Cholesterol (High) | Levels, foods, warning symptoms, drugs

High cholesterol

What is Cholesterol?

Cholesterol is a fatty substance produced by our body and which is also found in food. It is an essential element for the synthesis of many hormones, but also for the structure of the membrane that surrounds the cells. Excess or high cholesterol is not a disease in itself but a risk factor for other diseases of the heart and blood vessels.

After several years of too high levels, cholesterol gradually causes a loss of elasticity in the arteries and reduces their diameter. This is called atherosclerosis (or arteriosclerosis), a disease that can have serious consequences. The treatment of excess cholesterol is based on dietary measures and specific medications.


Excess cholesterol is not a disease in itself but a risk factor for other diseases of the heart and blood vessels. In fact, it is an excess of LDL cholesterol, also called bad cholesterol, which promotes the formation of deposits on the walls of the arteries. These deposits gradually cause a loss of elasticity in the arteries and reduce their diameter, which increases the risk of suffering from infarction, stroke or arteritis. It is estimated that 12 million French people suffer from excess LDL cholesterol.

The other fraction of cholesterol, HDL cholesterol or “good cholesterol”, traps cholesterol that is in excess in the blood and stimulates its elimination by the liver. It therefore has the effect of reducing the rate of cardiovascular disease.

Read: Heart diseases | List of cardiovascular diseases | Include pathologies that affect the heart and all of the blood vessels

Blood cholesterol levels tend to increase with age. After several years of being too high, cholesterol forms deposits on the walls of the arteries, called atherosclerotic plaques, which may contain other substances, such as calcium. This is called atherosclerosis (or arteriosclerosis). This disease causes no symptoms for years. However, the supply of oxygen and nutrients to the affected organs sometimes decreases considerably, causing severe and sometimes sudden symptoms over time.


Excess LDL cholesterol does not cause symptoms, but its deposition in the arteries can cause disease. For example, angina pectoris, a contraction of the arteries of the heart, even a myocardial infarction. If the arteries of the brain are affected, paralysis, dizziness or language disorders are possible, even a stroke. Finally, if the arteries in the legs are narrowed, arteritis causes intermittent calf cramps while walking. Erectile dysfunction is also observed.

Warning symptoms: overall, all the symptoms that may suggest a cardiovascular disease involving excess cholesterol are as follows:
  • pain in the calf muscle (on the back of the lower leg)
  • pain in the chest with a feeling of tightness,
  • nausea, dizziness,
  • fever, headache,
  • shortness of breath, palpitations,
  • feeling of coldness in the extremities,
  • loss of strength in the face, arms, legs, especially on one side,
  • speech difficulties,
  • visual disturbance,
  • etc


Triglycerides make up most of the fats we eat and that circulate in our blood. They are an essential source of energy for our body. It would seem that too high a level of triglycerides in the blood promotes the development of cardiovascular diseases, but opinions differ on this subject.

The level of triglycerides in the blood is usually below 1.5 g/l. An abnormally high level is often linked to excessive alcohol, uncontrolled diabetes, being overweight, overloading the liver with fat or taking certain medications.


A large number of factors can contribute to an increase in the concentration of LDL cholesterol in the blood:

a diet that is too high in animal fats and cholesterol;
overweight and obesity;
insufficient physical activity;
gender (men have higher LDL cholesterol).
Other disorders, such as diabetes, hypothyroidism, liver and kidney disease, can raise blood levels of LDL cholesterol.


The signs of atherosclerosis are different depending on the organs affected. They occur when blood flow is so diminished by cholesterol deposits that it prevents proper organ function. If the arteries of the heart are affected, the patient may develop attacks of angina pectoris (a contraction of the arteries which irrigate the heart muscle), or even a myocardial infarction (the death of a part of the heart muscle due to lack of oxygenation). Plaques in the arteries located in the abdomen can cause erectile dysfunction. If the arteries of the brain are blocked by atherosclerotic plaques, paralysis, dizziness, language disorders, etc. are possible. Sometimes pieces of plaque break off, migrate and clog a small downstream vessel. It is one of the causes of strokes (“brain attacks”).

Finally, if the arteries of the legs are narrowed, intermittent calf cramps are observed during walking: this is arteritis of the legs. This disease is all the more important as the cramps and pain occur after a very short distance. traveled or that they appear at rest. Severe arteritis of the legs can cause gangrene (the death of areas that are no longer irrigated) requiring amputation. Ultrasound can assess the decrease in blood flow in the artery and diagnose arteritis.


A large number of factors can contribute to an increase in the concentration of LDL cholesterol in the blood:
a diet that is too high in animal fats and cholesterol;
overweight and obesity;
insufficient physical activity;
gender (men have higher LDL cholesterol).
Other disorders, such as diabetes, hypothyroidism, liver and kidney disease, can raise blood levels of LDL cholesterol.


The detection of excess cholesterol is done by a blood test (carried out on an empty stomach) which evaluates the levels of LDL, HDL and total cholesterol, as well as that of triglycerides. From the age of 50, a systematic cholesterol assay is carried out every five years for women and every three years for men. This dosage may be more frequent in patients with multiple cardiovascular risk factors. When a blood test shows values ​​that are too high, the doctor has a second fasting blood test done to confirm the results of the first.

Atherosclerosis can be detected during a medical examination, in particular by auscultating the neck, groin or abdomen. The doctor looks for a breath sound reflecting the narrowing of the arteries. Taking the pulse also makes it possible to assess the extent of the decrease in blood flow.


From a blood sample, the analysis laboratory measures the parameters that make up the patient’s lipid profile.


The term total cholesterol includes HDL and LDL cholesterol levels, as well as one-fifth of the triglyceride level. This rate is usually less than 2 g/l.


Also called bad cholesterol. In the blood, the vast majority of total cholesterol is made up of LDL cholesterol. In a patient, the desirable LDL cholesterol level is determined by the doctor based on the presence of cardiovascular risk factors. In the absence of risk factors, an LDL cholesterol level is considered normal when it is below 1.6 g/l. If the patient has one or more risk factors (for example, a man over 50), this limit value is 1.3 g/l. Beyond that, therapeutic measures must be taken.


Also called good cholesterol, its role is to capture excess cholesterol in the blood and take it to the liver to be eliminated with the bile. The HDL cholesterol level is considered too low when it is below 0.35 g/l. A high level of HDL cholesterol (more than 0.60 g/l) protects against cardiovascular disease and cancels out a cardiovascular risk factor. Thus, a 50-year-old man (a risk factor) who has an LDL cholesterol level of 1.5 g/l and an HDL cholesterol level of 0.65 g/l will not be considered to require treatment. medical.


Triglycerides are the bulk of blood fats that are not found as cholesterol. The level of triglycerides increases after a rich and well-watered meal, during liver disease or after taking certain medications. The link between a high level of triglycerides (more than 1.5 g/l) and the risk of cardiovascular disease has not been clearly established.


By dividing the total cholesterol level (TC) by the HDL cholesterol level, we obtain the CT/HDL ratio, which is used to assess the risk of cardiovascular disease. This ratio is less used today.

Treatment of excess cholesterol

When a person has blood cholesterol levels that are too high on two consecutive blood tests, medical treatment may be necessary. The general practitioner decides on the appropriateness of the treatment according to several parameters: the blood levels of total, LDL and HDL cholesterol, the level of triglycerides and the existence of cardiovascular risk factors.


The treatment against excess LDL cholesterol consists first of all in giving the patient rules of lifestyle and diet. If three months of applying these rules is not enough to obtain acceptable values, drug treatment is necessary. The objective of this treatment is to maintain the LDL cholesterol level below a target threshold which is defined according to the number of cardiovascular risk factors present in the patient. When the LDL cholesterol level is kept below these values, the risk of cardiovascular disease is reduced.

When a drug treatment is prescribed, it is first administered in the lowest possible doses. If these are not enough, the dosage is gradually increased. The monitoring of the effectiveness and tolerance of these drugs is done using blood tests. The first of these control blood samples is taken between one and three months after the start of treatment.


In the absence of risk factors, the goal of treatment is an LDL cholesterol level below 2.2 g/l.
In the presence of a risk factor, the goal of treatment is an LDL cholesterol level below 1.9 g/l.
In the presence of two risk factors, the treatment goal is an LDL cholesterol level of 1.6 g/l.

In the presence of more than two risk factors, the goal of treatment is an LDL cholesterol level below 1.3 g/l.
In patients at high cardiovascular risk (history of cardiovascular disease, or type 2 diabetes with kidney damage or two other risk factors), the treatment goal is an LDL cholesterol level below 1 g/l.
Nevertheless, these target thresholds are only objectives and it is not recommended, for lack of sufficient studies, to try to reach them at the cost of excessive or poorly tolerated drug treatment.

When a drug treatment is prescribed, it is first administered in the lowest possible doses. If these are not enough, the dosage is gradually increased. The monitoring of the effectiveness and tolerance of these drugs is done using blood tests. The first of these control blood samples is taken between one and three months after the start of treatment.

Treatments of excess cholesterol in pregnant women

In most cases, cholesterol treatments can be suspended during pregnancy because high cholesterol levels in pregnant women do not represent a major risk. They must be interrupted if a pregnancy is desired. If pregnancy occurs while on cholesterol-lowering treatment, you should consult your doctor as soon as possible.

Medicines from the fibrate family can be used during pregnancy in certain exceptional situations (triglyceride level above 10 g/l which exposes you to a risk of pancreatitis).

Cholesterol-lowering diets

Preventing atherosclerosis means changing your lifestyle to lower your LDL cholesterol level. Dietary measures are essential but they should not be excessively restrictive to be followed over time: the good anti-cholesterol diet is the one that you can adopt in a sustainable way. In practice, the dietary measures recommended for people with excess LDL cholesterol vary depending on whether the patient is overweight or not.


In this case, the recommended measures essentially consist of limiting the consumption of foods high in saturated fat and cholesterol – the two are often combined in foods – and increasing that of unsaturated fats (in particular omega-3 fatty acids ) and fiber. Quitting smoking is also highly recommended.


If there were only three simple steps you could take to reduce your daily saturated fat and cholesterol intake, they would be:
Avoid using butter for cooking, save a nut for morning toast.
Significantly reduce your consumption of fatty meats such as rillettes, sausages, sausages and bacon.
Avoid eating cheese at all meals.


Replace the butter with margarine with phytosterols. You can find in supermarkets vegetable margarines enriched with these natural substances which help to lower LDL cholesterol levels. The recommended daily dose of phytosterols (one to two grams per day) corresponds to a daily consumption of 30 to 40 g of these margarines, enriched fats, i.e. the equivalent of the quantity spread on four or five rusks. Please note, it is best to seek the advice of your doctor when using these products for long periods. You can also use vegetable margarines to cook for the preparation of short crust or puff pastry.
In cakes, cakes and pancakes, replace butter with oil or margarine, which are high in unsaturated fats; 150 ml of oil replaces 200 g of butter.
Halve the number of egg yolks indicated in the recipes.
Degrease meat broths by placing them in the refrigerator. The grease freezes on the surface and can easily be removed.
Trim meat with a knife before cooking.
Prefer lean meats such as chicken, turkey, beef steak or rabbit, as well as fish, even fatty ones.
Prefer skimmed or semi-skimmed milk and dairy products.
Limit your consumption of coconut products.
Avoid buying products containing hydrogenated fats (trans fatty acids) and palm, copra or palm kernel oils, which are rich in saturated fatty acids.
Choose unsaturated fats (see below).
Eat more fiber. Fiber would reduce the absorption of dietary cholesterol by the intestine. They are found in fruits, vegetables, pulses and whole grains.

Can we eat eggs?
Consuming cholesterol-rich egg yolk has less of an impact on blood cholesterol levels than has been said. Its effect seems to vary according to genetic factors specific to each individual. Studies have shown that eating one egg a day does not increase mortality from cardiovascular disease. It is therefore not prohibited, but must be reduced when the blood cholesterol level does not decrease despite appropriate treatment.


Unsaturated fats are found in fatty fish such as salmon, sardines, mackerel and herring as well as vegetable oils such as olive, sunflower, corn, rapeseed, walnut, grapeseed or soy , for example. Omega-6 fatty acids, such as those found in corn and sunflower oils, appear to help lower blood LDL cholesterol levels. Those of the omega-3 family, present in oily fish and rapeseed or walnut oils, visibly play a positive role in the prevention of cardiovascular disease.

Use rapeseed oil in your salads, for example by making a mixture of equal parts rapeseed oil and olive or walnut oil.
Eat oily fish once or twice a week.
Eat nuts regularly, in reasonable quantities.


When consumed in excess, alcoholic beverages increase triglyceride levels and the risk of complications such as cardiovascular disease or inflammation of the pancreas. Consume less than three glasses a day if you are a man, and less than two glasses a day if you are a woman, which is the usual advice for good health.



In overweight people, limiting overall fat intake is a priority objective over reducing dietary cholesterol intake. Losing weight helps reduce LDL cholesterol levels and the risk of cardiovascular disease. Practicing physical activity on a regular basis, reducing the consumption of alcoholic beverages and quitting smoking are also important measures to reduce the risk of complications.

In overweight people, dietary advice for people without excess weight (detailed above) is also beneficial.


In general, practicing moderate physical activity every day is beneficial for your health. Sustained physical activity helps to lose weight, helps reduce blood levels of LDL cholesterol and increases those of HDL cholesterol. The optimal training to keep in shape is to do an endurance activity such as brisk walking, cycling or swimming three times a week for about 45 minutes. The intensity of the exercise should make you slightly out of breath, but still allow you to talk during the effort (but not to sing, speed up if you can). Exaggerated shortness of breath, heart palpitations or unusual pain, especially in the chest, must imperatively lead to the cessation of exercise and justify a medical consultation.

People who have too high a blood level of triglycerides must follow the same rules of hygiene of life. In addition, a diet low in calories and fast sugars is prescribed for them. They are also advised to stop all alcohol consumption.

Medications and treatments

There are several families of drugs intended to fight against excess LDL cholesterol; they are called lipid-lowering. They are used when three months of appropriate dietary measures (anticholesterol diet) have not been enough to bring LDL cholesterol levels back to normal.


These are the newer lipid-lowering drugs and the ones prescribed first when drug therapy is needed. They can effectively lower cholesterol levels in the blood by blocking an enzyme that participates in its synthesis in the body. Several studies have shown that statins have an important role in preventing cardiovascular events (myocardial infarction, stroke, arteritis) and in reducing the risk of mortality in patients with high cardiovascular risk. Nevertheless, the benefit of the treatment is individual and must be estimated by the doctor according to the risks incurred.

Adverse effects are most often mild: digestive disorders (constipation, nausea, flatulence, diarrhea, abdominal pain), headaches, fatigue, dizziness or cramps.

Adverse effects considered serious are rare (less than 1% of users) and occur especially at high doses: increase in liver enzymes (transaminases), muscle damage (muscle damage, destruction of muscle tissue).

Studies have shown that statins can also raise blood sugar. Their use in diabetics and people at risk of diabetes has been debated. After reassessing the files, the drug agencies (EMA and ANSM) believe that the benefit of these drugs remains favorable in the prevention of cardiovascular disease. In patients at risk for diabetes, blood glucose monitoring may be recommended.


Muscle pain: beware!
If you are taking a statin drug, and you experience unexplained muscle cramps, pain, tenderness or weakness (especially in the arms or thighs), report it to your doctor immediately. These symptoms can vary in intensity and are usually minor. However, exceptionally, it can be a serious muscle damage called rhabdomyolysis. It results in the destruction of muscle cells and can lead to potentially fatal kidney failure. Its occurrence is unpredictable. Muscle damage is observed more frequently in people over 70, those who suffer from alcoholism, kidney failure, hypothyroidism, etc. The risk also exists with hypolipidemic agents of the fibrate family and is increased in the event of association with statins.
People taking statins should be under regular medical supervision. A first blood test is established after four to six weeks of treatment and this is possibly adapted by the doctor. Then, a blood test is performed every three to six months to check the effectiveness of the treatment.

Grapefruit juice interacts with two statins: simvastatin and atorvastatin. Its consumption exposes you to a risk of overdose and an increase in the adverse effects of these two substances. People who are treated with these drugs should refrain from consuming grapefruit (juice and fruit). Other citrus fruits are not a problem.


Drugs from the fibrate family lower LDL cholesterol levels, but also partly blood levels of triglycerides and uric acid. They are used when statins have had no effect or have caused bothersome side effects. People taking fibrates should be under regular medical supervision. The doctor prescribes an initial assessment after two to three months of treatment and possibly modifies it when reading the results. He may decide to have a blood test done every two to three months for a year to check the effectiveness of the treatment.

The adverse effects observed may vary depending on the substance: difficult digestion, nausea or diarrhea, itching, hives, photosensitivity, dizziness or fatigue. Gallstones have also been reported.

Examples of drug names: LIPANOR, FEGENOR


Ezetimibe is a medication used to treat high blood cholesterol and certain other lipid abnormalities. Generally it is used together with dietary changes and a statin. Alone, it is less preferred than a statin. It is taken orally.

Ezetimibe inhibits the intestinal absorption of cholesterol. This substance is reserved for cases where statins alone are not an effective or sufficiently well tolerated treatment. In the first case, it can be associated with them; in the second case, it can replace the poorly tolerated statin. Its side effects are mainly digestive disorders.

Examples of drug names: EZETROL, ZETIA


Taking two hypolipidemic drugs from different families is sometimes necessary to obtain the optimal lowering of cholesterol levels in the blood. There are medicines that combine ezetimibe and a statin in a single tablet or capsule: ezetimibe and simvastatin (INEGY and generics), ezetimibe and atorvastatin (LIPTRUZET, RESELIP), ezetimibe and rosuvastatin (LIPOROSA, TWICOR). They are intended to simplify taking the treatment in patients already controlled by these substances taken alone simultaneously.

Examples of drug names:

  • Rosuvastatin + ezetimibe: LIPOROSA, SUVREZA, TWICOR
  • Statin + ezetimibe: INEGY, LIPTRUZET, RESELIP


Two monoclonal antibodies (alirocumab, evolocumab) are now available for the treatment of excess cholesterol, in addition to diet and other lipid-lowering treatments. They are designed to bind to a protein called PCSK9 which has a role in the liver’s ability to process cholesterol. By binding to and inhibiting the PCSK9 protein, these monoclonal antibodies increase the amount of cholesterol entering the liver and thereby lower blood cholesterol levels.

These drugs are in the form of a solution for injection in pre-filled pens to be administered subcutaneously, every 2 weeks. They must be stored in the refrigerator (between 2°C and 8°C). Self-injection is possible after training with a health professional.

The most common side effects of these drugs are local reactions at the injection site, upper airway symptoms (sore throat, runny nose, sneezing), itching, and development of anti-drug antibodies.

Examples of drug names(trade name) for Monoclonal antibodies: PRALUENT, REPATHA, ALIROCUMAB


Lomitapide belongs to the family of triglyceride transfer protein inhibitors. By blocking this protein, it lowers the level of triglycerides and cholesterol circulating in the blood. It is used, in combination with other lipid-lowering medicines, in adults with homozygous familial hypercholesterolaemia. Homozygous familial hypercholesterolemia is a genetic disease. If possible, it should be confirmed by a test before starting treatment.

The most common adverse effects of lomitapide are digestive: diarrhea (79%), nausea (65%), difficult digestion (38%), vomiting (34%), abdominal discomfort (20%) and increased liver enzymes (transaminases).

In order to limit digestive undesirable effects, this medication should be taken at least 2 hours after the evening meal.

Example of drug name (trade name): LOJUXTA


Colestyramine is a resin that traps bile acids and decreases the absorption of cholesterol by the intestine. Its main adverse effects are digestive disorders (pain, constipation, flatulence) and a risk of vitamin A, D, E and K deficiency. It can be associated with statins and fibrates.

Example of drug name (trade name): QUESTRAN


Omega-3 polyunsaturated fatty acids are sometimes prescribed for patients who have high blood triglyceride levels, as an addition to the diet. These fatty acids would inhibit the formation of LDL cholesterol. Their main adverse effect is a prolongation of blood clotting time.

Example of drug name containing omega-3 polyunsaturated fatty acids: Fish Oil, Omega-3, Lovaza, Omega 3-6-9 Complex

Use of herbal medicine

Phytotherapy is the art of healing with plants. A multitude of plants can help eliminate cholesterol better and normalize cholesterol levels.

Most of these cholesterol-lowering herbs occur naturally in food, but some are also available in capsules or herbal tea and used as dietary supplements.

If your cholesterol level is high, your doctor will first advise you to improve your eating habits and eat more fruits and vegetables. This is probably the most effective herbal medicine!


Few plants have shown interest in protecting the heart and blood vessels. Nevertheless, some fiber-rich plants could help prevent cardiovascular problems.


Oat bran and groats are rich in soluble dietary fiber and beta-glucans, which normalize LDL cholesterol levels in the blood. In 2012, the EFSA (European Food Safety Authority) estimated that oat products contribute to the maintenance of normal blood cholesterol levels provided that the food supplement (or food) contains at least 1 gram of beta-glucans per serving and that the person ingests 3 grams of beta-glucans per day.

In addition, these products may reduce the rise in blood glucose levels after a meal provided that the food contains at least 4 grams of beta-glucans for every 30 grams of carbohydrate present in the food, and that the food containing oats is consumed as part of a meal.


Psyllium seeds contain fibers which form a gel in the stomach capable of partly fixing the fats contained in food and thus reducing the absorption of cholesterol. The US Food and Drug Administration allows the following statement on food packages containing more than 1.7 g of psyllium fiber per serving: “When combined with a diet low in fat and cholesterol, soluble fiber from psyllium seed husks in this product may reduce the risk of cardiovascular disease. »

In 2012, the European health authorities (EFSA, European Food Safety Authority and the European Commission) ruled on certain health claims made by products containing psyllium (ispaghul) seeds or bran. After reviewing the scientific data, they felt that psyllium products cannot claim to help lower blood cholesterol levels.


Many clinical studies have focused on fresh garlic or standardized extracts. They have shown only modest efficacy in controlling blood cholesterol or blood pressure. Several cross-sectional analyzes reveal that daily administration of garlic only seems to reduce LDL cholesterol levels by 4-6%, which seems insufficient to lead to a benefit in the prevention of cardiovascular disease.


Flaxseed oil is particularly rich in polyunsaturated fatty acids (omega-3 fatty acids), which has led scientists to research a possible effect of flaxseed oil in preventing cardiovascular disease. But studies looking at the effects of flaxseed or flaxseed oil on LDL cholesterol levels have yielded conflicting results. In 2012, European health authorities banned foods and supplements containing flaxseed oil from claiming to help heart or blood vessel health.


Fenugreek and nopal are two plants that are sometimes proposed to reduce the absorption of fat by the intestine, because of their high fiber content. No studies have confirmed this claim.

In 2016, the EFSA (European Food Safety Agency) banned a dietary supplement containing fenugreek (Teestar) from claiming to lower blood sugar levels (for example, in type 2 diabetes).


Taking oats, flax seeds or psyllium can decrease the absorption of certain substances. It is generally advisable to respect a period of at least two hours between taking these plants and taking medication. People taking medications for high cholesterol (especially statins) should check with their doctor before taking oats. People taking anticoagulant therapy should refrain from taking garlic supplements.

People who suffer from celiac disease (gluten intolerance) should refrain from consuming products containing oats, even if, among several clinical studies, none have shown worsening of the disease during consumption. moderate amount of this cereal.

Cholesterol (excess) – symptoms, causes, treatments, levels, foods, warning, dietary supplements

Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

Sources: PinterPandai, Mayo Clinic, MedlinePlus, NHS UK, American Heart Association, British Dietetic Association (BDA), Canadian Society for Vascular Surgery

Photo credit: Fidsor / Pixabay

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