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Diagnosing Hyperlipidemia (High Cholesterol)

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By Editorial Team

4 min read

Reviewed by: HU Medical Review Board | Last reviewed: February 2024

High cholesterol, also known as hyperlipidemia, is a common health concern that often goes unnoticed. This is because there may be no early symptoms to alert you that something is wrong. And once symptoms are noticeable, high cholesterol likely has already caused damage to the arteries.1,2

This is why early diagnosis is crucial to prevent complications that can arise from high cholesterol. These complications can include heart attack and stroke. Thankfully, high cholesterol is very treatable after the diagnosis has been made.1

How is high cholesterol diagnosed?

The journey to a high cholesterol diagnosis usually begins with a visit to your primary care doctor. Specialists like cardiologists may get involved if further evaluation or specialized care is needed. Diagnosing high cholesterol involves a combination of health assessments and blood tests.2,3

Health history and lifestyle assessment

Your doctor will ask you questions about your medical history and your family history of heart disease. They will want to know about lifestyle factors such as diet, exercise, and whether you smoke or drink alcohol. These details help them understand your overall risk for high cholesterol.2

Physical exam

A physical exam can help your doctor find any visible signs of high cholesterol. These signs could be excess weight, high blood pressure, cholesterol deposits on the skin, or other signs of heart disease.2

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Blood tests

The main way to diagnose high cholesterol involves blood tests. These are known as lipid panels or cholesterol panels.2,3

Blood tests can help guide experts to recommend a treatment plan. These tests measure:2,3

  • Total cholesterol – All cholesterol components
  • Low-density (LDL) cholesterol – Often referred to as “bad” cholesterol because it can build up in the arteries, leading to plaque buildup
  • High-density (HDL) cholesterol – Considered “good” cholesterol because it helps remove LDL cholesterol from the bloodstream
  • Triglycerides – Another type of fat in the blood that can be measured individually

You may need some advanced blood tests, especially if you are high-risk or have a family history of high cholesterol. These advanced lipid panels measure things like apolipoprotein B (apoB) and LDL particle number (LDL-P), which can impact high cholesterol.4

You will be asked to fast (not eat or drink for a time) before your blood is drawn for the blood tests. Ask your doctor whether and how long to fast before these tests.3

Genetic testing

If you have a family history of high cholesterol, it may be a good idea to have genetic testing done. This kind of testing will let you know whether you carry the gene mutation for familial hyperlipidemia.1,5

What do the cholesterol numbers from a blood test mean?

Blood cholesterol is measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. According to United States guidelines, if your total cholesterol is:3

  • Below 200 mg/dL, you are in a healthy range
  • 200 to 239 mg/dL, your cholesterol is slightly high
  • 240 mg/dL and above, your cholesterol is in a high, unhealthy range

When should I get screened for high cholesterol?

Routine screening for high cholesterol is recommended for adults starting as early as age 20. Screening should be repeated every 5 years. However, people with specific risk factors may need more frequent screening.2

Consider getting screened earlier and more regularly if you have a family history of heart disease, diabetes, or high blood pressure. If you lead a sedentary lifestyle, smoke, or have obesity, you may want to get screened more often as well.2

How is high cholesterol treated?

A high cholesterol diagnosis might seem scary at first, but the good news is that there are many things you can do to get it under control.1,3,5

Lifestyle changes

A diagnosis of high cholesterol often prompts people to make lifestyle changes like losing weight. For people who are overweight, even a 5 to 10 percent weight loss can improve cholesterol numbers. The American Heart Association (AHA) suggests the following changes as well:1,5

  • Eating fewer processed foods and saturated fats, and more fresh vegetables and fruits
  • Exercising regularly for a total of 150 minutes of moderate-intensity exercise per week
  • Getting quality sleep
  • Quitting smoking

Medicine

Sometimes, changing lifestyle habits is not enough, and medicine is needed. Doctors may prescribe one of several medicines to help manage cholesterol levels. These medicines include:1,3,6

  • Statins
  • Cholesterol absorption inhibitors
  • Bempedoic acid
  • Ezetimibe
  • Bile-acid-binding resins
  • PCSK9 inhibitors
  • Fibrates
  • Omega-3 fatty acid supplements

Why does early diagnosis matter?

Early diagnosis allows for timely treatment and adopting lifestyle changes that can prevent health complications. When it comes to managing high cholesterol, the earlier you can get it under control, the better.1,5

The prognosis of high cholesterol has dramatically improved in the last few decades. Modern medicine and new therapies have come a long way. It is entirely possible to live a long life even after a high cholesterol diagnosis.1,5

Talk with your doctor

If you have concerns about your cholesterol levels, talk with your doctor. They can determine whether your levels are in a healthy range. If your cholesterol levels are high, they can work with you to develop a treatment plan that you can stick to.1,5,6

Remember, getting regular checkups, maintaining a healthy lifestyle, and knowing your cholesterol numbers can all help maintain heart health and reduce your risk of heart disease.