High cholesterol

High cholesterol symptoms: What are the early signs of high cholesterol?

Medically reviewed by Leslie Greenberg, MD

Board-Certified Family Physician

Updated Apr. 24, 2024 • Published Mar. 28, 2023

Fact Checked

Overview of high cholesterol

The body needs cholesterol to build cells, produce hormones, and ensure the health of nerve cells. While the body tries to keep serum cholesterol within certain levels, cholesterol levels can get too high, especially when we age. In and of itself, higher levels of cholesterol don’t make people sick. However, high cholesterol levels format plaques that stick to the walls of arteries and other blood vessels. These cholesterol plaques narrow blood vessel passageways and eventually block blood flow. Worse, they can shake loose and partly or completely block a blood vessel as a blood clot would. The resulting decrease in blood flow can be devastating and can cause a heart attack or stroke.

Unfortunately, high cholesterol doesn’t have symptoms. It feels and looks the same as normal cholesterol until the plaques obstruct blood flow. The only way to know if circulating cholesterol is high is to get a blood test.

Key takeaways:

High cholesterol is a common health condition that mostly affects older adults but can affect anyone regardless of age, sex, race, or ethnicity.
High cholesterol has no warning signs.
There are no serious symptoms of high cholesterol until it forms large plaques that obstruct blood flow. When symptoms appear, the symptoms of decreased blood flow to the heart can cause heart disease or aheart attack. When there is decreased blood flow to the brain this causes a stroke. Symptoms of any of these serious complications oftenrequire immediate medical attention.
High cholesterol is primarily caused by a genetic predisposition for high cholesterol. This can run in families. If a patient has an inactive lifestyle and a high-fat diet, the problem compounds. Other risk factors of atherosclerotic cardiovascular disease (ASCVD) include high blood pressure, BMI over 25, diabetes, and smoking.
High cholesterol requires a medical diagnosis.
High cholesterol generally requires treatment. High cholesterol usually improves with treatment.
Treatment of high cholesterol may include changing your diet, increasing physical activity, achieving and maintaining weight loss, and taking cholesterol-lowering drugs. Read more about high cholesterol treatments here.
Over time untreated high cholesterol often results in complications like atherosclerosis, heart disease, stroke, heart attack, and peripheral artery disease.
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What are the early signs of high cholesterol?

There are no early signs of high cholesterol. The only way to detect high cholesterol levels is by checking a blood test that measures cholesterol in the blood.

Other high cholesterol symptoms

There are no symptoms of high cholesterol. However, high cholesterol can cause atherosclerosis, a waxy buildup made up of cholesterol, fatty deposits, and other material that sticks on artery walls. Atherosclerosis can eventually result in serious complications such as coronary artery blockage, heart attack, stroke, and peripheral artery disease. Peripheral artery disease is a condition in which the ends of the body get decreased blood flow. Patients may have leg pain with walking that resolves after rest. This is because the feet are not getting enough blood flow and pain results.

Symptoms of atherosclerosis include:

Chest pain
Fatigue
Weakness
Heartbeat changes
Shortness of breath
Leg cramps
Sweating
Leg pain with walking that resolves with rest

High cholesterol vs. hyperlipidemia symptoms

Hyperlipidemia is high cholesterol. Lipids are fats, and cholesterol is part fat and part protein. So cholesterol is technically a fat. Hypertriglyceridemia means serum triglyceride levels are high. Some people may only have high triglyceride levels. Or both cholesterol and triglycerides may be high, which is also hyperlipidemia.

Types of high cholesterol: How can I tell which one I have?

Although a healthcare professional may give you a number, like, “your total cholesterol is 229,” there are several types of cholesterol and fats. “High cholesterol” could mean several things.

Cholesterol itself comes in two different types: low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

LDL cholesterol is the “bad” cholesterol. It is vital to the body’s functions, but it’s the one that forms plaques in the blood vessels. A high level of LDL cholesterol means that there’s an increased risk of developing atherosclerosis. People with hyperlipidemia over time have an increased risk of heart disease, stroke, and artery disease.

HDL cholesterol is known as “good” cholesterol. Its primary job is to scoop up other cholesterol molecules and take them to the liver to be eliminated. So high levels of HDL cholesterol decrease the risk of atherosclerosis, heart disease, and stroke.

Triglycerides are not cholesterol. They’re a type of fat. However, measuring triglyceride levels also indicates the risk of future heart disease.

All told, there are several ways cholesterol and triglycerides can go wrong. These include high tota lcholesterol, high LDL cholesterol, high triglycerides or low HDL cholesterol.

When to see a doctor for high cholesterol symptoms

Since there are no symptoms of high cholesterol, the only way to know if cholesterol levels are elevated is to get a blood test, called a “lipid panel.” The American Heart Association suggests everyone 20 years of age or older have cholesterol checks every four to six years or more often as scheduled by their doctor.

A doctor diagnoses high cholesterol from the blood test results. The blood test will measure total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels. The combined score as well as any comorbid medical conditions like diabetes or high blood pressure are used to calculate the risk of a cerebrovascular event (stroke or heart attack) within the next 10 years. If the probability is high enough, the doctor may suggest acholesterol-lowering drug to decrease the risk.

Any of the following results adds to the risk of developing atherosclerosis:

LDL cholesterol levels greater than 100 mg/dL
HDL cholesterol levels lower than 59 mg/dL
Total cholesterol levels higher than 200 mg/dL
Triglyceride levels higher than 150 mg/dL

Any of the following results significantly adds to the risk of atherosclerosis:

LDL cholesterol levels greater than 150 mg/dL
HDL cholesterol levels lower than 40 mg/dL
Total cholesterol levels higher than 240 mg/dL
Triglyceride levels higher than 500 mg/dL

Complications of high cholesterol

The most serious complication of high cholesterol is the blockage of the arteries that feed oxygen to the heart or brain. Atherosclerotic cardiovascular disease (ASCVD) can cause several complications including:

Angina (chest pain)
Coronary artery stenosis (insufficient oxygen to the heart)
Heart attack
Stroke
Peripheral artery disease
Other artery problems

How to treat high cholesterol symptoms

High cholesterol requires treatment. It typically does not get better without intervention.

High cholesterol treatment generally consists of:

Dietary changes: eat a low-fat, high-fiber healthy diet.
Physical activity: moderate exercise of at least 150 minutes per week.
Medications: take cholesterol-lowering drugs.

Several cholesterol-lowering drugs can help including:

Statins: these prescription drugs are usually the first type of drug prescribed. They lower cholesterol by partly shutting down the body’s production of cholesterol.
Ezetimibe: usually an additional medicine when statins do not decrease LDL level to less than 100. Ezetimibe is a drug that blocksthe digestive system absorption of cholesterol from foods.
Fibrates: if statins don’t decrease LDL to less than 100 or triglycerides remain above 150l, healthcare professionals may add a fibrate drug. These drugs increase the body’s breakdown of bad cholesterol and increase its production of good cholesterol.
Bile acid sequestrants: these medications interfere with the body’s ability to absorb fats and prevent the reabsorption of bile acid, which is made from the same molecule as cholesterol. Losing bile acid means the body must make less LDL cholesterol.
PCSK9 inhibitors: these monoclonal antibodies increase the body’s elimination of bad cholesterol.
Niacin: better known as vitamin B3, niacin reduces LDL cholesterol and increases HDL cholesterol. Niacin often causes hot flashes and patients rarely can tolerate the side effects.

Living with high cholesterol

Once high cholesterol is diagnosed, people should understand that it’s a lifelong diagnosis. Lifestyle changes and statins can decrease cholesterol levels into the healthy range, but lifestyle modifications and medications will be needed to maintain this. Fortunately, one of the best ways to treat high cholesterol is changing eating and other habits:

Eat a healthy diet low in saturated and trans fats
Opt for unsaturated fats
Eat foods high in soluble fiber (like whole grains)
Eat foods high in omega-3 fatty acids (like fish)
Avoid fatty meats, fried food, processed foods, and foods high in sugar
Exercise moderately 150 minutes or more per week
Stop smoking
Don’t drink too much alcohol (no more than 1 drink/day for women and 2 drinks/day for men)
Lose weight (Aim for a BMI less than 25.)

Most importantly, make changes

Cholesterol drugs are miracle drugs. They save millions of lives. But the most powerful tools people have to fight high cholesterol are long-term lifestyle changes. Weight loss, healthy diet, and physical activity have a major effect not only on cholesterol, but other health problems such as high blood pressure, obesity, and Type 2 diabetes. Unlike prescription drugs, the most common side effect of a healthy diet and lifestyle is an improved quality of life.

FAQs about high cholesterol symptoms

Is fatigue a symptom of high cholesterol?

Fatigue is not a symptom of high cholesterol. However, high cholesterol can cause plaque buildup in the heart’s arteries, called atherosclerosis. The plaque buildup can block blood flow to the heart, a condition known as coronary artery disease. Extreme tiredness and fatigue are both symptoms of coronary artery disease.

Does high cholesterol cause neck pain?

Neck pain is not a symptom of high cholesterol. When the large arteries in the neck (carotid arteries) have significant plaque, there are no symptoms until the patient suffers a stroke. There is no pain even when a patient has decreased blood flow to the brain and brain cells die.

Is neuropathy a sign of high cholesterol?

Neuropathy has many causes, but high cholesterol is not one of them. There may be an association between cholesterol levels and peripheral nerve damage caused by diabetes, but the exact relationship is not understood. People with diabetic neuropathy often have low levels of cholesterol. In these cases, healthcare professionals believe that there’s not enough cholesterol to repair the nerve damage caused by high blood sugar.

What’s next? Additional resources for people with high cholesterol symptoms

Medically reviewed by Leslie Greenberg, MD

Board-Certified Family Physician

Leslie Greenberg, MD, is a board-certified practicing family physician with more than 25 years of doctoring experience. She was a psychology major at Northwestern University near Chicago, then graduated with an MD from the University of Nevada School of Medicine. She completed her family medicine residency at St. Joseph Hospital in Wichita, Kansas. She has trained more than 350 family medicine resident-physicians, been in private practice, and delivered babies for 22 years.

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