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Diagnosis & Treatment

High Cholesterol

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How is High Cholesterol Diagnosed?

Diagnosis

High cholesterol is diagnosed based on a lipid panel, a laboratory test of blood drawn from the patient by a health care professional. The panel provides measurements of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total blood cholesterol. (Patients may be asked to fast for 12 hours before getting tested to get the most accurate results.) Established guidelines indicate the risk for heart disease associated with given cholesterol levels.

Because elevated cholesterol does not produce symptoms, it’s important to be tested regularly.

How is High Cholesterol Treated?

Treatment

Individuals with elevated cholesterol are often advised to try lifestyle modifications such as exercise, quitting smoking, and following a heart-healthy diet before taking medication to control their cholesterol levels.

If these measures are not successful in lowering elevated cholesterol, one of the following medications may be prescribed:

  • Statins - Drugs that slow LDL production in the liver
  • Ezetimibe - Limits the amount of dietary cholesterol absorbed by the small intestine and released into the bloodstream
  • PSCK9 inhibitors – These medications increase the amount of LDL absorbed by the liver, thereby reducing the amount circulating in the bloodstream. They are injectable and primarily given to people who cannot tolerate statin therapy.
  • Bempedoic acid - A drug that slows LDL production, similar to the statins
  • Bile-acid-binding resins - Increase bile acid production in the liver. Since cholesterol is used to produce bile acids (used in digestion), less cholesterol is released into the body.

Additional medications for high cholesterol may be prescribed to reduce high triglyceride levels. Patients who take cholesterol-lowering medications should be sure to follow dietary and lifestyle guidelines as recommended.

Do I Need Medication, Lifestyle Changes, or Both?

Do I Need Medication or Lifestyle Changes?

The decision to start treatment is about more than just a single high number; it’s about your total risk over the next 10 years.

  • Lifestyle: Almost every plan starts with "therapeutic lifestyle changes" — heart-healthy eating, regular exercise, and smoking cessation.
  • Medication: If lifestyle changes aren't enough, or if your risk is very high, your doctor may recommend:
    • Statins or non-statin therapies: Common class of medications that help your liver clear "bad" cholesterol from your blood and reduce the risk for plaque buildup in your arteries.
    • Ezetimibe: Limits the amount of dietary cholesterol absorbed by the small intestine and released into the bloodstream.
    • PCSK9 inhibitors: Medications that increase the amount of LDL absorbed by the liver, thereby reducing the amount circulating in the bloodstream. They are injectable and primarily given to people who cannot tolerate statin therapy.

These tools work in different ways to help your liver clear cholesterol more effectively.

Lifestyle changes to lower triglycerides

Lifestyle changes to lower triglycerides

For many patients, lifestyle changes, such as diet and exercise, are among the most effective ways to lower triglycerides without medication.

Nutrition

Small changes in your diet can make a big difference when it comes to your heart health.

Reduce added sugars and refined carbs

  • Limit soda, fruit juice, sweets, white bread, and pastries
  • Choose whole grains instead of white flour products

Choose healthy fats

  • Use olive oil instead of butter
  • Eat nuts, seeds, avocado
  • Limit fried and processed foods

Increase fiber

  • Fruits, vegetables, beans, and whole grains help regulate fat and sugar absorption

Eat more omega-3-rich foods

  • Fatty fish, such as salmon, sardines, trout, and mackerel

Limit alcohol

  • Even small amounts can sharply raise triglycerides in some people

Physical Activity

Regular exercise helps your body use fats more efficiently and lower your triglycerides.

Aim for:

  • At least 150 minutes per week of moderate activity (such as brisk walking)
  • Or 75 minutes of vigorous activity
  • Plus, muscle-strengthening exercises twice weekly

Weight Loss

Losing just 5–10% of body weight can significantly lower triglyceride levels and improve other heart risk factors.

Medications for high triglycerides

In addition to lifestyle changes, some people may also need medications, especially if triglycerides remain high or if cardiovascular risk is elevated.

Your doctor may recommend:

Statins

Primarily lower LDL cholesterol, but also modestly reduce triglycerides and significantly reduce heart attack and stroke risk. This is often first-line therapy when heart disease risk is present.

Fibrates

Lower triglycerides effectively and may be used when levels are very high or when statins alone are not enough.

Prescription Omega-3 Fatty Acids

Including icosapent ethyl, which has been shown in large clinical trials to reduce cardiovascular events in certain high-risk patients with elevated triglycerides.

These are different from over-the-counter fish oil supplements and are prescribed at therapeutic doses.

Niacin

May lower triglycerides but is used selectively due to side effects and limited added benefit for heart outcomes.

Your NewYork-Presbyterian physician will help determine if medication is appropriate based on:

  • Triglyceride level
  • Overall cardiovascular risk
  • Other medical conditions
  • Tolerance and safety considerations

When high triglycerides are Part of a bigger problem

In some cases, high triglycerides signal an underlying condition that needs specialized care.

Specialty evaluation may be needed if you have:

  • Triglycerides above 500 mg/dL (increased pancreatitis risk)
  • A personal or family history of severe lipid disorders
  • Recurrent pancreatitis
  • Poor response to standard therapy
  • Strong family history of early heart disease
  • Diabetes with persistent lipid abnormalities

NewYork-Presbyterian offers advanced lipid and metabolic clinics for complex or inherited disorders. If any of these risk factors apply to you, schedule a consultation today with a preventive cardiology or lipid specialist. Our team will guide you through next steps, help review your lab results, and create a personalized plan to manage high triglycerides safely and effectively.

 

FAQs

FAQs

Dietary guidelines for reducing high cholesterol generally focus on limiting foods high in saturated and trans fats that can cause raise cholesterol levels.

High cholesterol is usually genetic. However, dietary and lifestyle changes can help delay or prevent the condition. A specific genetic disorder called familial hypercholesterolemia increases the risk of heart disease at an earlier age, but this occurs in only about one in 250 people.

Yes. Reducing total cholesterol by 10% makes it possible to reduce the risk of heart disease by as much as 30%. Lowering your LDL levels and raising your HDL levels will also reduce your heart attack and stroke risk.

Because high cholesterol does not produce specific symptoms, it’s essential to get tested regularly. Whether or not you have any history of cardiovascular disease, if your lab results show cholesterol levels that fall into the borderline high or high-risk categories, be sure to seek additional guidance from your physician.

Your cholesterol numbers measure the fatty substances in your blood that help build cells. Clinicians use them to assess your long-term heart health because they can cause artery-clogging plaque if they are out of balance.

While "normal" depends on your personal health history, good cholesterol numbers for most adults are an LDL below 100 mg/dL, an HDL above 40–50 mg/dL, and triglycerides below 150 mg/dL.

Non-HDL cholesterol numbers are calculated by subtracting your "good" (HDL) cholesterol from your total cholesterol score. This provides a single value that represents all the potentially harmful, plaque-forming particles in your blood.

ApoB is a protein found on every "bad" cholesterol particle, allowing your doctor to count the exact number of particles that cause heart disease. This modern test provides a more precise risk assessment than a standard LDL test, especially for patients with complex health factors.

High cholesterol doesn't always mean you need a prescription, as we first look at your overall cholesterol numbers alongside your age, blood pressure, and family history. If lifestyle changes aren't enough, your doctor may discuss statins or non-statin therapies with you.

Most healthy adults only need a check-up every few years, but those with high cholesterol numbers or those starting new treatments may need testing every few months.

Get Care

Trust NewYork-Presbyterian for High Cholesterol Management

If you’re looking for high cholesterol and related cardiovascular risk care, schedule an appointment at one of NewYork-Presbyterian’s multiple locations throughout New York City, Westchester, or the Hudson Valley. One of our highly experienced cardiologists will provide a comprehensive evaluation to determine the cause of your high cholesterol and review all of your treatment options.

 

This content has been reviewed by the following medical editors.

Samuel Kim, MD