High cholesterol: levels, effects & treatment

Cholesterol is a fat-like substance (lipid molecule) and an essential element of our bodies. Cholesterol performs a number of tasks in the body, like stabilising the cell membranes and influencing their fluidity. Cholesterol is also the raw material for various compounds: it is essential to the production of bile acids and indispensable for the creation of vitamin D3. On top of that, cholesterol plays a part in the production of steroid hormones like oestrogen, testosterone and cortisol. 

What else does cholesterol do to the body? Cholesterol is essential to many metabolic processes, especially in the brain, where it is a constituent part of the ‘myelin sheath’. This allows stimuli to be transmitted quickly and precisely along the nerve fibres. 

The body produces cholesterol itself, primarily in the liver. That means we do not need to get it from our diet. But if you eat animal-based food products, you automatically take on board cholesterol. Blood cholesterol levels comprise two types of cholesterol: HDL cholesterol (“good” cholesterol”) and LDL cholesterol (“bad cholesterol”).

What is HDL cholesterol?

HDL cholesterol is “good cholesterol”. It transports excess cholesterol from the blood cells back to the liver. The liver then breaks it down and excretes it. HDL cholesterol thus protects the arteries from deposits and calcification.

HDL cholesterol levels serve as an indicator of our risk of cardiovascular diseases. Low HDL cholesterol levels are associated with an increased risk of arteriosclerosis and heart attacks. An increased HDL cholesterol level on the other hand may reduce the risk of cardiovascular diseases. However, high HDL cholesterol levels can also be caused by certain genetic disorders. In this case the HDL cholesterol does not protect against cardiovascular diseases. In turn, it is thought that very high HDL cholesterol levels increase the risk of these diseases.

The average HDL cholesterol level for men is over 1.0 mmol/l (millimole per litre), and over 1.3 mmol/l for women.

As well as HDL cholesterol, doctors measure total blood cholesterol and LDL cholesterol. This enables them to assess the risk of cardiovascular diseases as effectively as possible.

What is LDL cholesterol?

LDL cholesterol transports cholesterol from the liver to the body’s cells, where it serves as essential element of cell membranes and hormones. But small quantities are sufficient for this. If the level of LDL cholesterol in the blood is too high, the excess cholesterol accumulates on the vascular walls. This increases the risk of arteriosclerosis and cardiovascular diseases such as heart attacks and strokes.

The average level among adults is below 3.4 mmol/l.

Important: These figures are intended only as a rough indicator. Your ideal normal LDL cholesterol level depends on your risk of cardiovascular disease. The more risk factors apply to you, the lower your maximum LDL cholesterol level should be.

There are generally various reasons for an increased LDL cholesterol level. Talk to your doctor – they will recommend appropriate measures for reducing your LDL cholesterol level and reducing your risk of cardiovascular diseases.

Note: increased LDL cholesterol isn’t usually associated with symptoms. This means it is important to have regular check-ups, ideally every five years – from the age of 35 for men, and from the age of 45 for women If you exhibit any risk factors like high blood pressure or diabetes, regular check-ups are recommended from the age of 25 onwards.

Your doctor will take a blood sample to measure your cholesterol level. You don’t need an empty stomach for this. The lab will then analyse the sample using special tests. But what exactly is blood cholesterol? Blood cholesterol comprises the following values: 

• Total cholesterol
• LDL cholesterol
• HDL cholesterol
• Triglycerides

These four values are referred to as blood lipid levels. They indicate whether or not your cholesterol levels are normal. 

Cholesterol: normal levels for men and women

The difference between normal levels of cholesterol for women and men is minimal. Normal levels of total cholesterol are below 5.2 mmol/l for both sexes.

Take note: These figures are intended as a guide. Your doctor will take other information about your health into account when assessing your cholesterol levels. Even levels in the upper range of what is average, i.e. normal, may require treatment if you also present with other risk factors.

Cholesterol: too low? 

Insufficient levels may be rarer than elevated levels, but low cholesterol levels require medical attention too. This is because a cholesterol deficiency can cause various symptoms like fatigue, dizziness, muscle weakness and memory problems.

Cholesterol: too high?

Cholesterol is vital to the body. But too much cholesterol is associated with health risks. Permanently increased cholesterol levels cause what is referred to as hypercholesterolemia. 

Generally there are a number of possible reasons for increased cholesterol levels. Genetic predisposition plays an important role. If you have a family history of hypercholesterolemia, your body is missing certain receptors. It has more difficulty breaking down excess cholesterol. But even an unbalanced diet with lots of fat and sugar can cause excessive cholesterol levels. Other causes include smoking, alcohol abuse and a lack of exercise, being overweight, diabetes and high blood pressure as well as certain kidney and liver diseases. In some cases cholesterol may also be too high because of stress; persistent stress causes the body to release stress hormones. This stimulates cholesterol production.

In many cases, hypercholesterolemia can be present in the body long before symptoms come to light. Problems only emerge years later when deposits have formed in the blood vessels. Excess cholesterol levels often cause symptoms like:

• Tightness in your chest
• Difficulty breathing under pressure
• Leg pain while walking
• Impaired vision

Constantly high levels of cholesterol are sometimes associated with feelings of dizziness. Symptoms on the skin can also point to high cholesterol. For instance, yellow deposits, known as xanthomas, may form on the eyelids, elbows or knees. 

Note that not everyone with high cholesterol has these symptoms. Sometimes they can have different causes. So have your cholesterol levels checked by a doctor. This will give you clarity and prevent any consequential damage.

High cholesterol: symptoms in men

High cholesterol is more common in men than it is in women. This is due primarily to hormonal differences; testosterone reduces the “good” HDL cholesterol and increases the “bad” LDL cholesterol. Men who have higher cholesterol levels are often asymptomatic. Issues don’t emerge until the elevated levels lead to arteriosclerosis. This often causes knock-on effects like:

• Erectile dysfunction due to damage to the pelvic arteries
• Heart attacks due to build-ups in the coronary blood vessels, often before the age of 60
• Strokes due to vascular calcification
  

High cholesterol: symptoms in women

High cholesterol levels in women often occur from the age of 60 and after the menopause. The risk increases with age. This is mainly due to hormonal changes; falling oestrogen levels increase “bad” LDL cholesterol and lower “good” HDL cholesterol. High cholesterol levels usually don’t cause symptoms in women either – they only become noticeable when they cause arteriosclerosis. This leads to different symptoms in women than in men:

•  Shortness of breath
• Dizziness
• Nausea
• Impaired consciousness

High cholesterol also triggers symptoms such as fatigue and sweating for no apparent reason. Be sure to watch out for these signs. They may indicate an increased risk of cardiovascular disease.

There are various ways of effectively reducing cholesterol. The most important approaches include ensuring you are following a healthy lifestyle, opting for a balanced diet and exercising regularly. Take medication where necessary. This will help you to gradually bring your cholesterol levels into a healthy range. Find out below which treatment options are most likely to improve your cholesterol level.

Reducing cholesterol: diet for high cholesterol

A low-cholesterol diet alone will only have a limited impact on your cholesterol. A balanced diet is more important for high cholesterol levels. It offers protection against the potential consequences, such as cardiovascular illnesses and arteriosclerosis. Regular physical activity boosts this effect. Certain foods do however help to keep cholesterol levels within a healthy range. High-fibre foods such as vegetables, fruit, wholegrain products and pulses, for example, bind cholesterol in the gut and help to excrete it. Other cholesterol-lowering foods include oats and oat bran. They contain the fibre beta-glucan, which is proven to reduce LDL cholesterol in the blood.  

By the way, coffee influences cholesterol differently depending on how it is prepared. Unfiltered coffee like Turkish coffee and espresso contains diterpenes. These increase LDL cholesterol, but filter coffee does not. 

Which foods contain a lot of cholesterol? Saturated fats from animal-based foods such as eggs and butter, cholesterol from cheese, and trans-fats from ready-made products have an adverse effect. Eat these in moderation. Opt for fish as well as plant oils such as olive oil or rapeseed oil. They contain particularly high levels of healthy unsaturated fatty acids. Saltwater fish such as salmon and mackerel are valuable sources of omega-3. This has a positive effect on blood cholesterol. 

If you’ve got high cholesterol, there is no one answer to the question “What can I eat?”

Essentially, the best thing is to opt for a balanced diet with minimal saturated fatty acids. 

Lowering cholesterol: medication

What else can you do if you have high cholesterol? If a healthy lifestyle with a balanced diet and exercise is not enough, doctors may prescribe cholesterol-lowering medication.

Statins are the most common prescription cholesterol tablets. They inhibit an enzyme in the liver that is responsible for the body’s own cholesterol production. This lowers LDL cholesterol levels and slightly increases HDL cholesterol. Cholesterol absorption inhibitors on the other hand are drugs that prevent the absorption of cholesterol from food. Combined with statins, they also lower LDL cholesterol. Newer drugs such as PCSK9 inhibitors (evolocumab, alirocumab) and the cholesterol synthesis enzyme inhibitor bempedoic acid are suitable for patients who cannot tolerate statins or cannot reach their target levels even on a high dose.

Like all medication, cholesterol-lowering medication has side effects. The most common ones include muscle pain and weakness, increased liver enzymes and a higher risk of diabetes. Most symptoms are mild and often disappear with time. Talk to your doctor if you experience any ongoing symptoms. Switching to different cholesterol tablets will often help to reduce any side effects.

Lowering cholesterol: natural home remedies

Under certain circumstances, natural methods may also help lower cholesterol. These include home remedies, herbal preparations and dietary supplements.

• Do you want to lower your cholesterol naturally? Using vinegar as a home remedy may help. According to studies, apple cider vinegar may lower LDL cholesterol levels and increase HDL cholesterol. Take two tablespoons of apple cider vinegar diluted in water daily. Used regularly, it usually takes effect after a few weeks. 
• You can also lower cholesterol with supplements. According to various studies, omega-3 fatty acids, phytosterols and polycosanol have a positive effect on blood lipid levels. 
• For people who cannot tolerate statins, plant-based cholesterol tablets may be helpful. However, these are only intended as a supplement rather than a replacement for cholesterol-lowering drugs. Research findings differ as to whether or not plant-based cholesterol tablets can help in other cases.

How can you effectively lower your cholesterol? There are many ways of influencing your cholesterol levels. The key basis is a healthy lifestyle. This includes a balanced diet with plenty of fruit and vegetables as well as wholegrain products. Regular exercise and stress release will also improve your cholesterol levels. Your doctor will provide you with tailored advice on how to treat your high cholesterol and improve your levels. If need be, they will prescribe medication. The right strategy and a little patience can help you bring your cholesterol levels down to a healthy range and keep them there long-term.