There’s nothing inherently bad about cholesterol in your body or blood. But problems can develop if levels in your blood are too high. There are two main types of cholesterol that circulate in your blood: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). HDL, also known as “good” cholesterol, helps protect against the harmful effects of LDL, or “bad” cholesterol. If your LDL is too high or your HDL is too low, cholesterol can combine with other substances to form a hard deposit on the inside of your arteries, known as plaque. Plaque formation in your blood vessels — atherosclerosis — raises your risk of developing several health problems. If your cholesterol is too high, it’s important to take steps to lower it to avoid health problems down the road or to halt or potentially reverse problems you’ve already developed. While you should take cholesterol-lowering medication as prescribed, “there’s no replacement for lifestyle, and medication can never make up for it,” says Garg. He notes that the most important lifestyle measures you can take to lower cholesterol and reduce your risk of health complications include not smoking, exercising enough, following a heart-healthy diet, and losing weight if needed. Here’s what you should know about the most common health complications that can develop as a result of high cholesterol.
1. High Blood Pressure
If arteries throughout your body become narrowed due to plaque deposits, your blood pressure is bound to rise. That’s because your blood vessels can no longer relax as effectively to let your blood move at a healthy pressure level. Both high cholesterol and high blood pressure are “silent killers, in the sense that you don’t have any direct symptoms,” unless levels are extremely high, says Garg. But both can damage your blood vessels over time, raising your risk of further health problems.
2. Coronary Artery Disease
Coronary artery disease develops when plaque deposits form in the arteries supplying blood to the heart. At first this narrowing may cause no symptoms or overt problems. “If someone has coronary artery disease but they haven’t had a heart attack, and it’s been treated with a stent or it’s being managed with medication, the heart muscle can be normal,” says Garg. But if plaque in the coronary arteries reduces blood flow to the heart enough, it can lead to heart failure, the inability of the heart to pump enough blood throughout the body. And if a blood clot forms in the coronary arteries, it can lead to a heart attack.
3. Chest Pain (Angina)
Chest pain is a common symptom of reduced blood flow to the heart due to plaque buildup in the coronary arteries. “If you see any doctor for chest pain, one of the first things they’re going to start thinking about is coronary artery disease,” says Garg. When a blockage severely reduces blood flow to the heart, the heart muscle won’t get the oxygen it needs, which is a condition known as ischemia. “That ischemia can activate pain receptors,” Garg explains. While your doctor can prescribe drugs to ease chest pain in this situation, treating the pain won’t fix the underlying problem of plaque deposits.
4. Heart Attack
A heart attack occurs when the flow of blood to the heart is blocked. The blockage is usually caused by the buildup of plaque–fat and cholesterol–in your arteries. Sometimes the plaque can rupture and trigger the formation of a blood clot. High cholesterol isn’t only a factor in the initial formation of plaque in your coronary arteries. “Once that plaque forms, higher cholesterol can also lead to greater instability in that plaque,” which increases your risk of a heart attack, explains Garg.
5. Stroke
A stroke occurs when a blood clot travels to the brain, depriving the organ of oxygen and other nutrients. As with a heart attack, the longer the area is deprived of oxygen, the more permanent damage occurs. “Really we’re talking about the same risk factors” for a heart attack and stroke, says Garg. That’s because if your cholesterol is high and plaque is building up in your arteries, it’s going to affect arteries that lead to your heart and those that lead to your brain.
6. Peripheral Arterial Disease
When high cholesterol leads to plaque buildup in your blood vessels, your heart and brain aren’t the only areas problems can happen. You may also experience reduced blood flow to muscles in your legs. “If someone has a blocked artery in the leg that’s blocking blood flow to the muscle, [they] are going to complain of pain,” says Garg. “When [they] start walking, they feel leg pain, and when they stop walking, that pain goes away.” The pain in peripheral arterial disease is due to reduced oxygen to the leg muscles, just as chest pain from coronary artery disease happens because the heart isn’t getting enough oxygen.
7. Chronic Kidney Disease
Most people don’t think of their kidneys as organs that can be damaged by high cholesterol, but narrowed arteries leading to the kidneys are a common problem, says Garg. “If a significant enough blockage forms, then over time the kidneys are going to be deprived of oxygen, and it’s going to cause permanent damage,” Garg explains. One of the possible signs of blocked kidney arteries is high blood pressure that doesn’t respond to treatment with drugs. That’s because the kidneys play a key role in regulating blood pressure by filtering the fluid in our bodies, including in blood.
8. Alzheimer’s Disease
This suggests high LDL cholesterol is a newly discovered risk factor for dementia, although the researchers found no consistent relationship for HDL cholesterol and triglyceride levels. As of writing, medical researchers have not yet determined exactly how dementia and high cholesterol might be related.
How to Prevent Complications
Garg emphasizes that to address or prevent any complications from high cholesterol, “the first thing patients need to do is identify what about their lifestyle can be improved,” with the help of their healthcare team. The American Heart Association (AHA) recommends reducing saturated and trans fats in your diet; focusing on fruit, vegetables, whole grains, and lean protein; exercising at a moderate intensity for at least 150 minutes a week; and losing excess weight. “Once we get beyond [lifestyle changes], then we start to talk about what medications we can use to further reduce risk,” says Garg. There are a number of cholesterol-lowering medications, according to the AHA. The most commonly prescribed are statins, which work in the liver to prevent cholesterol from forming and can help reduce your risk of heart attack and stroke. Others include PCSK9 inhibitors, selective cholesterol absorption inhibitors, bile acid sequestrants, niacin, and fibrates. Talk to your doctor about which medication — or combination of medications — is right for you.
