Symptoms of High Cholesterol
High cholesterol itself causes no symptoms—it is a silent condition that remains completely asymptomatic until it causes cardiovascular complications. 1
Why High Cholesterol Is Asymptomatic
Familial hypercholesterolemia is generally asymptomatic in childhood and adolescence and is rarely associated with cardiovascular events in the first 2 decades of life, despite cholesterol levels being 2 to 3 times higher than unaffected individuals. 1
The burden of hypercholesterolemia is entirely attributable to premature cardiovascular events in adulthood resulting from long-term exposure to elevated cholesterol levels and progressive atherosclerosis—not from symptoms of the cholesterol elevation itself. 1
Elevated cholesterol works silently over decades, causing atherosclerotic plaque accumulation without producing any warning signs until a catastrophic event occurs. 2
Physical Signs That May Appear (Not Symptoms)
While patients don't feel symptoms from high cholesterol, certain physical examination findings may be present in severe cases:
Tendon xanthomas (cholesterol deposits in tendons, particularly Achilles and extensor tendons of hands) can develop in familial hypercholesterolemia but are physical signs detected on examination, not symptoms experienced by the patient. 1
Xanthelasma (yellowish cholesterol deposits around eyelids) may be visible but are not symptomatic. 1
Corneal arcus (grayish-white ring around the cornea) in individuals under age 45 suggests familial hypercholesterolemia but causes no visual symptoms. 1
When "Symptoms" Actually Appear
The first "symptom" of high cholesterol is typically a cardiovascular event:
By age 50 years, 50% of men and 25% of women with untreated familial hypercholesterolemia will experience clinical cardiovascular disease, presenting as myocardial infarction, angina, or sudden cardiac death. 2
Coronary artery disease occurs in 50% of men by age 50 years and 30% of women by age 60 years with untreated familial hypercholesterolemia. 2
By age 40 years, ischemic heart disease develops in 1 in 6 men and 1 in 10 women with untreated familial hypercholesterolemia. 2
Critical Clinical Implications
The absence of symptoms does not mean absence of disease—atherosclerosis progresses silently from childhood in individuals with elevated cholesterol. 2
Every 0.26–0.39 mmol/L (10–15 mg/dL) increase in non-HDL cholesterol is associated with an additional year of vascular aging, meaning a 15-year-old with heterozygous familial hypercholesterolemia has the same atherosclerotic burden as a 20–35 year old with average lipid levels. 2
Waiting for symptoms before screening or treating is a dangerous error—by the time symptoms appear, irreversible cardiovascular damage has already occurred. 1, 2
The Bottom Line
Do not rely on symptoms to identify high cholesterol. Screening based on risk factors (family history, age, other cardiovascular risk factors) is essential because the condition remains silent until it causes potentially fatal cardiovascular events. 1, 2