If you have high cholesterol, you have a higher risk of cardiovascular disease. That can include coronary heart disease, stroke, and peripheral vascular disease. High cholesterol has also been tied to diabetes and high blood pressure. In all cases, the main reason is that high cholesterol leads to fatty plaques that build up in arteries all over your body.
To prevent or manage these conditions, work with your doctor. You also can take some simple steps that will help you lower your cholesterol -- and your risk of any related diseases.
Understanding Cholesterol
To understand how cholesterol can lead to diseases, it helps to understand how cholesterol works.
There are different types of cholesterol:
- Low-density-lipoprotein (LDL) cholesterol, or “bad” cholesterol. When your LDL cholesterol levels are too high, your arteries can become too narrow and get blocked. This can cause stroke and heart problems.
- High-density-lipoprotein (HDL) cholesterol, or “good” cholesterol. Low levels of HDL cholesterol can contribute to heart disease and other issues, especially if your LDL cholesterol and triglyceride levels are high.
- Triglycerides. These are fats from the food you eat that circulate in your body, which can be stored in fat cells. Triglycerides aren’t actually a type of cholesterol, but their levels are measured along with HDL and LDL to see if you are at risk for, or have, atherosclerosis. (That's when fatty deposits build up in your artery walls, restricting blood flow and leading to a variety of issues like aneurysms and heart attacks.)
Cholesterol and Coronary Heart Disease
The main risk from high cholesterol is coronary heart disease, which can lead to death from a heart attack. If your cholesterol level is too high, cholesterol can build up in the walls of your arteries. Over time, this buildup -- called plaque -- causes arteries to harden and can restrict blood flow (atherosclerosis).
Arteries that feed the heart can narrow in certain areas and slow blood flow to part of the heart muscle. Or cholesterol plaques break off and float to smaller blood vessels and cause a partial or total blockage. Sometimes inflammatory cells might go to the broken plaque area and cause a narrowing there as well. Reduced blood flow can result in chest pain called angina, or in a heart attack if a blood vessel gets blocked completely.
Cholesterol and Stroke
Cholesterol plaques don’t just line your blood vessels in and around your heart. They also narrow certain arteries that lead to your brain. If a vessel carrying blood to the brain is blocked completely, you could have a stroke.
Cholesterol and Peripheral Vascular Disease
In addition to your heart and your brain, cholesterol plaque can cause symptoms in your legs and other areas outside of your heart and brain (peripheral vascular disease). Your legs and feet are the most common places to notice symptoms. You might notice cramps in your calves when you walk that get better with rest. This is like angina -- it works the same way -- but in your legs instead of your heart.
Cholesterol and Diabetes
If you have diabetes, that can upset the balance between levels of HDL, or “good” cholesterol, and LDL or “bad” cholesterol.
People with diabetes or insulin resistance often have blood that clots more easily, which can lead to more plaque building up in their arteries.
When your blood sugar stays high for a long time, the sugar sticks to proteins and fats. This is called advanced glycation end products (AGEs), and it’s been linked to diseases like heart disease.
People with diabetes, especially type 2 diabetes, can have low HDL and high triglyceride levels. Both of these boost the risk of heart and artery diseases.
If you have diabetes and have low levels of good cholesterol but high levels of bad cholesterol and high triglycerides, you have a condition called diabetic dyslipidemia. Up to 70% of people with type 2 diabetes have diabetic dyslipidemia.
People with type 1 diabetes who have their blood sugar under control usually have normal cholesterol levels. If they’re overweight or have obesity, though, they’re more likely to have high cholesterol. But that’s true for people without type 1 diabetes, too.
Cholesterol and High Blood Pressure
There's a link between high cholesterol and high blood pressure, or hypertension. High cholesterol seems to trigger inflammation and the release of certain hormones that causes blood vessels to tighten up. When that happens, it's called “endothelial dysfunction." Your blood pressure goes up because your heart has to work harder to pump blood through it.
High blood pressure is also linked to heart disease.
Cholesterol and Erectile Dysfunction
Erectile dysfunction is when a person can’t achieve or maintain an erection during sex. Over the long term, high cholesterol seems to trigger a narrowing of the smaller blood vessels of the penis when they should be stretching to allow more blood for an erection. In addition, when you have too much LDL cholesterol, it can build up in arteries and then join with other substances to form plaque that hardens and narrows the blood vessels even more (atherosclerosis). The result can be less blood flow to both the heart and the penis, which can lead to erectile dysfunction.
5 Steps to Lower Cholesterol and Risks of Related Diseases
A few simple changes can lower your cholesterol and cut your risk for conditions linked to high cholesterol.
Ask for expert advice on lifestyle changes. Your doctor can help you come up with a plan for healthy eating and exercise.
Give your diet a makeover. Go for foods like oatmeal, walnuts, tuna, salmon, sardines, and tofu. Stay away from things that are high in trans fats, saturated fats, and simple sugars.
Quit smoking. Smoking lowers your “good” (HDL) cholesterol. If you quit, you’ll have more of it. There are lots of other benefits for your whole body.
Get moving. Even modest amounts of exercise, like half an hour a day of brisk walking, help you control weight. It’s also good for other things that put you at risk for heart disease, like diabetes and high blood pressure. Exercise can lower your triglyceride levels and raise your HDL cholesterol. Both are good for your heart.
Take your medications. Your doctor will probably prescribe a medication called a statin to help lower your cholesterol, but some people have negative side effects when they take this type of drug. If that's the case for you, talk with your doctor about other treatment options.They may recommend an ACL inhibitor like bempedoic acid (Nexletol) or bempedoic acid and ezetimibe (Nexlizet). Both limit how much cholesterol your liver makes, but Nexlizet also lowers how much cholesterol your small intestine absorbs.
Other options include PCSK9 inhibitors like alirocumab (Praluent) and evolocumab (Repatha), which help your body clear LDL cholesterol from the blood. Inclisiran (Leqvio), a newer small interfering RNA (siRNA), lowers cholesterol by blocking how much PCSK9 your liver makes.
Always take your medicines as prescribed, and if you have questions, talk with your doctor or pharmacist.
Other Resources
These groups offer more information about treating and preventing cardiovascular disease and other conditions linked to high cholesterol.
American Heart Association. This organization is dedicated to advocacy and education about heart disease.
American Stroke Association. This agency teaches you to reduce your risk of stroke and make positive lifestyle changes.
InterAmerican Heart Foundation. This group works in Latin America and the Caribbean to lower disability and death from heart disease, stroke, diabetes, and other related conditions.
National Heart, Lung, and Blood Institute. This government agency supports research on the causes, prevention, and treatment of cardiovascular, lung, and blood diseases.
