High levels of cholesterol can first lead directly to
a. strokes
b. arteriosclerosis
c. heart attacks
d. heart failure select the best answer from the choices provided.

b. arteriosclerosis

Explanation:

The high level of cholesterol in the blood first leads to a medical condition known as arteriosclerosis. In this condition, bad cholesterol is deposited on the inner walls of blood vessels (arteries) that carry oxygen and nutrients. However, continuous deposition results in the reduction of vessels' diameter (plague is formed at later stages causing a blockage in the arteries).

It is important to consider that strokes, heart attacks, and heart failure comes at later stages when the blood flow is significantly reduced due to the blockage.

PS: I would like to mention that there are two forms of cholesterol, i.e. good cholesterol and bad cholesterol. Good cholesterol helps to remove the bad cholesterol which is already deposited of the inner walls of arteries.

c. spiritual heath is subjective.