Cholesterol & Cardiovascular HealthLong-term condition

High Cholesterol

Also called: dyslipidemia, high LDL, hyperlipidemia, high blood lipids

Cholesterol levels — particularly LDL — that raise the long-term risk of heart attack and stroke. It causes no symptoms and is found through a blood test.

Quick answer

What it is: Cholesterol is a fat the body needs, carried in the blood by particles. LDL particles deposit cholesterol into artery walls; when LDL stays high, those deposits build up over years.
Common symptoms: None. High cholesterol is silent and is found on a blood test, usually done as part of cardiovascular risk screening.
How it's treated: Diet and activity changes, and medication — most often a statin — when overall cardiovascular risk warrants it.
Who can help: A physician or nurse practitioner assesses your risk and sets an LDL target. Pharmacists help with side effects, adherence and reviews.
Warning signs: Chest pain, sudden weakness on one side or difficulty speaking are signs of a heart attack or stroke and need 911, not a cholesterol test.

Managing this long term? Pill4Me pharmacists in Chilliwack can help.

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What is high cholesterol?

Cholesterol is not a poison — the body uses it to build cell membranes and hormones. The problem is transport. LDL particles deliver cholesterol to tissues, and when there are more of them than the body needs, they lodge in artery walls and set off an inflammatory process that builds plaque. HDL particles carry cholesterol back to the liver, which is why the two are often described as 'bad' and 'good', though the picture is more nuanced than that shorthand suggests.

What is being treated is not really a number, it is risk. Two people with identical LDL can have very different chances of a heart attack in the next decade depending on age, blood pressure, smoking, diabetes and family history. That is why treatment decisions in Canada are usually based on overall cardiovascular risk rather than cholesterol alone, and why someone who has already had a heart attack is treated more aggressively than someone with the same number and no other risk factors.

Common symptoms

High cholesterol produces no symptoms of its own. It is detected through bloodwork. In rare inherited forms, physical signs can appear:

Fatty deposits in the tendons, particularly the Achilles
Yellowish deposits around the eyelids
A pale ring around the cornea appearing at a young age
A strong family history of heart attacks before age 55 in men or 65 in women, which can point to familial hypercholesterolemia

Having these symptoms does not confirm a diagnosis — they overlap with other conditions. Assessment by a pharmacist, physician or nurse practitioner is what establishes the cause.

Causes and risk factors

What causes it

Genetics, which set much of the baseline — familial hypercholesterolemia is more common than most people assume and causes very high LDL from a young age
Diet high in saturated and trans fats
Other conditions including hypothyroidism, kidney disease and poorly controlled diabetes, which raise lipids secondarily
Some medications, including certain steroids and immunosuppressants

What raises the risk of developing it

Family history of high cholesterol or early heart disease
Age
Smoking, which lowers HDL and damages artery walls
Type 2 diabetes
High blood pressure
Carrying extra weight, particularly abdominal
Low physical activity
Regular alcohol above recommended limits

Risk factors make a condition more likely across a population — they are not causes, and having several does not mean you will develop it.

When should I seek medical care?

Seek urgent or emergency care

Chest pain or pressure, pain spreading to the arm or jaw, or breathlessness with sweating — call 911
Sudden weakness or numbness on one side, difficulty speaking, or sudden vision loss — call 911
Severe unexplained muscle pain or weakness with dark urine while on a statin — this needs same-day medical assessment

If you are unsure how urgent something is, call 8-1-1 to speak with a HealthLink BC nurse at any hour, or 911 in an emergency.

Worth asking a pharmacist

Muscle aches after starting a statin — this is the most common reason people stop, and it is often fixable
Questions about whether a supplement or over-the-counter product interacts with your statin
Missed doses, or uncertainty about what time of day to take it
Cost and coverage questions
Whether grapefruit matters with your particular statin — it does with some and not others

See a physician or nurse practitioner

Cholesterol that is not reaching the target you were given
Muscle symptoms that are severe, or that persist after a pharmacist review
A new diagnosis in the family of early heart disease
Planning a pregnancy, since statins are stopped beforehand

How is high cholesterol treated?

Lifestyle measures

Replacing saturated fats with unsaturated ones, which lowers LDL more reliably than cutting dietary cholesterol
Soluble fibre — oats, legumes, psyllium — which has a modest but real LDL effect
Regular aerobic activity, which mainly raises HDL and improves overall risk
Stopping smoking, which is one of the largest single reductions in cardiovascular risk available
Weight management where appropriate

Medication

Statins are the first-line medication and the class with the strongest evidence for preventing heart attacks and strokes. Rosuvastatin and atorvastatin are the two used most in Canada. Ezetimibe is often added when a statin alone does not reach target, or used when statins are not tolerated. Newer injectable options such as PCSK9 inhibitors are reserved for high-risk patients or familial hypercholesterolemia and generally require Special Authority. The choice depends on how much LDL reduction is needed and what you tolerate.

Monitoring

A lipid panel is usually repeated a few months after starting or changing treatment, then periodically. Liver enzymes are checked if symptoms suggest a problem rather than routinely for most patients. Muscle symptoms are worth reporting whenever they appear rather than waiting for the next test.

This is a general overview, not a treatment plan. What is right for you depends on your history, your other conditions and everything else you take — that is a conversation with your prescriber or pharmacist.

Medications used for high cholesterol

These are commonly used in Canada for this condition. Being listed here does not mean a medication is appropriate for you — that depends on your assessment.

Crestor

rosuvastatin calcium

A statin taken once daily to lower LDL cholesterol and reduce long-term heart attack and stroke risk.

Lipitor

atorvastatin calcium

One of the most widely prescribed statins in Canada, taken once daily to lower LDL cholesterol and cardiovascular risk.

Browse every guide in the Drug Information A–Z.

Can a BC pharmacist assess high cholesterol?

Not for diagnosis

High cholesterol is diagnosed and managed by a physician or nurse practitioner and is not among the minor ailments BC pharmacists can diagnose. Where a pharmacist genuinely helps is with statin tolerance — muscle aches are the most common reason people quietly stop taking a statin, and dose changes, switching statin, or changing the timing often resolve it. We can also run a PharmaCare-covered medication review and raise the issue with your prescriber.

Coverage in British Columbia

Statins are available as low-cost generics and are widely covered, subject to your PharmaCare plan and deductible. Some cholesterol medications — particularly the injectable PCSK9 inhibitors — require Special Authority approval. Coverage depends on the medication, your indication and your plan; Pill4Me Pharmacy can check yours at 604-705-3644.

Coverage depends on the medication, indication, PharmaCare plan and, for some medications, Special Authority requirements — see BC PharmaCare.

Frequently asked questions

What is a good LDL cholesterol level?

There is no single number that applies to everyone. Targets are set from your overall cardiovascular risk: someone who has already had a heart attack or stroke is usually given a much lower LDL target than someone at low risk with no other conditions. Ask your prescriber what target applies to you — a level that is fine for one person can be too high for another.

Do statins cause muscle pain?

Muscle aches are the most commonly reported statin side effect and the most common reason people stop. In studies, the rate of true statin-caused muscle pain is lower than the rate people report, which does not make the symptom imaginary — it means the cause is worth checking rather than assumed. Often a lower dose, a different statin, or alternate-day dosing resolves it. What should never be ignored is severe unexplained muscle pain with dark urine, which needs same-day assessment.

Can a pharmacist prescribe cholesterol medication in BC?

Not for a new diagnosis — high cholesterol is not one of the minor ailments BC pharmacists can assess and prescribe for. Pharmacists can renew or adapt existing prescriptions in certain circumstances, review your medications, and work with your prescriber on tolerance problems. If you need an assessment or a new prescription, Pill4Me's virtual clinic can connect you with a BC physician.

Can I stop my statin once my cholesterol is normal?

The normal level is usually a result of the statin, not a sign the statin is no longer needed — LDL generally returns to its previous level within weeks of stopping. That said, whether to continue is a legitimate conversation to have with your prescriber, particularly if you are having side effects or your risk profile has changed. It is a decision to make together rather than by stopping and rechecking.

Does diet alone lower cholesterol enough?

It depends where you are starting from and what your risk is. Dietary change reliably lowers LDL to a degree, and for someone at low overall risk with modestly raised cholesterol that may be enough. For someone with established heart disease, diabetes, or an inherited form of high cholesterol, diet alone generally does not achieve the reduction needed. Both are usually used together rather than as alternatives.

Related conditions

High Blood Pressure Type 2 Diabetes

Guides and services

Statin muscle aches — what to do about them How BC PharmaCare coverage works

Managing this long term?

Most of what goes wrong with long-term conditions is medication-related — interactions, side effects that quietly stop people taking things, doses that drift out of step. A pharmacist review covers all of it, and moving your prescriptions to Pill4Me means someone is watching High Cholesterol between appointments.

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Pill4Me Pharmacy is at 5625 Promontory Rd Unit 101, Chilliwack, BC. We deliver free to Chilliwack, Sardis, Promontory, Vedder and Yarrow, and you can reach a pharmacist directly at 604-705-3644.