Age and other risk factors can contribute to increasing numbers that are often detected only by a blood test
By Kimberly Goad, AARP Published February 04, 2026
High cholesterol can be sneaky. Similar to other conditions that raise your risk for cardiovascular disease, such as high blood pressure, high cholesterol doesn’t usually cause obvious symptoms.
As a result, plenty of people — around 40 percent of adults in the U.S., according to a study published in JAMA Cardiology — are unaware they even have high cholesterol. This means they’re going untreated for a condition that can lead to heart attack, stroke, peripheral artery disease, chest pain or other cardiovascular problems.
But how can you stay vigilant about something that doesn’t readily make itself known?
“Know your numbers,” says Dr. Seth Martin, a preventive cardiologist at Johns Hopkins Medicine. “Very high levels of cholesterol can cause cholesterol buildup in the eyes and tendons that are detectable on a physical exam. However, most people don’t have those, and regular cholesterol blood tests are a reliable way to catch high cholesterol and intervene.”
The good news: Your annual checkup includes routine blood tests that measure cholesterol. What’s known as a lipid panel has readings for:
- HDL (high-density lipoprotein): Considered “good” cholesterol because it eliminates excess cholesterol in the body by carrying it from the bloodstream to the liver, which then removes it from the body. Optimal is 60 milligrams per deciliter or above.
- LDL (low-density lipoprotein): Considered “bad” cholesterol because it contributes to artery-clogging plaque buildup. Optimal is under 100 mg/dL.
- Triglycerides: The most common type of fat in your body. Optimal is under 150 mg/dL.
- Total: All the cholesterol in your blood. It includes both HDL and LDL, plus 20 percent of triglycerides.
As important as cholesterol numbers (particularly LDL) are, they don’t tell the whole story, says Martin. “We interpret and treat numbers in the context of a person’s cardiovascular risk,” he explains. “Treatment decisions are based on a comprehensive assessment, not just a single number.”
Here’s what you need to know about high cholesterol — the causes, risk factors, treatments and best ways to prevent it.
What is cholesterol?
Cholesterol is a waxy substance found in every cell of your body. Your liver makes most of it, and the rest comes from foods like meat, eggs and cheese.
Despite its reputation as the enemy of good health, it’s not inherently bad. In fact, your body needs cholesterol to build cells, produce hormones (like estrogen, testosterone and cortisol), synthesize vitamin D when your skin is exposed to sunlight and help your liver digest fats. Cholesterol is considered bad only if you have too much of it.
If too much LDL cholesterol circulates in the blood, it can lodge in the artery walls, where it combines with other substances to form plaque. Over time, the buildup causes arteries to narrow and become less flexible (a condition known as atherosclerosis), leading to a heart attack or stroke.
“Atherosclerosis is a systemic disease — not just a ‘heart’ disease but a cardiovascular disease that affects blood vessels in multiple areas of the body, from your head to your toes,” says Dr. Matthew Tomey, a cardiologist and faculty member at Mount Sinai Fuster Heart Hospital in New York.
High cholesterol “can contribute to the risk of disease in all these areas, with consequences ranging from stroke to heart attack to intestinal ischemia and abdominal pain, to leg pain and limb loss,” he adds.
What are the risk factors for high cholesterol?
Lifestyle plays a huge role. Smoking, drinking to excess, being physically inactive and eating a diet rich in saturated fats all raise your risk for high cholesterol.
Age also figures in. As you get older, your liver becomes less efficient at removing LDL cholesterol from your blood. Plus, hormonal shifts and an increased likelihood of chronic conditions (like diabetes, kidney disease, sleep apnea and liver disease) can affect cholesterol levels.
“If you have a family history of very high cholesterol from a young age or heart attacks at a young age, checking your cholesterol levels and discussing them with a knowledgeable physician is crucial,” says Dr. Ashish Sarraju, a preventive cardiologist at the Cleveland Clinic.
And yet research suggests that may not be happening.
One study, published recently in Circulation: Genomic and Precision Medicine, found that nearly 90 percent of people with a common inherited cause of dangerously high cholesterol known as familial hypercholesterolemia are not detected under current guidelines. The genetic condition leads to high levels of LDL cholesterol beginning at birth.
“High cholesterol isn’t just about the heart,” says Sarraju. There are risks for strokes or transient ischemic attacks (TIAs, sometimes called ministrokes), he explains. “If someone has high cholesterol, they may be at higher risk for vascular dementia due to disease in the small arteries supplying the brain.”
The peripheral arteries are also important, he adds. “High cholesterol can be associated with blockages in the arteries of the legs, predisposing people to pain with walking or foot ulcers.”
Treating high cholesterol
Depending on your specific risk factors, your doctor may first recommend lifestyle changes before prescribing medication.
“Lifestyle changes are a powerful foundation for cholesterol management, cardiovascular risk reduction and overall health,” says Martin. “Getting regular exercise and eating a heart-healthy diet that’s low in saturated and trans fats can often significantly lower LDL cholesterol and triglycerides.”
And losing weight — even just 5 to 10 percent of your overall body weight — can improve your cholesterol numbers, he adds.
If lifestyle changes don’t sufficiently lower your cholesterol, your doctor may prescribe medication. That used to almost automatically mean statins — a type of medication that lowers LDL by blocking the enzyme your liver needs to make cholesterol — but that’s no longer necessarily the case.
“Treatment has evolved from focusing solely on diet to having powerful medications that lower LDL cholesterol and lower cardiovascular risk,” says Martin.
“Statins became the first-line medications starting in the 1980s, and more recently there has been the introduction of multiple, effective non-statin medications,” he says. “For instance, ezetimibe, PCSK9 inhibitors, bempedoic acid — with a combination treatment approach becoming more common.”
Preventing high cholesterol
Maintaining a heart-healthy lifestyle can go a long way toward keeping your cholesterol levels in check. The American Heart Association recommends limiting saturated fat to less than 6 percent of daily calories and avoiding trans fats altogether.
Aim for at least 150 minutes per week of moderate-intensity aerobic exercise (like brisk walking, swimming, cycling), and give up smoking and vaping (by quitting, you can lower your triglycerides and increase your HDL levels).
“Sometimes, it is hard to convince [a patient] that they need to aggressively change their lifestyle or start medications if they feel fine,” says Sarraju. “But we don’t want to wait for symptoms of high cholesterol — typically that means a coronary event or stroke. We want to make changes years or decades before this can happen.”
Citing the findings of a landmark study published in The New England Journal of Medicine showing a nearly 50 percent reduced risk of coronary artery disease in adults at a high genetic risk who maintained a healthy lifestyle, Tomey says: “We can all benefit from a healthy diet and lifestyle — even if genetics predispose to high cholesterol or cardiovascular disease.”
Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader’s Digest.
