High cholesterol (hypercholesterolemia)

Health professionals speak of “hypercholesterolemia” when cholesterol levels in the blood are too high. Too high levels can increase the risk of cardiovascular disease.

At a glance

  • Cholesterol levels in the blood that are too high can increase the risk of cardiovascular disease.
  • High cholesterol levels are not a disease on their own.
  • There are different opinions on what is considered to be too high.
  • A cholesterol level that is too high is just one of many risk factors for cardiovascular disease.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Hypercholesterolemia (high cholesterol): man holding a greasy sausage with a fork There is a pan under the sausage.

What is high cholesterol (hypercholesterolemia)?

Many people worry about their cholesterol because high cholesterol levels in the blood, i.e. hypercholesterolemia, can increase the risk of cardiovascular disease.

Doctors consider people to have high cholesterol (“hypercholesterolemia”) when certain levels are exceeded, but high cholesterol levels are not a disease on their own. There are also different opinions on what is considered to be too high. It is important to remember that high cholesterol is just one of many risk factors for cardiovascular disease. This means that cholesterol levels alone tell us little about a person’s risk.

What symptoms indicate high cholesterol (hypercholesterolemia)?

High cholesterol doesn't cause any symptoms. But if someone has high cholesterol over many years, their risk of cardiovascular disease – such as angina, heart attacks and strokes – might be higher than normal. It can therefore be a good idea for people who have high cholesterol to do something about it.

What causes high cholesterol (hypercholesterolemia)?

Cholesterol levels mainly depend on people’s genes and lifestyle.

Some people already have very high cholesterol as children because of their genes. There are various types of this so-called familial or primary hypercholesterolemia, which sometimes can pose a serious health risk. 

But in most people, cholesterol levels are mainly influenced by lifestyle factors such as diet and exercise habits. When these factors cause high levels, doctors call this acquired hypercholesterolemia.

Sometimes people’s cholesterol levels increase because of a medical condition they have, such as an underactive thyroid gland. Taking certain medications can also make your blood cholesterol levels go up somewhat. 

What are the risk factors for high cholesterol (hypercholesterolemia)?

As a general rule, the higher the cholesterol levels, the higher the risk of cardiovascular disease. But cholesterol isn't the only risk factor. Many other things can have an influence – both positive and negative. The risk of cardiovascular disease can only be properly assessed if all the factors are considered together.

People’s individual risk can be determined with the help of special tables or computer programs, sometimes called risk calculators. This is best done together with a doctor.

Risk factors for hypercholesterolemia: old age, men more at risk than women, family history, smoking, high blood pressure, type 2 diabetes, high cholesterol levels.

Various pieces of information about risk factors are needed in order to calculate the risk. These are the main risk factors: 

  • Age: The risk of cardiovascular disease increases with age.
  • Sex: Men are at higher risk than women.
  • Family history: People are at greater risk if they have a brother or father who had a heart attack or stroke before the age of 55, or if they have a sister or mother who had a heart attack or stroke before the age of 65. 
  • Smoking: Smoking increases the risk more than, for instance, moderately high cholesterol levels.
  • High blood pressure: High blood pressure (hypertension) puts extra strain on the heart and blood vessels.
  • Type 2 diabetes: People who have type 2 diabetes have a greater risk of cardiovascular disease than people of their age who don't have diabetes.
  • Cholesterol levels: High total cholesterol, high LDL cholesterol (“bad” cholesterol) and low HDL cholesterol (“good” cholesterol) are potentially harmful. 

Is screening available?

In Germany, people who have statutory health insurance are entitled to a general health check-up every three years from the age of 35. Younger people (between the ages of 18 and 35) can have the check-up once. The aim of this check-up is to detect early signs of cardiovascular disease, diabetes and kidney problems. The examination involves having blood pressure taken, and blood and urine tests, for example. Total cholesterol is measured too. 

How is high cholesterol (hypercholesterolemia) diagnosed?

Cholesterol doesn't dissolve in water or blood. To be able to transport it in the blood, the body packs cholesterol into tiny parcels, together with various proteins and other components. Based on these other elements in the parcels, the different kinds of cholesterol can be distinguished between in a laboratory.

When looking at cholesterol levels, two different types are usually measured. The two types have different effects on health. In everyday language they are often referred to as “good” and “bad” cholesterol:

  • HDL cholesterol: HDL (high-density lipoprotein) cholesterol levels are the proportion of “good” cholesterol in the total cholesterol. Normal to high HDL cholesterol levels are associated with a lower risk of cardiovascular disease than low HDL cholesterol levels.
  • LDL cholesterol: LDL (low-density lipoprotein) cholesterol levels are the proportion of “bad” cholesterol. High LDL cholesterol levels are associated with a higher risk of cardiovascular disease.

The “total cholesterol” level is also measured. This describes how much cholesterol someone has in their blood overall. High total cholesterol levels tend to be unfavorable.

It is best to measure total cholesterol and LDL cholesterol levels on an empty stomach. That is why people are asked to stop eating, and only drink water, twelve hours before being tested.

Important: There is some disagreement about when cholesterol levels are “too high”. People are often diagnosed with “hypercholesterolemia” if their total cholesterol or LDL cholesterol is above the level that has been defined as “healthy”.

HDL cholesterol levels below the threshold level are also considered to be unfavorable. These levels can be measured in two different units: either as milligrams per deciliter (mg/dL) or as millimoles per liter (mmol/L).

The following levels are considered to be "good" in healthy people:

  • Total cholesterol: levels below 200 mg/dL (5.2 mmol/L)
  • LDL cholesterol: levels below 130 mg/dL (3.4 mmol/L)
  • HDL cholesterol: levels above 40 mg/dL (1 mmol/L) in men and above 50 mg/dL (1.3 mmol/L) in women

Some experts criticize the use of pre-defined threshold levels because it means that a large number of people are considered to have a health problem. Based on these definitions, a 2010 study by the Robert Koch Institute found that more than half of all Germans had high cholesterol.

How is high cholesterol (hypercholesterolemia) treated?

Treatment for high cholesterol is not about lowering cholesterol levels. Instead, it is about reducing a higher risk of cardiovascular disease to as normal a level as possible. Good treatments are characterized by actually preventing cardiovascular disease, and by having proven this in studies.

People who are at higher risk of cardiovascular disease are often advised to follow some general measures as part of their treatment. These include the following:

  • not smoking
  • reducing the amount of saturated fats in their diet
  • eating a “Mediterranean diet”
  • getting a lot of exercise
  • losing weight

Some of these measures may also lower cholesterol levels.

When assessing medications it isn't enough to look only at how they affect cholesterol levels. A group of medications known as statins can be prescribed for people who haven't had a heart attack, stroke or other cardiovascular disease. They are the only group of medications proven to be effective in treating hypercholesterolemia. Statins have been shown to lower LDL cholesterol levels, and also seem to have other positive effects on blood vessels. There is some disagreement among researchers about whether the beneficial effects of statins are only due to their cholesterol-lowering ability or whether other factors play a role too.

For more detailed information, for instance on how cholesterol levels can be lowered without medication, visit gesundheitsinformation.de.

What is life like with high cholesterol (hypercholesterolemia)?

On gesundheitsinformation.de some people with high cholesterol levels share their experiences.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

Did you find this article helpful?