Genetics is one factor that may affect your cholesterol levels. Having a close relative with high cholesterol means you may be more likely to have it too.

If a close relative has high cholesterol, you’re more likely to have it yourself. However, many lifestyle factors, particularly diet and exercise, also affect levels of cholesterol.

Keep reading to learn more about risk factors for cholesterol and things you can do to manage your levels.

Being diagnosed with high cholesterol usually means you have either high LDL (low-density lipoprotein) cholesterol, or a high level of total cholesterol. Total cholesterol is also sometimes called serum cholesterol. It’s the sum of LDL and HDL cholesterol and 20% of your triglycerides, a type of fat.

LDL cholesterol and total cholesterol can be used as indicators of your risk of developing cardiovascular disease and other complications.

Learn more: What is serum cholesterol, and why is it important? »

A variety of risk factors contribute to unhealthy levels of cholesterol, including genetics, lifestyle choices, or a combination of the two.

Familial hypercholesterolemia

Having a close relative, such as a parent, sibling, or grandparent, who has high levels of cholesterol is called familial hypercholesterolemia, and it means you may be at a higher risk of having it too, because you may have inherited genes that contribute to high cholesterol levels. People with familial hypercholesterolemia can’t control their cholesterol through diet and exercise alone and may also need to take medication.

Obesity or large waist circumference

Obesity is defined as a body mass index (BMI) of 30 or higher. A large waist circumference is 40 or more inches for men and 35 or more inches for women. Fat that accumulates in your waist increases your risk of elevated cholesterol and other cardiovascular complications.

Elevated blood sugar

High levels of glucose can increase LDL cholesterol and decrease HDL cholesterol. High levels of glucose in your blood can also damage the lining of arteries which can increase your risk of fatty deposits building up in your arteries.

Lifestyle factors

Some risk factors for high cholesterol may be completely controlled by lifestyle choices. These include diet, exercise, and smoking.


Eating a diet high in saturated and trans fats can increase your cholesterol levels. Foods high in these types of fats include:

  • red meat
  • full-fat milk and yogurt
  • fried foods
  • highly processed sweets


Exercise can increase your HDL cholesterol and decrease your LDL cholesterol. That means that adding exercise to your routine can help promote healthy levels of cholesterol in your body.

Aim for 150 minutes of moderate to high intensity aerobic exercise each week. If you’re new to exercise, work your way up to that goal. Be sure to talk with your healthcare professional before starting any new exercise routines. Adding resistance exercises, such as weightlifting or yoga, into your exercise plan may help too.

Quitting smoking

Smoking can have a negative impact on your heart health. That’s because tobacco damages the walls of your blood vessels. This makes it more likely for fat deposits to build up.

Talk with your doctor or healthcare professional about smoking cessation programs that may work for your lifestyle. Sometimes you may need to try more than one method to stop smoking. Having a support group can help.

Learn more: 14 tips for quitting smoking »

High levels of unhealthy cholesterol can reduce the flow of blood through your vessels. Over time, this can increase the risk of developing the following conditions:

High levels of cholesterol are usually asymptomatic. To determine your cholesterol levels, you’ll need a blood test. Your primary care physician will draw your blood to check lipid levels. This is called a lipid panel, and it’s a standard procedure for most primary care physicians. Your results will typically include:

  • total cholesterol
  • HDL cholesterol
  • LDL cholesterol, sometimes including particle count in addition to the total amount
  • triglycerides

There are two additional cholesterol tests you may have, Lipoprotein-a (Lp(a)) and Apolipoprotein B (ApoB). These tests measure proteins related to LDL and can help your doctor assess your cardiovascular health and risks.

Generally, doctors use the following guidelines when interpreting the results of total cholesterol:

Cholesterol levels and what they mean

healthy total cholesterolbelow 200 mg/dL
at-risk total cholesterol200 to 239 mg/dL
high total cholesterolabove 240 mg/dL
lipoprotein a – Lp (a)at or above 50 mg/dL
apolipoprotein B (ApoB)at or above 130 mg/dL

Your doctor will also interpret the other numbers to get a more complete picture of your health.

When you should get tested

If you’re at low risk for high levels of cholesterol, you should start getting lipid panel screenings starting at age 40 for women and 35 for men. You should have your levels tested about every five years.

If you have more risk factors for cardiovascular disease and high cholesterol, you should start getting lipid panel screenings in your 20s and at more frequent intervals. If the results show you have unhealthy levels of cholesterol or other lipids, your doctor will work with you to create a treatment and monitoring plan.

Genetic testing

If you think you may be at risk for familial hypercholesterolemia, your doctor may recommend genetic testing. Genetic testing can identify faulty genes and determine if you have familial hypercholesterolemia.

If you do test positive for familial hypercholesterolemia, you may need more frequent lipid panels.

Other cholesterol testing

Apolipoprotein (b) (ApoB) and lipoprotein (a) (Lp(a))

Newer cholesterol testing includes ApoB and Lp(a) testing. Both ApoB and Lp(a) are proteins associated with LDL. High levels of these substances may indicate you are at a higher risk for cardiovascular disease.

Treating high cholesterol can be challenging, so you may need to use a combination of methods to manage your levels. These methods may include:

  • managing other conditions, such as diabetes
  • lifestyle changes like diet, exercise, and avoiding smoking
  • prescription medications types, such as:
    • statins
    • cholesterol absorption inhibitors
    • bile acid sequestrants (binding agents)
    • PCSK9 inhibitors
    • adenosine triphosphate-citrate lyase (ACL) inhibitors
    • fibrates
    • niacin (nicotinic acid)
  • omega-3 fatty acid ethyl esters
  • marine-derived omega-3 polyunsaturated fatty acids (PUFA)

A recent study found that high niacin levels may actually increase your risk of cardiovascular disease. It’s important to discuss medications you are prescribed with your doctor or healthcare professional.

Here are some changes you can make to help reduce your risk for high cholesterol:

  • Healthy diet: Eating a diet high in fiber-rich grains, protein, and unsaturated fats will lower harmful LDL cholesterol. Avoid eating a lot of foods high in animal-based saturated fats, such as full-fat dairy, highly processed sweets, and red meat. Focus on eating healthy foods such as:
    • green vegetables
    • lentils
    • beans
    • oatmeal
    • whole grain breads
    • low fat dairy
    • low fat meats, such as poultry
  • Exercise regularly: The surgeon general recommends 150 minutes of moderate- to high intensity aerobic exercise each week. Additionally, consider adding in some resistance exercises to increase muscle mass.
  • Stop or reduce smoking: If you need help quitting smoking, talk to your doctor. They can recommend smoking cessation programs. It also helps to have a support group, so talk to a close friend or family member about your goal to quit smoking and ask them to help offer encouragement and support.
  • Maintain a healthy body weight and low percentage of body fat: Try to aim for a BMI below 30. Additionally, men should aim for a body fat percentage below 25% and women below 30%. If you need to lose weight in the form of body fat, you should aim to establish a calorie deficit each day. A combination of a healthy diet and exercise routine help in maintaining a healthy weight or losing weight, if needed.
  • Limit alcohol consumption: Women should limit alcohol to no more than one drink per day, and men should limit it to no more than two drinks a day. One drink is considered 1.5 ounces of liquor, 12 ounces of beer, or 5 ounces of wine.

Your doctor may also recommend prescription drugs to manage cholesterol. These include statins, PCSK9 inhibitors, and bile acid sequesterants. If you’re taking any of these drugs, they should be used in addition to healthy lifestyle choices.

If you’re unable to control your cholesterol with lifestyle changes and medication, your doctor may need to perform apheresis or surgery to reduce levels of cholesterol. Apheresis is a technique that filters the blood, but it’s infrequently used.

Can high cholesterol run in families?

Yes. If you have a close relative – parent, grandparent, or sibling – who has high cholesterol, you are more likely to have it yourself.

How do you know if your high cholesterol is genetic?

Inherited high cholesterol or familial hypercholesterolemia is more common in certain ethnicities: those of French Canadian, Finnish, Lebanese, and Dutch descent. If you are from these groups, your high cholesterol may be genetic. There are also blood tests and genetic tests that can help a doctor determine if your high cholesterol is genetic.

What are 5 signs of high cholesterol?

High cholesterol itself has few, if any, signs or symptoms, but the conditions it causes do. While there are many signs and symptoms of cardiovascular disease, here are 5 common ones:

  • chest pain
  • xanthelasmas (yellow growth around the corners of the eye)
  • corneal arcus (light-colored ring around the iris)
  • eruptive xanthomas (yellowish, bumpy, raised rash)
  • digestive symptoms like nausea, indigestion, or heartburn

Why is my cholesterol high when I have a healthy diet?

While cholesterol is most often controlled by lifestyle things like diet, exercise, and smoking, you can have a genetic or inherited type of high cholesterol, so having a healthy diet might not ensure that your cholesterol is low.

High cholesterol may be caused by a variety of genetic and lifestyle factors. If not managed properly, it can lead to a variety of health complications. You can use various methods to optimize your cholesterol levels, including:

  • a healthy diet
  • exercise
  • avoidance of substance misuse
  • medications prescribed by your doctor