High cholesterol symptoms: what you feel, which signs you can see and when to go to your GP

In this article you can read what you feel when you have high cholesterol, which signs can be visible on the outside and when it is time to see your GP. That matters, because high cholesterol causes no symptoms, so waiting for high cholesterol symptoms tells you nothing about your level.⁠¹ The BioProfile heart and blood vessel scan gives you an indication of where you stand today in this area, as one of the 11 health areas the full scan assesses. The scan is not a diagnosis. It is insight, to see where you stand today and to help you make better choices in your diet and lifestyle. The scan does not measure your cholesterol. For that you need a blood test result.⁠¹

High cholesterol symptoms: what you feel

Usually nothing. The Hartstichting writes that you generally notice nothing from raised cholesterol and have no symptoms.⁠⁴ Thuisarts, the website of the Dutch GPs, puts it clearly: high cholesterol is not a disease, and it causes no symptoms.⁠¹

So symptoms of high cholesterol, in the sense of something you feel, do not exist. Tiredness and headaches are not named in these sources as symptoms of high cholesterol. Your heart rate is something you can measure yourself, and what a normal heart rate is has its own page. Cholesterol only shows up in a blood value.⁠¹

When is cholesterol too high

The Hartstichting says cholesterol is too high when the total is above 5 mmol/l, LDL is above 3 or non-HDL is above 3.8. For the total, 5 to 6.5 is slightly raised, 6.5 to 8 is raised and 8 or higher is very high.⁠⁴ Thuisarts adds that an LDL below 3 is usually good, with a lower limit of 2.6 or 1.8 for people at higher risk. An HDL above 1 is good, and so are triglycerides below 2.⁠¹

For healthy people who take no cholesterol medicines, a total below 5 is usually good, and your own target value depends on your risk of heart and vascular disease. A total of 8 or more sits at the top of both scales.

The value is also higher at an older age. The Lifelines study measured 133,540 Dutch adults who had no heart or vascular disease and took no cholesterol-lowering medicines. Across the men’s age groups, the median LDL value at 49 was 64 per cent higher than at 20.⁠⁵ The study did not follow people over the years. It compared age groups at a single moment.

Signs that can be visible: inherited high cholesterol

One form of high cholesterol can be visible on the outside: familial hypercholesterolaemia (FH), an inherited high cholesterol. Thuisarts names three visible signs: thickening of the tendons, such as the Achilles tendon; yellow bumps around the eyes; and a whitish-yellow ring around the coloured part of the eye in someone younger than 45.⁠² Very high values at a young age also point to FH, for example an LDL above 6 or a total above 8.⁠⁴

A pooled analysis of 104 studies covering about 11 million people estimated that about 1 in 313 people have FH, with large differences between the studies. Among people with early ischaemic heart disease, the share was 6.7 per cent.⁠³ Put simply: on average about 1 in 300 people have FH, and among people with early ischaemic heart disease it is about 1 in 15.

A Copenhagen study followed 12,745 adults for up to 33 years. The 563 people with yellow deposits on their eyelids, called xanthelasmata, clearly had a heart attack more often than the others, even after their cholesterol was taken into account. The ring around the iris added little on its own.⁠⁶ For you, that means: a yellow spot on your eyelid deserves attention. It is a reason to go to your GP.⁠²

High cholesterol in women

Women have the same symptoms of high cholesterol as men: none that you can feel.⁠⁴ The difference lies in the timing. In the Lifelines data, the median LDL value in women was roughly the same across the age groups up to 35, and 42 per cent higher across the groups from 35 to 59.⁠⁵ The study did not follow women over the years. It compared age groups. The heart symptoms women do feel are covered in our article on heart symptoms in women.

Why a level without symptoms still counts

A European panel of experts weighed more than 200 studies with over 2 million participants. The higher the LDL, the greater the risk of atherosclerotic cardiovascular disease, the heart and vascular disease caused by narrowed arteries. The longer the exposure lasts, the greater the effect appears to be. The panel concludes that LDL causes this disease.⁠⁷ In plain words: LDL works silently and over years, which is why a number tells you more than a feeling.

What you can do with your diet

According to the Voedingscentrum, saturated fat raises LDL. The most important step to lower it is to replace foods high in saturated fat with foods high in unsaturated fat. Fibre from fruit (pectin) and from oat products (beta-glucan) also lowers LDL. Plant sterols, 1.5 to 3 grams a day, can lower LDL by 7 to 11 per cent, and the European Union sets 3 grams a day as the safe maximum.⁠⁸ In plain words: swapping fats is the biggest step, and sterols add a modest step on top. The sources do not say how quickly this works.

When to see your GP

Thuisarts names these reasons to contact your GP: thickening on a tendon, yellow bumps around the eyes, or a whitish-yellow ring around the iris before the age of 45. Two other reasons are a heart or blood vessel disease before you are 60, and a parent, child, brother or sister with inherited high cholesterol.⁠² If many people in your family have very high cholesterol, that is a sign too, and your GP can work out how high your personal risk is.⁠¹

In summary

High cholesterol causes no symptoms, so the symptoms people search for are nothing you can feel. A total above 5 counts as too high, and 8 or more sits at the top of the scale. Yellow bumps around the eyes, thickening on a tendon, a ring around the iris before you are 45, early heart disease or FH in the family can point to an inherited form. These signs are reasons to see your GP. LDL matters because it works over years without giving any signal. Swapping saturated fat for unsaturated fat is the most important step with food. The heart and vascular scan gives you insight into yourself and a starting value.