High levels of cholesterol can first lead directly to
a.

strokes

b.

arteriosclerosis

c.

heart attacks

d.

heart failure

okay the answer is actually arteriosclerosis. Because its the first step to having a heart attack. The definition of Arteriosclerosis is "The build-up of fats, cholesterol, and other substances in and on the artery walls." So when the build up occurs then your blood vessels start to narrow and that becomes high blood pressure. If not enough blood is being delivered to the heart then the heart starts trying to pump even harder and faster until it turns into a heart attack. so the answer is Arteriosclerosis. 
hopefully that cleared up alot of things:)