholesterol—and Why Does It Matter?
Cholesterol is a natural substance produced by the liver and also found in the food we eat. Your body uses it to build healthy cells and hormones. But when there’s too much of the wrong kind—especially LDL (low-density lipoprotein) cholesterol—it can build up in the walls of your arteries like rust inside pipes.
Over time, this buildup, known as atherosclerosis, narrows the arteries and restricts blood flow. The heart must pump harder. Plaques can rupture, triggering blood clots that cause heart attacks or strokes.
You won’t feel it happening—but it’s there. And that’s why understanding and managing hyperlipidemia, or high blood fats, is so crucial.
Breaking Down the Numbers: Good vs. Bad Cholesterol
There are two main types of cholesterol you need to know:
- LDL ("bad" cholesterol): High levels cause fatty plaques to form in your arteries.
- HDL ("good" cholesterol): Helps remove excess cholesterol from your bloodstream, transporting it back to the liver for disposal.
- A third player, triglycerides, are another type of fat in your blood that also contribute to cardiovascular risk when elevated.
A simple lipid profile blood test will show:
- Total cholesterol
- LDL cholesterol
- HDL cholesterol
- Triglycerides
- In my practice, I often use tools like the Framingham Risk Score to assess your 10-year heart disease risk based on these values, your blood pressure, lifestyle, and family history.
What Causes High Cholesterol?
Many factors influence your cholesterol—some within your control, others not. Common risk factors include:
- A diet high in saturated fats and trans fats
- Lack of regular physical activity
- Obesity or being overweight
- Smoking
- Type 2 diabetes
- High blood pressure
- Family history of hypercholesterolemia
- Genetic conditions such as familial hypercholesterolemia
- Even thin, seemingly healthy individuals can have elevated cholesterol due to genetics. That’s why screening matters, even if you feel fine.
Taking Action: How to Lower Cholesterol Naturally
Many of my patients are relieved to learn they have powerful tools at their fingertips. You don’t need to overhaul your entire life overnight—small changes create ripple effects.
Lifestyle changes that truly work:
- Eat heart-smart: Focus on vegetables, fruits, legumes, fish, nuts, olive oil, and whole grains. Limit red meats, processed foods, and full-fat dairy. Avoid anything with trans fats.
- Move more: Aim for 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity per week. Exercise helps lower LDL and raise HDL.
- Quit smoking: Cigarettes lower your HDL and speed up arterial damage. Quitting brings near-immediate cardiovascular benefits.
- Lose excess weight: Losing even 5–10% of your body weight can significantly improve cholesterol and triglyceride levels.
When Lifestyle Changes Aren’t Enough: Medication Options
If your numbers remain elevated, especially if you have other risk factors like diabetes or a prior heart event, we may consider cholesterol-lowering medications, including:
- Statins – Reduce liver production of cholesterol
- Ezetimibe – Blocks cholesterol absorption in the gut
- Bile acid sequestrants – Help remove cholesterol via digestion
- Fibrates or nicotinic acid – Lower triglycerides and modestly affect LDL/HDL
- Bempedoic acid or PCSK9 inhibitors – Newer options for those who can’t tolerate statins
- Each plan is personalized, balancing effectiveness, side effects, and your cardiovascular risk profile.
Frequently Asked Questions
Q: Can I tell if I have high cholesterol without a test?
No. High cholesterol is often asymptomatic—you won’t feel it. That’s why blood tests are so important.
Q: How young should I start testing?
Adults should begin cholesterol screening by age 20, and earlier if there’s a strong family history.
Q: What’s the difference between cholesterol and triglycerides?
Both are fats in your blood, but triglycerides are more influenced by sugar and alcohol intake, while cholesterol relates more to fat intake and genetics.
Q: Do I need lifelong medication?
Not always. Some patients lower their cholesterol enough through lifestyle alone. Others may need long-term medication, especially with a strong family history or previous heart issues.