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High Cholesterol

About 86 million U.S. adults have total cholesterol above 200 mg/dL. High cholesterol usually causes no symptoms, so a blood test is the only way to know. Everyday habits and, for many people, medicine lower it — and with it the risk of heart attack and stroke.

Signs of a heart attack — call 911 right away: chest pain or discomfort; feeling weak, light-headed or faint; pain or discomfort in the jaw, neck or back; pain or discomfort in one or both arms or shoulders; or shortness of breath. Women are more likely to also have unusual or unexplained tiredness and nausea or vomiting (CDC).

Signs of a stroke — think B.E. F.A.S.T. and call 911: Balance loss or dizziness; Eye (vision) changes; Face drooping on one side; Arm drifting downward; Speech slurred or strange; Time to call 911. Note the time symptoms started, and call an ambulance rather than driving (CDC).

Red yeast rice is not a gentle herb. Some products contain monacolin K, which is chemically identical to the prescription statin lovastatin, so they can cause the same side effects and drug interactions; some are contaminated with citrinin, which may damage the kidneys (NCCIH, NCCIH). Because of this, MBHA advises never taking red yeast rice together with a statin or other cholesterol medicine unless your prescriber says so, and never in place of a prescribed medicine (NCCIH).

Never stop a statin on your own. Stopping without your provider can lead to a serious problem, in rare cases even death. If you have side effects or want to stop or switch, talk to your prescriber first (MedlinePlus, NHLBI).

What is cholesterol?

Cholesterol is a waxy, fat-like substance made by your liver, which uses it for jobs such as making hormones and digesting fats (CDC). Your body needs it, but in the right amounts (NHLBI); too much can stick to artery walls as plaque, narrowing or even blocking them (MedlinePlus).

The numbers on your lipid panel

A blood test called a lipid panel measures LDL (“bad”) cholesterol, the main source of buildup in the arteries; HDL (“good”) cholesterol, which helps remove it; non-HDL cholesterol (total minus HDL); total cholesterol; and triglycerides, a different blood fat that can also raise heart risk. General healthy levels for most adults are total cholesterol below 200 mg/dL, non-HDL below 130, LDL below 100, and HDL of 60 or higher (below 40 is low for men, below 50 for women); a triglyceride level below 150 is normal (MedlinePlus). Children and teens have their own ranges.

Your overall risk matters more than any one number

The numbers that are best for you depend on your age, blood pressure, weight, family history and more (MedlinePlus). U.S. guidelines therefore look at your overall chance of a heart attack or stroke, not a single cholesterol target for everyone:

  • The 2018 AHA/ACC cholesterol guideline asked clinicians to talk through each adult’s overall risk, the benefits, side effects and costs before starting a statin; people with an LDL of 190 mg/dL or more were to start one without a risk calculation (AHA/ACC guideline, 2018).
  • In 2026, the ACC, AHA and nine other groups published a new guideline that “retires and replaces” the 2018 one and also covers high triglycerides and Lp(a) (ACC/AHA guideline, 2026). It uses a new risk tool called PREVENT to estimate 10- and 30-year risk, recommends earlier treatment, and brings back LDL goals that depend on that risk (ACC, 2026).
  • MedlinePlus now lists these risk-based LDL goals: 100 mg/dL or below for low or borderline risk; 70 or below for high risk or for people who already have heart disease; and 55 or below for people with heart disease at very high risk (MedlinePlus).

A coronary calcium scan can help decide whether you need medicine (MedlinePlus). High blood pressure, smoking and diabetes add to your risk (USPSTF) — see our blood pressure guide. A guide to heart disease is coming soon.

How common is it?

About 86 million U.S. adults age 20 or older have total cholesterol above 200 mg/dL, and nearly 25 million have levels above 240 mg/dL. About 7% of U.S. children and teens ages 6 to 19 have high total cholesterol. Only slightly more than half (54.5%, or 47 million) of adults who could benefit from cholesterol medicine are taking it, and about two thirds of adults say they have had their cholesterol checked in the last 5 years (CDC).

Why it matters — and why you can’t feel it

High LDL cholesterol usually causes no symptoms; most people find out from a routine blood test (NHLBI). Untreated, it can lead to heart attack and stroke (NHLBI). Plaque narrows the arteries and can block blood flow to the heart, causing chest pain (angina) or a heart attack (CDC); heart disease and stroke are two leading causes of death in the U.S. (CDC).

What raises cholesterol?

  • Habits: an unhealthy lifestyle is the most common cause of high LDL or low HDL (NHLBI), especially a diet high in saturated fat, extra weight, inactivity and smoking (MedlinePlus).
  • Things you can’t change: cholesterol tends to rise with age, and high cholesterol is most often diagnosed between ages 40 and 59 (MedlinePlus, NHLBI). Men ages 20 to 39 have a higher risk than women, but a woman’s risk goes up after menopause. Family history and ethnicity matter too (MedlinePlus).
  • Health conditions and medicines: conditions such as chronic kidney disease, diabetes, an underactive thyroid and sleep apnea, and some medicines for other problems (such as beta-blockers, certain diuretics and steroids), can raise cholesterol. Don’t stop a medicine on your own — ask your provider (NHLBI).

When to get checked

  • Adults: the CDC says most healthy adults should be checked every 4 to 6 years, and more often if you have heart disease, diabetes or a family history of high cholesterol (CDC). NHLBI and MedlinePlus suggest every 5 years for younger adults, every 1 to 2 years for men 45 to 65 and women 55 to 65, and every year after 65 (NHLBI, MedlinePlus).
  • Children: the American Academy of Pediatrics recommends that all children have a cholesterol test between ages 9 and 11, and earlier — even from age 2 — if a parent or grandparent has had heart problems or unhealthy cholesterol, or the family history is unknown (AAP). Teens should be tested again between 17 and 21 (CDC).
  • Fasting: the test can be done fasting or not; your provider may ask you to fast for 8 to 12 hours (NHLBI). Follow your own instructions.
  • Statins to prevent a first heart attack or stroke: the U.S. Preventive Services Task Force (2022) recommends a statin for adults 40 to 75 with at least one risk factor (unhealthy cholesterol, diabetes, high blood pressure or smoking) and a 10-year risk of 10% or more, and selective use at 7.5% to under 10%. This doesn’t apply to people with an LDL above 190 mg/dL or known familial hypercholesterolemia (USPSTF, 2022).

Lp(a): a once-in-a-lifetime test

Lipoprotein(a), or Lp(a), is a type of lipoprotein measured by a separate blood test. Your level is unlikely to change much from childhood to old age. It isn’t usually part of a routine lipid panel (NHLBI). The 2026 guideline recommends measuring Lp(a) at least once in every adult’s lifetime, and offering people with a high level early ways to lower their heart risk whatever their LDL (ACC, 2026); MedlinePlus likewise lists an Lp(a) test once as an adult (MedlinePlus). Ask about it, especially if your family has a history of early heart disease or stroke (NHLBI).

Familial hypercholesterolemia (FH)

FH is an inherited condition that affects about 1 in 311 people (CDC); the AAP puts it at 1 in 250 children (AAP). The main sign is an LDL over 190 mg/dL in adults or over 160 mg/dL in children. Untreated, heart attacks happen in 30% of women with FH by age 60 and 50% of men with FH by age 50 — but finding and treating it early can cut the risk of coronary artery disease by about 80% (CDC).

  • Signs to mention to your provider: bumps or lumps around the knees, knuckles or elbows; a swollen or painful Achilles tendon; yellowish areas around the eyes; or a whitish-gray half-moon on the outer edge of the cornea (CDC). Fatty skin bumps are called xanthomas (NHLBI).
  • Family testing: if genetic testing finds an FH gene change, your relatives can be tested for the same change (CDC).
  • Treatment: lifestyle changes alone are often not enough; people with FH often need more than one type of cholesterol medicine, and children with FH may need a statin, often starting by age 8 to 10 (CDC).

When to see a doctor: if you have never had your cholesterol checked or are due for a test; if a parent, brother or sister had a heart attack or stroke at a young age, or has very high cholesterol; if you notice any of the FH signs above; or if you have side effects from a cholesterol medicine. Ask your health care team how often you should be screened (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Heart-healthy habits for everyone; a statin as the first-choice medicine; ezetimibe, bempedoic acid, PCSK9 inhibitors (including inclisiran) or other medicines when a statin isn’t enough or isn’t tolerated. Regular blood tests. Medicare covers cholesterol, lipid and triglyceride tests once every 5 years — $0 if your provider accepts assignment. Generic atorvastatin was listed under $10 for 30 tablets with a free discount coupon. Newer injectable medicines cost more; ask your plan. Statins lower the risk of heart attack and stroke and usually cause no side effects. If muscle aches start, your provider can test and switch medicines. Medicines control cholesterol but don’t cure it.
Chiropractic Being researched — coming soon.
Acupuncture Being researched — coming soon.
Herbal medicine Plant sterols and stanols, soluble fiber (oats, barley, psyllium), fish oil for triglycerides, garlic, soy. Red yeast rice and niacin act like drugs and need medical supervision. Cost estimate being researched. Effects are small compared with cholesterol medicines; in a 2023 trial six common supplements did no better than placebo for LDL. Never take one instead of a prescribed medicine.
Massage therapy Being researched — coming soon.
MBHA Wellness Coach Less saturated fat, more fiber, regular activity, a healthy weight, quitting smoking, less alcohol (too much raises triglycerides), knowing your family history and keeping up with lab tests. Cost estimate being researched. Supports — never replaces — medical care. Lifestyle changes help lower cholesterol and should continue even when you take medicine.

Approach 1 of 6

Conventional medicine (AMA)

Treatment is built around your overall risk of heart attack and stroke, decided together with your provider (AHA/ACC guideline, 2018, ACC, 2026). It almost always combines heart-healthy habits with medicine when needed, and medicines control cholesterol but don’t cure it (MedlinePlus).

1. Lifestyle first — and always

Your provider may suggest heart-healthy eating, regular physical activity, a healthy weight, managing stress, quitting smoking, good sleep and limiting alcohol, and you should keep these habits up while taking medicine (NHLBI, MedlinePlus). The 2018 guideline put a heart-healthy lifestyle first for everyone, at every age (AHA/ACC guideline, 2018). Details are in the MBHA Wellness Coach and Heart-healthy eating sections below.

2. Statins

Statins are the most common medicines for high cholesterol. They slow how much cholesterol the liver makes and help it clear LDL already in the blood, and studies show they lower the risk of heart attack and stroke in people with high LDL (MedlinePlus, NHLBI). They can also lower triglycerides and may raise HDL (MedlinePlus). In the 2018 guideline, a statin is the first medicine for people who need one, with other medicines added if LDL stays too high (AHA/ACC guideline, 2018).

3. Other medicines

We name medicines here so you can talk about them with your provider; we don’t list doses.

For people at very high risk whose LDL stays too high on the strongest statin they can tolerate, the 2018 guideline described adding ezetimibe first and then a PCSK9 inhibitor (AHA/ACC guideline, 2018).

4. Side effects — and what to do about muscle aches

  • Statins usually don’t cause side effects. They may raise the risk of type 2 diabetes, mainly in people already at high risk. They can cause abnormal liver enzyme tests, but actual liver damage is very rare (MedlinePlus).
  • Muscle aches: some people report muscle problems on a statin. Tell your provider, who may order a blood test for muscle damage. The pain may go away if you switch to a different statin; muscle damage is rare, and muscles may heal after a switch (MedlinePlus, NHLBI). Don’t just stop the medicine — that decision belongs with your prescriber.
  • Interactions: grapefruit (fresh or juice) changes how the liver breaks down some statins, and some medicines and supplements can interact with statins (MedlinePlus). Show your pharmacist everything you take.
  • Pregnancy: statins should not be taken during pregnancy or breastfeeding (MedlinePlus). If you are planning a pregnancy, talk with your provider ahead of time (NHLBI).

5. Follow-up tests

After you start a statin, your provider may repeat the lipid panel 1 to 3 months later, then every 3 to 12 months (NHLBI). Your care team will keep monitoring your levels (CDC).

What it costs

  • Medicare cardiovascular screening: blood tests for cholesterol, lipid and triglyceride levels once every 5 years. You pay nothing if your provider accepts assignment (Medicare.gov).
  • Generic statins: one discount-card site listed 30 tablets of generic atorvastatin (one common strength) at $6.99 at some pharmacies with free sign-up, against a retail price of $138.91 (prices read October 2026; they vary by strength and pharmacy) (SingleCare).
  • Newer medicines: the 2018 guideline called the cost-effectiveness of PCSK9 inhibitors low at mid-2018 list prices (AHA/ACC guideline, 2018). The maker of one PCSK9 inhibitor (Repatha) says about 84% of Medicare prescriptions cost patients $50 or less a month, based on its 2025 claims data (Repatha.com (manufacturer)). Ask your plan and pharmacist what you would pay.

Find a medical doctor in our directory

Approach 4 of 6

Herbal medicine

A few foods and supplements have modest effects on cholesterol, but their effects are small compared with cholesterol medicines (NCCIH). In a 2023 trial of 190 people, none of six common supplements lowered LDL significantly more than a placebo did (NCCIH). Don’t take supplements instead of your prescribed medicine (NCCIH).

Red yeast rice — acts like a drug

Some products contain substantial monacolin K, which is structurally identical to the statin lovastatin; products with added or enhanced lovastatin are unapproved new drugs and not sold legally in the U.S. Amounts vary widely between brands and usually aren’t on the label. High-monacolin products can cause the same side effects as statins, including muscle, kidney and liver damage, and the same types of drug interactions; some products contain citrinin, a kidney toxin, even when labeled “citrinin-free.” It is not recommended in pregnancy or breastfeeding (NCCIH). See the warning at the top of this page about combining it with a statin.

Plant sterols and stanols

Studies show that stanol or sterol supplements taken with meals can lower cholesterol, and foods or supplements containing them may carry an FDA-approved health claim that they may reduce the risk of heart disease. They are generally safe for most healthy people (NCCIH). Under the FDA rule, the claim applies as part of a diet low in saturated fat and cholesterol (21 CFR 101.83). People with the rare inherited condition sitosterolemia have high plant sterol levels linked to early artery disease (NCCIH) — ask your provider first if it runs in your family.

Soluble fiber: oats, barley and psyllium

The FDA allows foods with soluble fiber from whole oats, barley or psyllium seed husk to say that such fiber, “as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease” (21 CFR 101.81). Foods naturally high in fiber, such as oatmeal and beans, may help prevent and manage high LDL and triglycerides (CDC). Psyllium safety: foods with dry psyllium must warn that they should be eaten with at least a full glass of liquid, that too little liquid may cause choking, and that people who have difficulty swallowing should avoid them (21 CFR 101.17).

Fish oil (omega-3s) — for triglycerides

The omega-3s EPA and DHA lower triglycerides but don’t affect other blood fats. Prescription omega-3 products are approved for very high triglycerides and differ from typical supplements. Side effects are usually mild — an unpleasant taste, bad breath, headache, heartburn, nausea or diarrhea (NCCIH).

Garlic

Garlic supplements may lower total and LDL cholesterol to a small extent in people with high cholesterol (NCCIH); the effect is modest compared with cholesterol medicines (NCCIH). Garlic may increase the risk of bleeding and can make some drugs, including saquinavir, less effective (NCCIH). Tell your provider if you take a blood thinner or aspirin, especially before surgery (NCCIH).

Niacin (vitamin B3)

Niacin can lower LDL and triglycerides and raise HDL. You can buy it without a prescription, but talk to your provider before using it for cholesterol — high doses can cause serious side effects (MedlinePlus). Adding prescription niacin to certain statins has not been shown to lower the risk of heart disease or death compared with those statins alone, and niacin commonly causes flushing (MedlinePlus).

Other products

Soy foods can have a small effect and green tea a modest one (concentrated green tea extracts have been linked to rare liver problems); flaxseed results are mixed (NCCIH). Chromium, vitamin C, artichoke extract, hibiscus, coenzyme Q10 and selenium have not been found to work (NCCIH).

Before you take any supplement, show it to your doctor or pharmacist — especially if you take a statin or other heart medicine, a blood thinner, or several prescriptions, or are pregnant or breastfeeding. “Natural” doesn’t always mean safe, some supplements interact with medicines, and most haven’t been tested in pregnancy or in children (NCCIH). We don’t list doses here.

Approach 6 of 6

MBHA Wellness Coach

Daily habits make a real difference to cholesterol, and your provider will want you to keep them up even if you take medicine (MedlinePlus). An MBHA Wellness Coach can help you build these habits one at a time — alongside, never instead of, your medical care.

Eat for your heart

Limit saturated fat, choose foods low in saturated fat, trans fat, sodium and added sugars, and eat more fiber and unsaturated fats (CDC). The details are in the Heart-healthy eating section below.

Move more

  • Adults need 150 minutes of moderate-intensity activity a week, such as brisk walking, plus at least 2 days of muscle-strengthening activity (CDC).
  • Regular activity helps you keep a healthy weight and can lower cholesterol and blood pressure. Children and teens need 1 hour of activity every day (CDC).

Weight, smoking and alcohol

Know your family history — and your numbers

  • Ask relatives about high cholesterol, early heart attacks and strokes. A family history means you may need checks more often (CDC) and may be a reason to test Lp(a) (NHLBI) or test your children early (AAP).
  • Keep a simple record of your lipid results and bring questions to each visit. A coach can help you stay on track with follow-up tests and medicine routines — but only your care team should change your treatment.

What it costs

Cost estimate being researched.

Another approach

Heart-healthy eating

Your body makes all the cholesterol it needs, so you don’t need to get it from food (CDC). What you eat still matters: saturated fat is the main dietary problem, and cutting it helps lower blood cholesterol (MedlinePlus).

The basics

The DASH eating plan, built for blood pressure, follows the same principles — vegetables, fruits and whole grains, with limits on foods high in saturated fat (NHLBI). See our blood pressure guide.

What it costs

Cost estimate being researched.

Still being researched: Chiropractic, Acupuncture, Massage therapy. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating High Cholesterol? Tell us.

Member stories

Living with High Cholesterol? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

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Which approaches have you tried?

What did you try, what did it cost, and what changed for you? Please leave out anything you’d rather keep private.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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