Middle-aged adults who feel fine but have very high 'bad' cholesterol might be more likely to have hidden heart plaque, even if they don’t have symptoms.

In healthy-looking middle-aged Americans with low heart disease risk, higher 'bad' cholesterol is linked to more buildup in heart arteries — and the more cholesterol, the more common these buildups are.

If a middle-aged person has very high 'bad' cholesterol but feels fine, they’re more than 2.6 times as likely to have early signs of heart artery buildup — even if everything else about their health is accounted for.

Even if middle-aged people have high cholesterol, nearly half of them might still have completely clean heart arteries, and over a third show no signs of plaque buildup — so high cholesterol doesn’t always mean clogged arteries.

Even if a heart scan shows no calcium buildup, nearly 3 in 10 middle-aged people with high 'bad' cholesterol still have soft plaque in their arteries — meaning the usual heart risk test might miss early warning signs.

Middle-aged Americans who feel fine but have high 'bad' cholesterol are more likely to have hidden heart artery plaque, especially if they already show signs of artery calcification — and those with very high cholesterol have the worst kinds of plaque.