What is high cholesterol?
High cholesterol — specifically elevated LDL (bad) cholesterol — contributes to plaque buildup in arteries, raising the risk of heart attack and stroke. About 38% of US adults have elevated total cholesterol.
Treatment depends on cardiovascular risk, not just lab numbers. Younger healthy people with moderate elevation may benefit from lifestyle alone. Higher-risk patients (existing heart disease, diabetes, family history, smoking) benefit substantially from statins.
Do I have high cholesterol? Common signs
If most of these describe what you're experiencing, telehealth may be a good next step:
What causes it
Genetics (familial hypercholesterolemia in some cases), diet high in saturated/trans fats, obesity, sedentary lifestyle, smoking, diabetes, hypothyroidism, kidney disease, certain medications.
Is it contagious?
No.
The number that matters most is LDL, not total cholesterol — and it always has to be interpreted alongside your overall cardiovascular risk.
Can it be treated online?
Established lipid disorders with prior labs are well-suited to telehealth. New diagnoses benefit from in-person workup including secondary causes. Severe familial hypercholesterolemia or refractory cases may need lipidology consultation.
How high cholesterol is treated
Lifestyle first for low-risk patients. Statins are mainstay for moderate-to-high risk: atorvastatin, rosuvastatin are most potent and commonly used. Ezetimibe adds modest reduction. PCSK9 inhibitors (alirocumab, evolocumab) for severe cases or statin intolerance. Bempedoic acid is newer option.
Self-care while you wait
- Reduce saturated fat — replace with mono/poly unsaturated
- Increase soluble fiber (oats, beans, fruit)
- Eat more plant sterols (in fortified foods)
- Fish 2x weekly for omega-3
- Exercise 30 min most days
- Maintain healthy weight
- Quit smoking
- Limit alcohol
How long does it last?
Lifelong management. Statins typically continued indefinitely once started.
Frequently asked questions
Do I need a statin?
Depends on cardiovascular risk score (ASCVD risk calculator). LDL >190, diabetes 40–75 with LDL >70, or 10-year ASCVD risk >7.5% generally benefit.
Are statin side effects common?
Muscle aches occur in 5–10% — often manageable by switching statins, reducing dose, or alternate-day dosing. Serious side effects are rare.
Will diet alone fix it?
For mild elevation in low-risk patients, often yes — 10–20% LDL reduction is realistic. For higher-risk or higher numbers, lifestyle + statin gets you to target.
What about red yeast rice?
Contains lovastatin-like compounds — works similarly to low-dose statin but unregulated potency. Inferior to prescription statins.
Is HDL still 'good cholesterol'?
Higher HDL associated with lower risk, but raising HDL pharmacologically hasn't reduced events. Focus is on lowering LDL.
