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Cholesterol is a vital component of your body — in fact, it’s a building block for human tissues.

But too much cholesterol can increase your risk of developing conditions such as heart disease and stroke. It can also cause blood clots. For these reasons, cholesterol levels should be monitored and maintained with healthy lifestyle choices.

Typically, high cholesterol levels do not show up until adulthood. But someone can be predisposed to have high cholesterol levels. In these cases, cholesterol levels usually start being elevated in childhood, increasing the risk of developing heart disease even earlier.

If someone is predisposed, the condition is known as familial hypercholesterolemia (FH). It is a genetic predisposition to having higher levels of cholesterol — specifically LDL cholesterol, the “bad” kind — that can lead to plaques in blood vessels.

Like all types of high cholesterol, it’s possible to manage FH. But living with this condition requires making changes to your lifestyle, including eating a better diet, taking medications, and prioritizing movement.

According to 2021 research, familial hypercholesterolemia is an inherited form of hypercholesterolemia where most individuals have high levels of cholesterol at birth. People with FH have a high level of low-density lipoproteins (LDL) in their bloodstream.

LDL carries cholesterol to the cells to help with making cell walls, hormones, and other vital components for the body. But when there is an excessive amount of cholesterol, the unused cholesterol is dumped into the blood vessels. This can cause plaques to form, which can later block arteries.

In FH, genetic anomalies cause the usual process of distributing and disposing of cholesterol to be inadequate. This occurs no matter how healthy you are.

High cholesterol that is acquired rather than genetic is frequently related to poor diet and excess weight. It can also be linked to other diseases such as diabetes. It typically develops in adulthood.

Both acquired and familial hypercholesterolemia cause stress on the blood vessels and heart. In addition, both lead to an increased risk of developing heart disease.

It’s possible to lower hereditary high cholesterol using many of the same tools that people with acquired high cholesterol would use. These strategies include diet and exercise changes (discussed below). In addition, there are supplements that may be helpful.

Yet, researchers in a 2019 review reported that the challenge with FH is that mutations to the genes that regulate LDL processing make managing cholesterol levels more difficult.

Therefore, most people with hereditary hypercholesterolemia may have to use medications in addition to lifestyle changes to manage the condition.

Manage obesity

For adults, obesity is defined as having a body mass index (BMI) of 30% or higher. The CDC typically uses BMI to measure a person’s risk of obesity. It is based on the ratio of height to weight. A BMI greater than 25% is believed to increase your risk of developing heart disease, as well as other medical issues.

It’s important to note that BMI isn’t always the most effective way to predict health outcomes. It is an oversimplified method that sometimes fails to take a person’s full health profile into account, leading to misconceptions and even discrimination.

Weight discrimination in healthcare can often prevent people who are overweight from seeking care.

Still, many believe that managing obesity is one of the most important ways to help manage high cholesterol.

Read more on how to manage obesity.


Starting to exercise regularly can be incredibly helpful for many aspects of your health. Physical activity can increase energy demand and help regulate fat and carbohydrate levels. It also contributes to weight loss.

Research in 2015 notes that losing 10% of your weight will significantly reduce your risk of cardiovascular disease.

Exercise also has a direct effect on decreasing oxidative stress on the body. Oxidative stress is when normal substances that are produced by the body burning energy start to build up excessively and cause damage to cells.

The two main forms of exercise that help in managing cholesterol levels are:

A 2021 study found that combining resistance training at least 2 times per week with aerobic exercise had the greatest effect on decreasing unhealthy cholesterol levels.

Be mindful of your diet

Eating a balanced, healthy diet can make a big difference in decreasing high cholesterol levels.

Some dietary habits that can help lower cholesterol levels include:

  • Make sure your diet is high in vegetables, fruits, nuts, beans, fish, and lean meats.
  • Decrease your intake of saturated fats — less than 7% of your daily intake.
  • Increase soluble fiber intake to 10–20 grams per day.

If you drink alcohol, it can also help to maintain a moderate intake.

If you’re unsure how to make changes to your diet or are finding it challenging, consulting a dietitian or nutritionist may help.

Cut down or stop smoking

Quitting smoking is another way to decrease cholesterol levels and boost health. If you find it hard to quit, you may want to start by cutting back and then use a program or tool to stop completely.

Even if you don’t smoke, it’s also important to avoid inhaling passive smoke (or “secondhand smoke”), which can decrease your risk as well.

Manage your other conditions

Finally, if you have other medical issues — especially those associated with high cholesterol like hypertension or diabetes — managing those conditions can help decrease your cholesterol levels. It will also decrease your overall risk of cardiac issues.

There are many medications available to help people manage high cholesterol.

Statins are the class of medication that’s typically used for management. They inhibit the production of cholesterol.

While they’re prescribed for the acquired type of high cholesterol, they can also be given to children with familial hypercholesterolemia. However, children need to be monitored more frequently than adults due to side effects.

Most people will require other medications in addition to statins to appropriately manage their cholesterol levels. Some examples include:

Outside of prescription medications, adding nutraceuticals may be helpful as well. Nutraceuticals are natural dietary supplements, isolated nutrients, and special diets that may alter cellular function.

A few options include:

These can work to lower cholesterol levels as well. But supplements alone are typically not enough for treating hereditary high cholesterol and are often used in combination with prescription medications.

If you’re considering taking any supplement or vitamin, consult your doctor first to make sure it’s safe to take with your other medications. They may also be able to help you find the right one and dose that’s best for your health.

Many people think of high cholesterol and heart attacks, but FH can lead to several health issues other than heart attacks.

If left untreated, familial hypercholesterolemia may lead to:

  • chest pains (angina)
  • increased risk of stroke
  • coronary artery disease
  • LDL cholesterol levels greater than 500 mg/dL
  • xanthomas, cholesterol deposits in the tendons
  • xanthelasmas, yellowish waxy deposits that can occur around the eyelids
  • corneal arcus, a white, gray, or bluish ring around the eye

All of these issues are due to excess cholesterol not being taken up by the liver. Instead, the cholesterol is deposited into the bloodstream, leading to complications.

Diagnosing familial hypercholesterolemia can be difficult unless you and your doctor know there’s a history of high cholesterol or FH in your family. However, blood tests can reveal a fasting blood lipid level of 190 mg/dL or greater in adults, or 160 mg/dL or greater in children.

The presence of xanthoma or corneal arcus before age 40 is also usually a good indicator of FH. And any family history of premature coronary artery disease or high cholesterol is also a sign that you may have FH.

Another way to find out about a diagnosis is to get genetic testing done. This can help identify genetic anomalies that lead your body to have high levels of LDL cholesterol. Still, this may not be accessible to everyone.

Yes, children can be treated for hereditary high cholesterol. It’s actually important to start lifestyle changes early to help improve health and manage cholesterol levels.

If a child’s cholesterol levels are significantly high, they may need to start taking medications to minimize any health complications later in life.

It’s important for children to be monitored more frequently when they start taking medications. There is a chance of developing muscle breakdown. In this case, they would be given a 3-month “holiday” to allow the levels in their body to decrease.

Nevertheless, the earlier FH is treated, the less risk there is of developing heart issues later in life.

While there is currently no cure for hereditary high cholesterol, it can be managed.

Because it’s genetic and not acquired, someone with FH will have to monitor and manage it throughout life to ensure no complications arise.

Familial hypercholesterolemia can be a challenging condition that someone will need to manage throughout their life. When left untreated, it can increase your risk of developing cardiac issues.

FH differs from typical high cholesterol in that it is a genetic condition and not acquired.

If you had high cholesterol in childhood or have a family history of high cholesterol, it’s important to get your cholesterol levels tested routinely.

If you think you or your child may have symptoms of FH, reach out to a healthcare professional. The earlier a treatment plan is developed, the better.