Cholesterol is a natural component in everyone’s blood, and supports normal function of cell membranes, hormone levels and more. However, having too much, is considered hyperlipidemia, hypercholesterolemia or high blood cholesterol — a major risk factor for heart attack, heart disease and stroke. About 71 million Americans have high cholesterol.

Here’s what happens in your body when you have high cholesterol: The waxy cholesterol builds up in artery walls and contributes to plaque, a hard deposit that narrows and clogs the arteries. (You may hear this referred to as atherosclerosis, or “hardening of the arteries.”)

When plaque builds up, it becomes harder for the heart to circulate blood and oxygen, which can cause chest pain or shortness of breath with increased exertion (angina). If a blood clot forms at the site of a disrupted plaque in a narrowed artery, it can block blood flow to the brain (a stroke) or to the heart (a heart attack).

There are actually several different types of cholesterol, one of which is high density lipoprotein (HDL) cholesterol. High levels of some kinds of cholesterol, including low density lipoprotein (LDL) cholesterol, can be harmful to your heart and blood vessels.

Prevention

To keep blood cholesterol numbers in a desirable range, it helps to follow these practices:

• Know your numbers. Adults over age 20 should have their cholesterol measured at least every five years. That gives you and your doctor a chance to intervene early if your numbers start to rise.
• Stick to a healthy diet. Saturated fats, trans fats and dietary cholesterol can all raise cholesterol levels. Foods thought to keep cholesterol low include monounsaturated fats (such as nuts and olive oil), polyunsaturated fats (such as fish and canola oil) and water-soluble fiber (such as oats, beans and lentils). Get practical ideas to on eating for cardiovascular health.
• Exercise and manage your weight. Along with a healthy diet, staying fit and maintaining a normal weight for your height lower your cardiovascular risks by minimizing the odds of other contributing health problems like obesity and diabetes. If you’re overweight, losing as little as 5 to 10 percent of your weight can significantly lower your risk of cardiovascular disease. Learn how implementing an exercise routine helps your heart in The ABCs of Moving More for Heart Health.

Treatment

Only one in three people who have high LDL cholesterol have the condition under control. The main goal of treatment is to lower, or control, your LDL level to minimize your personal risk for heart attack or cardiovascular disease, based on your cholesterol numbers and other risk factors, such as a history of cardiovascular disease.

Lifestyle changes are recommended for anyone with high cholesterol. These include:

Diet upgrades. First on the treatment menu is a heart-healthy diet. “I find that my patients generally love the Mediterranean diet,” says Johns Hopkins Ciccarone Center cardiologist Michael Blaha, M.D., M.P.H. “It tastes great, it’s satiating, and there’s excellent evidence that it reduces cholesterol and cardiovascular risk.”

Highlights of the Mediterranean diet include reducing saturated fat (found in animal products, butter, whole and 2% dairy products, coconut oil and palm oil) and trans fats (found in fried foods and baked goods). Eat mostly polyunsaturated or monounsaturated fats (found in fish, avocadoes, olive oil, nuts, and canola and soybean oil). Alcohol can raise triglycerides, so you may be advised to cut back.

Regular exercise. Aim for at least 30 minutes of exercise a day, most days. The American Heart Association recommends 40 minutes of moderate to vigorous exercise three to four times per week.

Weight management. This step is especially important for those who are overweight and who have high triglyceride levels or too-big waistlines (above 40 inches for men or 35 inches for women).

Medications. In addition to lifestyle changes, some people are prescribed drugs designed to lower cholesterol. Here are some of those medications:

• Statin medications slow the liver’s production of cholesterol and can help remove cholesterol circulating in the blood.
• Selective cholesterol absorption inhibitors (like ezetimibe) prevent the absorption of cholesterol from the intestine and help removal in the liver.
• PCSK9 inhibitors may be available for patients with high cholesterol in certain circumstances.
• Resins (bile acid sequestrants) bind to bile, a digestive acid, which causes the liver to produce more bile and thus use up more cholesterol.
• Fibrates lower triglycerides (rather than LDL levels).
• Niacin (nicotinic acid) is a B vitamin that affects the production of fats in the liver.
• Omega-3 fatty acid medications derived from fish oils also work to lower high triglyceride levels.

Lowering Your Cholesterol

Working to lower your cholesterol can be a long-term effort, and changing your health habits is key, Blaha says. To increase your odds of success:

• Don’t count on medications alone. You have to make lifestyle changes as well, according to Blaha.
• Start small. Modifying your diet and lifestyle in minor ways will make it easier to incorporate those changes into your life over the long haul. For example, rather than embarking on a drastic calorie-cutting diet, start by swapping out high-cholesterol and high-fat foods you love for healthier choices. For instance, buy skim milk instead of whole. Substitute olive oil for butter when you cook. Purchase foods with “no trans fats” on the labels.
• Know your cholesterol-lowering drugs. Some of these medications interact with grapefruit and pomegranate (and their juices). Pay close attention to your doctor’s guidelines about cholesterol drugs, and never stop taking them without consulting your physician. Be sure to report medication side effects to your doctor.

Research

New guidelines for LDL levels and addressing cardiovascular disease risk

New guidelines for assessing your heart disease give you and your doctor powerful tools for estimating your cardiovascular disease risk and lowering your LDL cholesterol levels. Working with your health care team, you can create a plan with a customized combination of lifestyle changes, medications and continued monitoring.

A cost-effective test can detect the early risk factors for heart disease

Using computerized tomography (CT), a coronary artery calcium scan can detect calcium and plaque in the walls of your heart’s arteries. The test is relatively inexpensive and can reveal early warning signs of heart disease so you can take action to lower your risk.

PSCK9 inhibitors can lower your LDL cholesterol: a lot

PSCK9 inhibitors may be a good choice for people with an inherited form of high cholesterol. These new drugs can lower dangerous LDL levels by half or more. The drugs’ costs are high, but the health care industry is working with manufacturers and pharmacists to bring the price down and make PSCK9 inhibitors available to more people.