Hyperlipidemia is the medical term for high levels of fats, or lipids, in the blood; most people know it as high cholesterol. It covers several patterns: high LDL cholesterol, high triglycerides, low HDL cholesterol, or a combination. What they share is that, over years, excess cholesterol-carrying particles lodge in artery walls and build plaque, which narrows arteries and sets the stage for heart attack, stroke and poor circulation in the legs.
High cholesterol causes no symptoms. You cannot feel it, and many people discover it only after a heart attack. That is why we check cholesterol routinely at NYMD Center and treat it according to your overall risk, not just a single number.
Genes play a large role, and some people have high cholesterol despite a careful diet. Diet and activity still matter: too much saturated and trans fat from fried and processed foods, fatty red meat, full-fat cheese and pastries, too little fiber, and too little exercise all push numbers in the wrong direction. The encouraging part is that high cholesterol is one of the most treatable cardiovascular risk factors.
Understanding the numbers
A standard lipid panel reports several values. LDL cholesterol is the main driver of plaque, and the American Heart Association notes there is no single target for everyone: goals depend on your age and risk, and are lower for people with diabetes or prior heart disease. HDL cholesterol helps carry cholesterol away from arteries, and higher levels are generally better, though HDL should not be judged alone. Triglycerides, the fat that stores excess energy from your diet, are generally considered normal below 150 mg/dL. Non-HDL cholesterol, total cholesterol minus HDL, captures all the particles that can cause plaque.
Two further tests sharpen the picture. Apolipoprotein B counts the number of plaque-causing particles directly, which helps when triglycerides are high or LDL seems to understate risk. Lipoprotein(a) is a particle whose level is mostly inherited; the AHA recommends every adult be tested at least once, because a high level raises risk even when other numbers look fine.
Clues to familial hypercholesterolemia
Some people inherit a gene that keeps LDL very high from birth. This is familial hypercholesterolemia, and it causes heart attacks decades earlier than usual if untreated. Clues include a very high LDL, a parent or sibling who had a heart attack at a young age, and, as the AHA describes, cholesterol deposits in the Achilles tendons or tendons of the hands and elbows. When we suspect it, we treat more aggressively and recommend testing close relatives.
How we evaluate high cholesterol at NYMD Center
Evaluation begins with a lipid panel. Fasting is not always needed; the NHLBI notes that a lipid panel can be done with or without fasting, though we may ask you to fast 8 to 12 hours if triglycerides are high or a first result needs confirming. We add ApoB and Lp(a) where appropriate.
We then look for secondary causes, because treating them can improve cholesterol on its own. An underactive thyroid, kidney disease, poorly controlled diabetes, heavy alcohol use and certain medications can all raise lipids, so we check thyroid function, kidney and liver function and blood sugar. For more on the thyroid link, see our thyroid disease page.
Finally, we estimate your 10-year cardiovascular risk, combining cholesterol with age, blood pressure, smoking and diabetes, as part of heart and stroke risk screening. When your risk is intermediate and the decision about medication is uncertain, a coronary calcium scan, a low-dose CT that shows calcified plaque, can help decide.
Treatment options, least invasive first
Diet and activity
Everyone starts here. Limiting saturated and trans fats, eating more fiber from oats, beans, vegetables and whole grains, eating fish about twice a week, staying active and losing excess weight all improve lipids. Cutting sugar, refined carbohydrates and alcohol lowers triglycerides in particular. For some people with mild elevations and low risk, this is enough.
Statins
Statins are the main medication for lowering LDL and the best-studied drugs for preventing heart attack and stroke. They are usually taken once a day. We are honest about muscle aches, the side effect people worry about most. Mayo Clinic notes that when compared with placebo, the risk of statin-related muscle pain is about 5 percent or less, and that serious muscle damage is very rare. If you do have aches, do not simply stop; we can pause, switch to a different statin or lower the dose, and most people find a regimen they tolerate.
Ezetimibe
Ezetimibe reduces cholesterol absorption from the gut. It is a daily pill with few side effects, added to a statin when LDL is not at goal or used when statins are not tolerated.
PCSK9 inhibitors
PCSK9 inhibitors are injections, typically every two to four weeks, that lower LDL substantially. They are reserved for people at high risk, including familial hypercholesterolemia, whose LDL stays high despite other treatment. Cost and insurance approval are the main hurdles.
Treating high triglycerides
High triglycerides are treated first by addressing their causes: sugar and refined carbohydrates, alcohol, excess weight, diabetes and certain medications. When they remain high, prescription omega-3 or other medication may be added, and very high levels are treated promptly because they can inflame the pancreas.
What to expect at your visit
Bring prior cholesterol results and your medication list, and any family history of early heart disease or high cholesterol. Expect a review of your diet and activity, a physical exam including blood pressure, and blood work if it is not current. We recheck lipids after any treatment change to confirm the effect, then at regular intervals. Cholesterol care pairs naturally with management of high blood pressure, and patients interested in a broader prevention plan can explore our longevity medicine program.
Questions patients ask
Do I need to fast before a cholesterol test?
Often not. A lipid panel can be done with or without fasting, and non-fasting results are adequate for most screening. We may ask you to fast for 8 to 12 hours if your triglycerides were high before or if we need to confirm a result. We will tell you when booking whether fasting is needed.
Are statins safe?
For most people, yes. Statins are among the most studied medications and lower the risk of heart attack and stroke. Muscle aches are the most discussed side effect, but Mayo Clinic notes the risk compared with placebo is about 5 percent or less, and serious muscle damage is very rare. Tell us about aches instead of stopping on your own.
What is lipoprotein(a)?
Lipoprotein(a), or Lp(a), is a cholesterol-carrying particle whose level is mostly set by your genes. A high level raises the risk of heart attack and stroke even when LDL is normal, and it usually causes no symptoms. The American Heart Association recommends that every adult be tested at least once in their lifetime.
Can I lower my cholesterol without medication?
Many people can improve their numbers with diet, exercise and weight loss, especially when elevations are mild. People with very high LDL, familial hypercholesterolemia, diabetes or high overall cardiovascular risk usually need medication in addition to lifestyle changes. Your risk estimate, not just the cholesterol number, guides that decision.
How often should cholesterol be checked?
Most adults with normal results need a check every few years, and the American Heart Association suggests screening at least every five years for adults. People with high cholesterol, other risk factors or who are on treatment are checked more often, including a few weeks to months after starting or changing medication.