It’s no secret that high cholesterol levels are linked to a higher risk of heart disease, heart attack, and stroke. Understanding how high cholesterol affects the health of your cardiovascular system and contributes to related health problems is the first step to learning how to mitigate your risk for heart disease. Here, we look at the effects of high cholesterol on your heart—and how you can take control over your heart health starting now.

Table of Contents

  1. Cholesterol and atherosclerotic cardiovascular disease
  2. Cholesterol and ischemic heart disease
  3. High cholesterol, diabetes, and high blood pressure
  4. Lower your cholesterol to reduce your heart disease risk
  5. FAQs about cholesterol and your heart

Cholesterol and atherosclerotic cardiovascular disease

Atherosclerosis is a type of heart disease in which plaque builds up inside your arteries, which may result from high cholesterol, triglyceride levels, and other fats found in the blood. The plaque left behind by LDL “bad” cholesterol hardens over time and narrows your arteries, limiting the flow of oxygen-rich blood to your organs. 

Atherosclerotic cardiovascular disease (ASCVD) can affect any artery in the body, including those in your heart, brain, and extremities. Other risk factors for atherosclerosis include diabetes, high blood pressure, sleep apnea, stress, and excessive alcohol consumption.

Depending on where the buildup and blockage occurs, atherosclerosis can cause ischemic heart disease, a term given to heart problems caused by narrowed arteries. 

Cholesterol and ischemic heart disease

When arteries are too narrow to deliver blood oxygen to various parts of the body , often during physical exertion or periods of stress, it’s known as ischemic cardiovascular disease. Types of ischemic cardiovascular disease include coronary artery disease, coronary microvascular disease, carotid artery disease, and peripheral artery disease.

Coronary heart disease

A major risk associated with high cholesterol is coronary heart disease, also known as coronary artery disease, which is the leading cause of death in the U.S. Coronary heart disease results when the heart’s arteries can’t deliver enough blood to the heart, depriving it of oxygen. If the blood flow is partially or totally cut off, a heart attack can occur.

While a number of factors may cause or contribute to coronary heart disease, including injury or disease that affects the arteries, a common cause is the buildup of plaque inside the larger coronary arteries (atherosclerosis).

Symptoms of coronary heart disease aren’t always the same for everybody—and some people don’t experience any symptoms at all. You may not know you have coronary artery disease until you have chest pain, a heart attack, or sudden cardiac arrest. 

Other risk factors for coronary heart disease that you can mitigate through lifestyle changes or medication include high blood pressure, diabetes, obesity, and mental health conditions like anxiety or depression. 

Carotid artery disease

Carotid artery disease develops when plaque builds up inside the carotid arteries, which are located on each side of your neck. Each carotid artery divides into an internal and an external artery. The internal carotid arteries move blood—and the oxygen it carries—to the brain. The external carotid arteries supply blood to the face, neck, and scalp. Carotid artery disease is a major cause of stroke in the U.S. A stroke may occur in a few ways:

  • Plaque buildup in the carotid arteries cuts off blood flow to the brain and causes a stroke. 
  • A piece of plaque breaks away from the main artery and gets stuck in a smaller artery in the brain. 
  • A blood clot develops where the plaque in the artery ruptures or cracks. The clot may partially or completely block the artery—or break off and block a smaller artery in the brain.

If the flow of blood is cut off for more than a few minutes, brain cells begin to die, and the function of parts of the body those brain cells controlled may suffer permanent damage.

Symptoms of carotid artery disease often don’t occur at all until it causes a transient ischemic attack (TIA), a stroke, or a bruit, which is a whooshing sound your carotid arteries make that your doctor can hear through the stethoscope.

In addition to high cholesterol, other risk factors for carotid artery disease include smoking, high blood pressure, and insulin resistance or diabetes. All of these can damage the inner layers of the carotid arteries. When damage occurs, the healing process may cause plaque buildup on the damaged area. 

Peripheral arterial disease

The plaque associated with high cholesterol can cause symptoms in other parts of your body, too. When the plaque builds up in the arteries to the legs, it’s known as peripheral arterial disease, or PAD. This condition is fairly common, especially in people over the age of 65, and affects more than 10 million Americans at any given time. 

Peripheral artery disease may not cause symptoms for some people. For others, symptoms may include fatigue or cramping of the buttock, thigh, hip, or calf muscles. These usually occur after walking a certain distance, and they go away with rest. People with advanced PAD may experience pain in the feet or toes while at rest, and those with open wounds or ulcers on the feet may have a serious case, which may progress to gangrene and require amputation.  

High cholesterol is a risk factor for PAD, along with factors like smoking, high triglycerides, high blood pressure, kidney disease, diabetes, and obesity.

High cholesterol, diabetes, and high blood pressure

It’s hard to talk about just one risk for heart disease, because risk factors like high cholesterol, diabetes, and high blood pressure are all intricately connected. Each affects the others, and each is a risk factor for the others. All of these conditions increase your risk for heart disease, and when they occur together, the risk is much higher. Here’s how high cholesterol is related to diabetes and high blood pressure.

High cholesterol and diabetes

Diabetes results from the body’s inability to produce or properly use insulin, which is produced by the pancreas to usher blood sugar (glucose) from the blood into the cells to use as fuel. 

As a result, too much sugar remains in your bloodstream and attaches to the low-density lipoproteins (LDL) that carry “bad” cholesterol through the bloodstream. The glucose that hitches a ride on LDL cholesterol causes the LDL particles to stick to artery walls more easily, which may lead to atherosclerosis. People with diabetes who have low HDL (“good”) cholesterol levels and high LDL and triglyceride levels have a considerably heightened risk of heart and artery diseases.

High cholesterol and high blood pressure

High blood pressure, or hypertension, occurs when the force of the blood pushing against the walls of your blood vessels is too high. Both high blood pressure and high cholesterol damage the inner lining of the blood vessels, and both contribute to atherosclerosis and an increased risk of heart disease and stroke. But having both high blood pressure and high cholesterol dramatically increases your risk of heart disease.

Around 60 percent of people with high blood pressure also have high cholesterol. The relationship between high blood pressure and high cholesterol is complicated, but it goes both ways. When excess cholesterol in the artery walls stiffens and narrows the arteries, the heart must work harder to get blood through them, which increases your blood pressure. High cholesterol also appears to trigger inflammation, which causes the release of hormones that lead the blood vessels to constrict, raising blood pressure.

High blood pressure causes damage to the arteries by making tears in the walls, where cholesterol can easily build up, increasing the odds of developing atherosclerosis. 

Lower your cholesterol to reduce your heart disease risk

Risk factors for heart disease that you can’t change include advancing age, family history, genetic factors, race, and ethnicity. But addressing the factors you can change will make a big difference in lowering your risk for heart disease, heart attack, and stroke—despite the unchangeable factors working against you.

With lifestyle changes or medication—or both—you can lower your cholesterol levels and your blood pressure to reduce your heart disease risk. Not sure where to start? Our guide on how to lower your cholesterol without medication provides the foundation you need to start making changes to your lifestyle today. You’ll also find our comprehensive guide to cholesterol medication helpful if your cholesterol is high due to genetic factors. 

FAQs about cholesterol and your heart

Can high cholesterol cause irregular heartbeat?

High cholesterol may play a role in the development of cardiac arrhythmias, or irregular heartbeat. In addition to causing plaque buildup in the arteries, high cholesterol has been shown to change the properties of the membranes in heart cells. These complex changes increase your risk for ventricular arrhythmias, which cause most sudden cardiac deaths in the U.S., and atrial fibrillation, which is responsible for 15 percent of all strokes in the U.S.

Does high cholesterol affect heart rate?

A higher pulse rate and elevated blood pressure are often associated with high cholesterol. When plaque builds up along blood vessel walls and narrows them, your heart rate may increase as it must beat faster to get enough oxygen-rich blood through them. 

How do you get rid of heart cholesterol?

Making certain lifestyle changes can lower your cholesterol in as little as a few weeks or as long as three months. These lifestyle changes include getting regular exercise, eating a healthy diet, quitting smoking, and cutting back on drinking. If lifestyle changes don’t lower your cholesterol after 12 weeks, medication can help reduce cholesterol—and your heart disease risk.

What cholesterol level increases the risk of a heart attack?

Although recommended cholesterol levels vary by age and are different for men and women, in general, total cholesterol levels of 240 mg/dL and above sharply increase your risk for heart disease and heart attacks. If you currently have cardiovascular disease, you can lower your risk by keeping your LDL cholesterol under 70 mg/dL. If you have a high risk of heart disease or multiple risk factors, keep your LDL cholesterol under 100 mg/dL. Everyone else should aim for LDL cholesterol levels of 130 mg/dL or less and triglyceride levels of less than 150 mg/dL.

What are the warning signs of high cholesterol?

High cholesterol on its own doesn’t produce symptoms. The only way to know whether your cholesterol levels are too high is to have your cholesterol checked at least every five years—more often if you’re older or have an elevated risk of high cholesterol or heart disease. If you experience symptoms like chest pain while you’re exercising, shortness of breath, dizziness, or an irregular heart beat, schedule an appointment with your physician to rule out high cholesterol, high blood pressure, and other conditions associated with an increased risk of heart disease. 

Take control of your heart health with Forward

Forward’s healthy heart program, open to all members, is a 12-week, doctor-led course that includes genetic and blood testing, lifestyle assessments, and a personalized prevention plan to help you reduce your risk of heart disease. Ongoing support and biometric monitoring helps you keep tabs on your progress, and you can get answers, schedule in-person or virtual appointments, and access your care team 24/7 through our user-friendly app. 

No long waits. One flat fee. No copays — ever.

Fed up with a soul-sucking healthcare system? Same. With unlimited visits, personalized insights and real, actionable results, find out what it’s like to actually enjoy seeing your doctor.