High Cholesterol: What Your Numbers Mean, Long-Term Risks and Treatment

High cholesterol has no symptoms, but over many years it builds plaque inside your arteries and raises the risk of heart attack and stroke. A simple blood test finds it, and treatment lowers the risk. Here is what your numbers mean, what happens if cholesterol stays high, and the treatment options, from a physician you can see in person in Lehi, Utah or by secure video.

What is cholesterol?

Cholesterol is a waxy substance your body needs to build cells and hormones. Your liver makes most of it, and some comes from food. It travels in your blood in particles called lipoproteins. A cholesterol test (a “lipid panel”) measures:

LDL cholesterol

Often called “bad” cholesterol. Too much LDL gets into artery walls and forms plaque. LDL is the main number used to guide treatment.

HDL cholesterol

Often called “good” cholesterol, because it helps carry cholesterol away from the arteries. Low HDL is linked to higher risk, but medicines that only raise HDL have not been shown to prevent heart attacks.

Triglycerides

Another type of fat in the blood. High triglycerides often go along with extra weight, diabetes, alcohol and diets high in sugar and refined carbohydrates.

Non-HDL cholesterol

Your total cholesterol minus HDL. It counts all the particles that can form plaque and is especially useful when triglycerides are high.

Some people also get a one-time test for lipoprotein(a), or Lp(a), a largely inherited type of cholesterol particle that raises heart risk. The 2026 cholesterol guideline recommends measuring it at least once in adulthood. Lifestyle changes have little effect on it, so it usually does not need to be repeated.

What the numbers mean

There is no single number that is right for everyone. Your physician looks at your cholesterol results together with your overall risk of heart attack and stroke, and decides with you whether treatment makes sense and how far to lower your LDL.

Very high LDL (190 mg/dL or higher before treatment) can be a sign of an inherited condition such as familial hypercholesterolemia, or of other medical causes. It usually needs medicine, and family members may need testing too.
Very high triglycerides can inflame the pancreas (pancreatitis), so they are treated promptly.
Low HDL is read as part of your overall risk, not as a treatment target on its own.

To estimate your 10-year risk, your physician uses a calculator (the AHA PREVENT equations, for adults 30 to 79) that combines age, cholesterol, blood pressure, diabetes, smoking and kidney function. Family history and other factors can move your risk up or down, and some people benefit from a coronary artery calcium scan to help decide.

It has no symptoms, so get tested

You can’t feel high cholesterol. The 2026 guideline recommends a cholesterol check about every 5 years for adults in their 20s, more often if you have risk factors, and as part of a regular heart-risk check as you get older. Many tests don’t require fasting; we will tell you if yours does.

Long-term effects if it stays high

Years of high LDL lead to plaque that narrows and stiffens arteries (atherosclerosis). A piece of plaque can break open and form a clot that suddenly blocks blood flow.

Heart attack and heart disease

Plaque in the heart arteries can cause chest pain and heart attack.

Stroke

Plaque in the arteries to the brain, including the neck arteries, can cause a stroke or “mini-stroke”.

Leg artery disease

Narrowed leg arteries (peripheral artery disease) can cause leg pain with walking, slow-healing sores and, in severe cases, amputation.

The risk adds up with time and with other conditions such as high blood pressure, diabetes and smoking. Very high triglycerides can cause pancreatitis, a painful and sometimes dangerous inflammation of the pancreas. Lowering LDL lowers the risk of heart attack and stroke, and the benefit is larger the higher your risk.

What raises cholesterol

Genes play a big role. Some people inherit a condition that keeps LDL high from birth, such as familial hypercholesterolemia (FH), in which the body can’t properly clear LDL from the blood, or a high lipoprotein(a). Other causes include diets high in saturated and trans fats, extra weight, low activity, smoking, type 2 diabetes, an underactive thyroid, kidney or liver disease, pregnancy and some medicines. Alcohol and sugary drinks mainly raise triglycerides.

How weight affects cholesterol

Losing extra weight lowers triglycerides the most, raises HDL, and modestly lowers LDL. Thin people can have high cholesterol too, especially when it runs in the family, so being at a healthy weight does not mean your numbers are fine. For many people, especially with inherited high cholesterol, lifestyle changes alone are not enough, and needing medicine is not a failure.

Treatment option 1: daily habits

Eat a heart-healthy pattern: vegetables, fruit, whole grains, beans, nuts, fish and olive or canola oil. Swap saturated fats (fatty red meat, butter, full-fat cheese, many fried and processed foods) for unsaturated fats, and avoid trans fats.
Add soluble fiber from oats, beans, lentils, fruit and vegetables, which can help lower LDL.
Limit sugary drinks, sweets and alcohol, especially if your triglycerides are high.
Move most days: at least 150 minutes a week of moderate activity, such as brisk walking.
Don’t smoke or vape. Quitting raises HDL and lowers heart risk.
Reach and keep a healthier weight if you have extra weight.

Treatment option 2: medicines

Medicine is usually recommended if you already have heart or artery disease, or if your LDL is 190 or higher. It is also commonly recommended for most adults 40 to 75 with diabetes, for some adults with chronic kidney disease, and when your estimated risk is high enough after a discussion with your physician. These are the main types:

Statins

Pills that lower the liver’s production of cholesterol. They are the first choice for most people and lower LDL by about 30% to more than 50%, depending on the dose. They lower the risk of heart attack and stroke.

Ezetimibe

A pill that lowers how much cholesterol your gut absorbs. Often added to a statin when more LDL lowering is needed.

Bempedoic acid

A pill that blocks a different step in the liver’s cholesterol production. An option for people who can’t take a statin or need more lowering. It can raise uric acid, so tell us if you have gout.

For very high triglycerides, other medicines may be added to lower the risk of pancreatitis. Side effects: most people take statins without problems. Muscle aches are the most common complaint, and switching the dose or the statin often helps; serious muscle injury is rare. Statins can raise blood sugar slightly, but for most people the heart benefit is much larger. Other cholesterol medicines have their own side effects, which we review before you start. Tell your physician if you are pregnant, planning a pregnancy or breastfeeding: most people stop statins during pregnancy after talking with their prescriber, breastfeeding is generally not recommended while taking a statin, and rare very-high-risk cases are decided with a specialist. Don’t stop on your own. Some newer medicines can be expensive without insurance, so we talk through cost as part of the choice.

Follow-up tests

After starting or changing a cholesterol medicine, a repeat lipid panel in about 4 to 12 weeks shows how well it is working. After that, it is usually checked every 3 to 12 months, depending on your situation.

How Restoration Health can help

When we provide your primary care, we can order and explain your cholesterol tests, estimate your 10-year risk, check for causes such as thyroid or kidney problems, and talk through whether medicine makes sense for you. If you start medicine, we follow your results and side effects and adjust the plan at follow-up visits, in person in Lehi or by secure video for patients located in Utah. Because high cholesterol often comes with high blood pressure and diabetes, we look at all three together. If weight is part of the picture, our medical weight-loss program is available if you want it.

Important safety information

Call 911 for signs of a heart attack: chest pain, pressure or squeezing; pain spreading to the arm, back, neck or jaw; shortness of breath; cold sweat, nausea or lightheadedness. Women are somewhat more likely to have shortness of breath, nausea and back or jaw pain.
Call 911 for signs of stroke, even if they go away: face drooping, arm or leg weakness on one side, slurred or confused speech, or sudden loss of balance or vision.
Severe belly pain, especially with vomiting, needs emergency care, particularly if your triglycerides are very high.
On a statin: contact your clinician promptly for severe muscle pain or weakness, especially with dark urine, or for yellowing of the skin or eyes.

Ready to talk it through?

We can explain your cholesterol numbers, estimate your risk and decide on a plan with you. Book a primary care visit in person in Lehi or by secure video (for patients located in Utah at the time of the visit). Self-pay primary care visits are $75 (10 minutes), $149 (20 minutes) or $199 (30 minutes), and the price is shown before you book. Lab tests are billed separately by an outside lab. We can send lab orders to Quest or Labcorp. See all prices.

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Frequently asked questions

Do I need to fast before a cholesterol test?

Usually not. Many cholesterol tests are done without fasting. We may ask you to fast if your triglycerides were high before or if a fasting test would change the plan.

Can I lower my cholesterol without medicine?

Often by some amount. Eating less saturated fat, more fiber, being active and losing extra weight help, especially for triglycerides. For people at higher risk or with inherited high cholesterol, lifestyle changes are usually not enough on their own, and medicine adds protection.

Are statins safe?

For most people, yes. Statins are among the most studied medicines and lower the risk of heart attack and stroke. Muscle aches are the most common complaint and can often be managed by changing the dose or the statin. Serious side effects are rare.

What is lipoprotein(a)?

Lipoprotein(a), or Lp(a), is a largely inherited type of cholesterol particle that raises the risk of heart attack and stroke. The 2026 guideline recommends testing it at least once in adulthood. A high level is one reason to treat other risk factors more closely.

I’m not overweight. Can I still have high cholesterol?

Yes. Genes are a major cause, and people of any size can have high LDL. The only way to know is a blood test.

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Reviewed by a Utah-licensed physician at Restoration Health Medical Group. Last updated October 2026. This page is general information, not medical advice for you. Don’t start, stop or change a medicine without talking with your own clinician. For a medical emergency, call 911.