Symptoms of high cholesterol

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Cholesterol is not necessarily ‘bad’. On the contrary, cholesterol is a type of fat (lipid) that is essential for the construction of cell walls and the production of bile acids (which play a major role in the absorption of nutrients in the intestines), various hormones and Vitamin D. In short, cholesterol is indispensable for various important bodily functions. However, in order for cholesterol to do its job, the body must have the right amount of cholesterol. Otherwise, it can cause problems.

How does cholesterol work?

The liver makes about almost of all the cholesterol in your body. The rest comes from your food. After it is produced, it is packaged and ‘delivered’ via the intestines and the bloodstream to cells that need it.

The particles that package cholesterol for transport are called lipoproteins (round particles made of fat and proteins). These packages prevent fat from clotting in the blood. There are three types of lipoproteins: HDL, VLDL and LDL. HDL (high-density lipoproteins) and VLDL (very-low-density lipoproteins) are considered good types of cholesterol. LDL (low-density lipoproteins) is sometimes called ‘bad’ cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries.

What is high cholesterol?

If you have been told you have a high cholesterol level, it means you have too much LDL cholesterol in your blood. LDL cholesterol sticks to the inside of arteries, leading to a buildup of fatty deposits causing them to become clogged.

Blood tests

The easiest thing to do is to have your blood tested at your doctor's office. Nowadays there are also home test kits available that tell you your cholesterol level. With these kits, you take a blood sample at home which you post to a laboratory for testing, and you receive your results later by e-mail. Your blood is tested for the presence of inflammatory activity and various fats, including ‘good’ cholesterol (HDL) and ‘bad’ cholesterol (LDL). The relationship between these levels is an important factor in estimating your risk of cardiovascular disease.

What are the symptoms of high cholesterol?

High cholesterol is often labelled a silent killer because it is often symptomless. Meanwhile it can cause significant damage to the heart and arteries, increasing the risk of cardiovascular disease. Therefore, we will divide the symptoms into two categories: direct and indirect consequences.

Visible symptoms of high cholesterol

The only visible symptoms that may be a direct consequence of high cholesterol levels are:

  • Yellow bumps on or near your eyelid (xanthomas).
  • White ring around the edge of the cornea (arcus lipoides).
  • Papules and nodules in the tendons (xanthomas). The most common areas for xanthomas to develop are tendons in the hands, elbows, knees, neck, and in the Achilles tendon.

Indirect consequences of high cholesterol

There are also symptoms that are indirect consequences of high cholesterol. In other words, high cholesterol can be recognised by symptoms that are partly caused by this condition. For example, symptoms caused by arteriosclerosis, a condition where your arteries become narrowed, making it difficult for blood to flow through them.


Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause arteries to narrow, blocking the flow of oxygen-rich blood. This process is very gradual. Symptoms may go unnoticed until a significant blockage (50% stenosis) causes problems.

What symptoms you can get as a result of high cholesterol depends on the severity and the location of the narrowing.

Angina pectoris

Decreased blood flow to the heart can cause chest pain. Chest pain that results from your heart being deprived of freshly oxygenated blood is called angina. Angina attacks are typically prompted by exertion or physical exercise when the hard-working heart muscle requires greater amounts of oxygen. The chest tightness or pain is caused by insufficient oxygen.

Tiredness and shortness of breath

Other possible signs of high cholesterol include fatigue, shortness of breath, dizziness, excessive sweating and nausea. When high cholesterol leads to narrowed or blocked arteries in your legs, this could give rise to certain signs, such as leg cramps or a tired or numb feeling in your legs when walking, climbing stairs or running. The popular name for this condition is ‘shop window legs’ (referring to the regular need of patients with this condition to stop in front of shop windows). If you have atherosclerosis in the arteries leading to your brain (cerebral atherosclerosis), you may have coordination problems or temporary loss of vision.

Heart attack

When a blood vessel becomes completely blocked, the tissue it supplies will not get any oxygen. When the flow of blood to the heart is blocked, this causes a heart attack. When one of the blood vessels that supply your brain with oxygen-rich blood becomes blocked, this can cause a transient ischaemic attack (TIA) if blood supply is briefly blocked, or a stroke in the case of persistent blockage.

These blockages are usually caused by a blood clot that forms at the site of a plaque whose cap has ruptured. The blood flowing over the top of the plaque clots, causing a blockage in the artery at the site of the rupture, or the clot can be carried downstream.

Common symptoms of a heart attack are moderate to very severe chest pain. This pain can reach through to the jaws, shoulders and back.

TIA or stroke

The symptoms of a TIA include paralysis in the face, blindness in one or both eyes or double vision, and slurred or garbled speech. These symptoms are only temporary. The symptoms of a TIA are similar to that of stroke, but they may only last a short while a stroke can cause permanent disability. These implications of high cholesterol can be life-threatening.

What is the treatment for high cholesterol?

High cholesterol can be treated in two ways:

  • Lifestyle changes (diet and exercise).
  • Medication (statins).

Change your lifestyle

For slightly elevated cholesterol levels (5-7 mmol/l), making lifestyle changes may be sufficient. A healthier diet alone could lower your cholesterol by up to 10%.

Avoid saturated fat

The most important dietary advice is to cut back on saturated fats or eliminate them from your diet altogether. Saturated fats are found in fat meat (such as sausages), cheese, cream, cakes and pastries. The maximum recommended amount of saturated fat is 30g per day for men and 20g per day for women.

Eat omega-3 fatty acids

Use olive oil or flaxseed oil instead of coconut or palm oil for cooking. Have at least five portions of a variety of fruit and vegetables every day. Fruit and vegetables do not contain saturated fat which increases cholesterol and can serve as a substitute for other foods that do. Incorporate oily fish such as mackerel, tuna and salmon into your diet at least twice a week. Oily fish is rich in omega-3 fatty acids that lower cholesterol levels. Avocados and nuts are also a good source of omega-3 fatty acids.

Cut back on sugar

Triglycerides rise when you eat higher amounts of sugar and drink alcohol. So cut back on sugar-containing foods and drinks!

Eggs are OK

Although eggs are high in dietary cholesterol, it’s OK to eat them. The body processes eggs in beneficial ways, so they have a minimal impact on blood cholesterol level.

Red yeast rice

Red yeast rice seems to play a role in naturally lowering blood cholesterol levels. Studies have shown that certain red yeast rice products that contain statin can significantly lower levels of total cholesterol (up to 25%). However, at this point, not enough research has been done for us to be able to recommend it.

Stop smoking

Quitting smoking is another thing you can do to lower your cholesterol levels. The chemicals in cigarettes reduce ‘good’ cholesterol (HDL) and also damage the walls of blood vessels.


At least 30 minutes of exercise every day improves cholesterol metabolism and can help with weight loss, which in turn lowers cholesterol.

Consider using medication

Medication is recommended in all cases where there is an increased risk of vascular disease due to other factors: high blood pressure, diabetes, smoking, or a family history of vascular diseases. If there is a high risk of blockage (>10% chance of blockage in the next 10 years) or if you have already experienced a blockage in the past, then medical treatment is necessary.

Statins block an enzyme the body needs to make cholesterol. Statins work more effectively when they are taken at night. This is because the enzyme which makes the cholesterol is more active at night. There are different types of statins, all of which have been shown to lower ‘bad’ cholesterol (LDL) by 25-40%, even in low doses.

Unfortunately, like all medicines, statins can cause side effects. Possible side effects include muscle pain, headache, gastrointestinal symptoms and decreased liver function. Taking a higher dose increases the risk of side effects, while this will only lower cholesterol by approx. an additional 6%. Therefore, treatment with statins should start at a low dose, and cholesterol levels and liver function must be checked after three months.

Another medicine that can be used is ezetimibe, which works in the intestine to stop your body from absorbing cholesterol. However, this medicine is less effective and has more side effects.

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