Table of Content

  1. Genetic and acquired causes of high cholesterol
  2. Risk factors for high cholesterol
  3. What are the warning signs of high cholesterol?
  4. Can high cholesterol be reversed?
  5. FAQs about cholesterol

Cholesterol is a type of fat that travels in your bloodstream attached to lipoproteins. Low-density lipoproteins, more commonly known as LDL cholesterol, are the bad guys that stick to the walls of your arteries and harden into plaque, reducing or blocking the flow of oxygen-rich blood to your organs and tissues. High-density lipoproteins, hailed as the “good” HDL cholesterol, moves along and picks up as much LDL as it can and takes it back to the liver, where it’s processed and expelled from the body. 

Triglycerides aren’t cholesterol, but they’re another type of fat found in the blood. Triglycerides are created from the extra calories you consume, and they’re stored in your fat cells until your body needs them for energy. A lipoprotein known as very low-density lipoprotein, or VLDL, carries the triglycerides from your fat cells to your tissues for fuel. Once the VLDL drops off the fuel, it becomes LDL cholesterol and adds to the plaque buildup in your arteries. 

Having high levels of “bad” cholesterol generally means you have high cholesterol, which increases your risk for cardiovascular disease. High triglyceride levels and low “good” HDL cholesterol also increase your risk for cardiovascular diseases. 

But how do LDL cholesterol and triglyceride levels end up so high? 

Genetic and acquired causes of high cholesterol

When high cholesterol is the result of genetics, it’s known as familial hypercholesterolemia. It may be caused by a mutation in the LDL-receptor gene that causes LDL cholesterol levels to rise above 19 mg/dL. This genetic defect accounts for at least 85 percent of familial hypercholesterolemia. Two other common genetic causes of high cholesterol include mutations in apolipoprotein B and in a gene known as PCSK9. 

The most common cause of high cholesterol, though, is the combination and interaction of unidentified genetic factors and a range of lifestyle factors—most importantly, a lack of exercise and a poor diet. Lifestyle choices that lead to high cholesterol are known as “acquired” causes.

In addition to genes and lifestyle factors, secondary causes of high cholesterol may include: 

  • Hypothyroidism
  • Chronic kidney disease
  • Pregnancy
  • Cholestasis, a liver disorder affecting the flow of bile
  • Lupus, an autoimmune disorder 
  • Certain medications, including some immunosuppressants and diuretics.

Risk factors for high cholesterol

Risk factors aren’t causes, but rather things that may increase the chances that you’ll develop a certain disease. Some risk factors, like age and sex, can’t be controlled, but others, like a sedentary lifestyle or a poor diet, can. These are the most common risk factors that increase your chances of developing high cholesterol.


Anyone can have high cholesterol—even children—but it’s most common in people between the ages of 40 and 59. That’s because as you age, your metabolism changes, and your liver isn’t the dynamo it once was at removing “bad” LDL cholesterol from your body. Additionally, by your fourth or fifth decade, any unhealthy habits you’ve long had may begin to take their toll on your health. 


Women and men have many differing risk factors for high cholesterol. Men are more likely than women to have high cholesterol between the ages of 20 and 30, but women are more likely to have high cholesterol at all other ages. High cholesterol in women may have risk factors that don’t apply to men, such as birth control pills, menopause, and pregnancy. After the age of 45, men’s risk for high cholesterol increases, and women’s risk increases after the age of 55.

Race and ethnicity

Your race or ethnicity may influence your risk for high cholesterol and heart disease due to both specific genetic factors and sociocultural influences. Non-Hispanic white people are more likely than other populations to have high total cholesterol levels, while Asian Americans—including people of Indian, Japanese, Filipino, and Vietnamese descent—are more likely than other groups to have high levels of “bad” LDL cholesterol. While Hispanic Americans are more likely to have lower “good” HDL cholesterol levels, Black Americans are more likely to have higher HDL levels—but they’re more likely to develop high blood pressure and diabetes than other groups. 

Family history 

Families often have similar cholesterol levels, either due to genetic factors or sociocultural factors, or—more likely—a combination of these. In some cases, though, genes play a major role in developing high cholesterol, which is one reason why the Centers for Disease Control recommends that a person’s first cholesterol test should occur between the ages of nine and 11. If you have a family history of high cholesterol or premature atherosclerotic cardiovascular disease that affected a man younger than 55 or a woman younger than 65, your doctor will likely recommend regular screenings and preventive lifestyle modifications.

Poor nutrition

You really are what you eat. The food you consume affects every organ and every cell in your body. Nutritious food has a positive effect on your overall health, and unhealthy food has a negative effect. Overly processed foods and a lack of fresh fruits and vegetables and whole grains increase your risk for high blood pressure, high cholesterol, heart disease, cancer, obesity, and type 2 diabetes. Eating for good health reduces your risk and helps you manage existing conditions. A nutritious diet can even help reverse some conditions—like high cholesterol and high blood pressure. Nutrition is wildly complicated, and the vast amount of information and misinformation isn’t easy to sort through. Our guide to lowering your cholesterol through diet helps you make sense of it all.


Obesity, defined as having a body mass index (BMI) of 30 or higher, is a risk factor for high cholesterol—and it’s associated with a higher risk for type 2 diabetes, high blood pressure, heart disease, and other health problems. Obesity may cause increased levels of blood glucose, triglycerides, and LDL cholesterol as well as decreased HDL cholesterol levels through a variety of mechanisms influenced by metabolism, inflammation, and insulin resistance. Research shows that losing just five to 10 percent of your body weight reduces the risk of cardiovascular disease—even if you remain in the obese range. The more weight you lose, the more your risk goes down. 

High blood pressure 

High blood pressure increases your risk for high cholesterol, and vice-versa. High blood pressure causes tiny tears in the lining of your blood vessels, and “bad” LDL cholesterol sticks to these spots and builds up more easily, increasing the risk of heart attack and stroke. Having both high cholesterol and high blood pressure dramatically increases your risk for heart disease.


People who have diabetes are at risk for developing high cholesterol due to elevated blood glucose levels. Sugar in your blood attaches to the LDL cholesterol particles and makes it easier for bad cholesterol to adhere to the lining of the blood vessels. 


Smoking cigarettes or a pipe is an important risk factor for high cholesterol, high blood pressure, and heart disease. Smoking affects cholesterol levels by altering your lipid (fat) profile. It’s been shown that smoking lowers “good” HDL cholesterol and raises triglyceride levels. However, quitting smoking increases good cholesterol levels—after four years smoke-free, your risk for cardiovascular disease is cut nearly in half.

What are the warning signs of high cholesterol?

That’s the scary thing about high cholesterol: It has no symptoms, and that’s why regular cholesterol screenings are so important. High cholesterol leads to the buildup of plaque in the arteries, a condition known as atherosclerosis. If high cholesterol and atherosclerosis go undiagnosed and untreated, they may lead to coronary artery disease, heart attack, or stroke. 

Can high cholesterol be reversed?

For most people, it’s actually very easy to lower cholesterol—in theory. In practice, it’s a little more challenging and complex. Some risk factors for high cholesterol you can’t control include genetics, age, sex, family history, race, and ethnicity. But aside from genetics, those are the least important risk factors for high cholesterol.

In fact, modifying certain behaviors is the number-one way to lower your cholesterol quickly and naturally. And if you have co-occurring conditions, like high blood pressure or diabetes—well, modifying these exact same behaviors is the number-one way to improve those, too. 

The science is clear, and your doctor will be very clear, too: In order to reduce your cholesterol without medication, you need to quit smoking, start exercising, eat a nutritious diet, and cut down on those cocktails—starting now. And also, reduce your stress and try to sleep better. 

Depending on your cholesterol levels and other risk factors, your doctor may give you a timeline for lowering your cholesterol through lifestyle modifications before the conversation will need to turn to medication. 

But if lowering your cholesterol (or your blood sugar, or your blood pressure, or your weight) was really that easy, heart disease wouldn’t be the number-one killer in the U.S. While some people have the skills and mindset to make sweeping, permanent changes in their behaviors, many don’t. The fact is, making behavioral changes is hard, and it requires a lot of support. 

Fear of heart disease and sheer willpower often aren’t enough to sustain behavioral changes for the long-term. Willpower takes a lot of energy, and making what may be numerous lifestyle changes practically overnight may leave some people feeling angry, deprived, and depressed. These negative emotions make it even more mentally taxing to implement and stick with new habits. 

If you have high cholesterol, read our guide to lowering cholesterol quickly and naturally to understand how diet, exercise, stress, and various other factors affect your cholesterol levels. Then, read our essential guides on how to lower your cholesterol fast through eating, exercising, and banishing stress and vices. We’ve got tips on not just what to do, but also how to do it in a way that keeps you positive, motivated, and successful for the long-haul.

guide to understanding cholesterol levels to get an idea of what the general healthy cholesterol ranges are.

How often should you get screened for cholesterol?

Your first cholesterol screening should take place between the ages of nine and 11. After that, get a complete lipid panel every five years unless your doctor recommends more frequent screenings due to certain risk factors. Once men reach the age of 45 and women reach the age of 55, get screened every two years—more often if your doctor recommends it. After age 65, everyone should have an annual cholesterol screening.

Heart disease is complicated. Forward can help.

A Forward membership makes it easy for you to take control of your health. Our app provides full access to your health care team, test and assessment results, health goals, and progress. As your primary care provider, Forward emphasizes prevention through our doctor-led healthy heart program, cancer prevention program, and weight-loss and stress management clinics. Regular check-ins with your care team help you monitor your health and stay motivated to reach your goals.

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.