Too much cholesterol (ko-LES-ter-ol)
in the blood, or high blood cholesterol, can be serious. People with
high blood cholesterol have a greater chance of getting heart
disease. High blood cholesterol itself does not cause symptoms, so
many people are unaware that their cholesterol level is too high.
WHAT IS CHOLESTEROL?
To understand high blood
cholesterol, it is important to know more about cholesterol.
Cholesterol is a waxy, fat-like substance that is found in all cells
of the body. Your body needs some cholesterol to work the right way
and makes all the cholesterol you need. Cholesterol is also found in
some of the foods you eat. You use cholesterol to make hormones,
Vitamin D, and substances that help you digest foods.
Blood is watery and cholesterol
is fatty. Just like oil and water, the two do not mix. So, in order
to travel in the bloodstream, cholesterol is carried in small
packages called lipoproteins (lip-o-PRO-teens). The small packages
are made of fat (lipid) on the inside and proteins on the outside.
Two kinds of lipoproteins carry cholesterol throughout your body. It
is important to have healthy levels of both:
LDL (low density lipoprotein)
cholesterol is sometimes called "bad" cholesterol. High LDL
cholesterol leads to a buildup of cholesterol in arteries. The
higher the LDL level in your blood, the greater chance you have for
getting heart disease.
HDL (high density lipoprotein)
cholesterol is sometimes called "good" cholesterol. HDL carries
cholesterol from other parts of your body back to your liver. The
liver removes the cholesterol from your body. The higher your HDL
cholesterol level, the lower your chance of getting heart disease.
WHAT IS
HIGH BLOOD CHOLESTEROL?
Too much cholesterol in your blood can build up
in the walls of your arteries (blood vessels that carry blood from
the heart to other parts of the body). This buildup of cholesterol
is called plaque (PLACK). Over time, plaque can cause narrowing of
the arteries. This is called atherosclerosis (ath-er-o-skler-O-sis)
or "hardening of the arteries." Special arteries, called coronary
arteries, bring blood to the heart. Narrowing of your coronary
arteries due to plaque
OTHER
NAMES FOR HIGH BLOOD CHOLESTEROL
Hypercholesterolemia
Hyperlipidemia.
WHAT
CAUSES HIGH BLOOD CHOLESTEROL?
A variety of things can affect the
cholesterol levels in your blood. Some of these things you can
control and others you cannot.
You can control:
What you eat. Certain foods have types of
fat that raise your cholesterol level.
Saturated fat raises your LDL cholesterol
level more than anything else in your diet.
Trans fatty acids (trans fats) are made
when vegetable oil is "hydrogenated" to harden it. Trans fatty
acids also raise cholesterol levels.
Cholesterol is found in foods that come
from animal sources, for example, egg yolks, meat, and cheese.
Your weight. Being overweight tends to
increase your LDL level, lower your HDL level, and increase your
total cholesterol level.
Your activity. Lack of regular exercise can
lead to weight gain and raise your LDL cholesterol level.
Regular exercise can help you lose weight and lower your LDL
level. It can also help you raise your HDL level.
You cannot control:
Heredity. High blood cholesterol can run in
families. An inherited genetic condition (familial
hypercholesterolemia) results in very high LDL cholesterol
levels. It begins at birth, and results in a heart attack at an
early age.
Age and sex. Starting at puberty, men have
lower levels of HDL than women. As women and men get older,
their LDL cholesterol levels rise. Younger women have lower LDL
cholesterol levels than men, but after age 55 they have higher
levels than men.
WHAT
ARE THE SINGS AND SYMPTOMS OF HIGH BLOOD CHOLESTEROL?
There are usually no signs or symptoms of high blood cholesterol.
Many people don't know that their cholesterol level is too high.
Everyone age 20 and older should have their cholesterol levels
checked at least once every 5 years. You and your doctor can discuss
how often you should be tested. How is High Blood Cholesterol
Diagnosed?
High blood cholesterol is diagnosed by checking levels of
cholesterol in your blood. It is best to have a blood test called a
lipoprotein profile to measure your cholesterol levels. Most people
will need to "fast" (not eat or drink anything) for 9 to 12 hours
before taking the test.
The lipoprotein profile will give information about your:
Total cholesterol
LDL (bad) cholesterol: the main source of
cholesterol buildup and blockage in the arteries
HDL (good) cholesterol: the good cholesterol
that helps keep cholesterol from building up in arteries
Triglycerides: another form of fat in your
blood.
If it is not possible to get a lipoprotein profile done, knowing
your total cholesterol and HDL cholesterol can give you a general
idea about your cholesterol levels. Testing for total and HDL
cholesterol does not require fasting. If your total cholesterol is
200 mg/dL or more, or if your HDL is less than 40 mg/dL, you will
need to have a lipoprotein profile done.
Cholesterol levels are measured in milligrams (mg) of cholesterol
per deciliter (dL) of blood. See how your cholesterol numbers
compare to the tables below.
Total Cholesterol Level
Total Cholesterol Category
Less than 200 mg/dL
Desirable
200-239 mg/dL
Borderline high
240 mg/dL and above
High
LDL Cholesterol Level
LDL Cholesterol Category
Less than 100 mg/dL
Optimal
100-129 mg/dL
Near optimal/above optimal
130-159 mg/dL
Borderline high
160-189 mg/dL
High
190 mg/dL and above
Very high
HDL Cholesterol Level
HDL Cholesterol Category
Less than 40 mg/dL
A major risk factor for heart
disease.
40 - 59 mg/dL
The higher, the better.
60 mg/dL and above
Considered protective against heart
disease.
Triglycerides can also raise your risk for heart disease. Levels
that are borderline high (150-199 mg/dL) or high (200 mg/dL or more)
may need treatment. Things that can increase triglycerides include:
Overweight
Physical inactivity
Cigarette smoking
Excessive alcohol use
Very high carbohydrate diet
Certain diseases and drugs
Genetic disorders.
HOW IS
HIGH BLOOD CHOLESTEROL TREATED?
The main goal of cholesterol-lowering treatment is to lower your LDL
level enough to reduce your risk of having a heart attack or other
diseases caused by hardening of the arteries. In general, the higher
your LDL level and the more risk factors you have, the greater your
chances of developing heart disease or having a heart attack. (A
risk factor is a condition that increases your chance of getting a
disease.) Some people are at high risk for heart attack because they
already have heart disease. Other people are at high risk for
developing heart disease because they have diabetes or a combination
of risk factors for heart disease. Follow the steps below to find
out your risk for getting heart disease.
Check the list to see how many of the risk factors you have. These
are the risk factors that affect your LDL goal:
Cigarette smoking
High blood pressure (140/90 or higher or on
blood pressure medicine)
Low HDL cholesterol (less than 40 mg/dL)*
Family history of early heart disease (heart
disease in father or brother before age 55; heart disease in mother
or sister before age 65)
Age (men 45 years or older; women 55 years or
older).
* If your HDL cholesterol is 60 mg/dL or
higher, subtract 1 from your total count
Use your medical history, number of risk factors, and risk score to
find your risk of developing heart disease or having a heart attack
in the table below.
If you have
You Are in Category
And Your LDL Goal is
Heart disease, diabetes or risk
score more than 20%
I. Highest Risk
Less than 100 mg/dL
2 or more risk factors and risk
score 10 to 20%
II. Next Highest Risk
Less than 130 mg/dL
2 or more risk factors and risk
score less than 10%
III. Moderate Risk
Less than 130 mg/dL
0 or 1 risk factor
IV. Low to Moderate Risk
Less than 160 mg/dL
After following the above steps, you should have an idea about your
risk for getting heart disease or having a heart attack. The higher
your risk, the lower your LDL goal. There are 2 main ways to lower
your cholesterol:
Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering
diet (called the TLC Diet), physical activity, and weight
management. TLC is for anyone whose LDL is above goal.
Drug Treatment--if cholesterol-lowering drugs are needed, they are
used together with TLC treatment to help lower your LDL.
The higher your risk for heart disease, the lower your LDL goal will
be. Your doctor will set your LDL goal. Using the following guide,
you and your doctor can develop a possible plan for treating your
high blood cholesterol.
Category I, Highest Risk, your LDL goal is less than 100 mg/dL.
Your LDL Level
Treatment
If your LDL is 100 or above
You will need to begin the TLC diet
together with drug treatment.
Even if your LDL is below 100
You should follow the TLC diet on
your own to keep your LDL as low as possible.
Category II, Next Highest Risk, your LDL goal is less than 130
mg/dL
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin the TLC diet
If your LDL is 130 or more after 3
months on the TLC diet
You may need drug treatment along
with the TLC diet.
If your LDL is less than 130
You will need to follow the heart
healthy diet.
Category III, Moderate risk, your LDL goal is less than 130 mg/dL.
Your LDL Level
Treatment
If your LDL is 130 or above
You will need to begin treatment
with the TLC diet
If your LDL is 160 or more after
you have tried the TLC diet for 3 months
You may need drug treatment along
with the TLC diet.
If your LDL is less than 130
You will need to follow the heart
healthy diet.
Category IV, Low to Moderate Risk, your LDL goal is less than 160
mg/dL
Your LDL Level
Treatment
If your LDL is 160 or above
You will need to begin the TLC diet
If your LDL is still 160 or more
after 3 months on the TLC diet
You may need drug treatment along
with the TLC diet.
If your LDL is less than 160 mg/dL
You will need to follow the heart
healthy diet.
Lowering Cholesterol with TLC
TLC is a set of lifestyle changes you can make to help lower your
LDL cholesterol. The main parts of TLC are:
The TLC Diet
The TLC Diet recommends:
Limiting the amount of saturated fat and
cholesterol you eat.
Eating only enough calories to achieve or
maintain a healthy weight.
Increasing the soluble fiber in your diet. For
example, oatmeal, kidney beans, and apples are good sources of
soluble fiber.
Adding cholesterol-lowering food such as
margarines that contain plant sterol or stanol esters for some
people.
WEIGHT
MANAGEMENT
Losing weight if you are
overweight can help lower LDL. Weight management is especially
important for those with a group of risk factors that includes high
triglyceride and/or low HDL levels and being overweight with a large
waist measurement (more than 40 inches for men and more than 35
inches for women).
Physical Activity
Regular physical activityis recommended for everyone. It can help
raise HDL and lower LDL and is especially important for those with
high triglyceride and/or low HDL levels who are overweight with a
large waist measurement.
Cholesterol-lowering Medicines
Along with changing the way you eat and exercising regularly, your
doctor may prescribe medicines to help lower your cholesterol. Even
if you begin drug treatment, you will need to continue TLC. Drug
treatment controls but does not "cure" high blood cholesterol.
Therefore, you must continue taking your medicine to keep your
cholesterol level in the recommended range.
There are five major types of cholesterol-lowering medicines:
1.
Statins
Very effective in lowering LDL ("bad")
cholesterol levels Safe for most people Rare side effects to watch for are liver and
muscle problems. Bile Acid Sequestrants (seh-KWES-trants) Help lower LDL cholesterol levels Sometimes prescribed with statins Not usually prescribed as the only medicine to
lower cholesterol Nicotinic (Nick-o-tin-ick) Acid Lowers LDL cholesterol and triglycerides, and
raises HDL ("good") cholesterol Should only be used under a doctor's
supervision.
2.
Fibrates
Lower triglycerides May increase HDL (good) cholesterol levels When used with a statin, may increase the
chance of muscle problems
3.
Ezetimibe
Lowers LDL cholesterol May be used with statins or alone
Acts within the intestine to block cholesterol absorption When you are under treatment, you will be
checked regularly to:
Make sure your cholesterol level is in
control
Check for other health problems
You may take medicines for other health
problems. It is important that you take ALL medicines as
prescribed by your doctor. The combination of medications may
lower your risk for heart disease or heart attack.
When trying to lower your cholesterol or
keep it low, it is important to remember to follow your
treatments for other conditions you may have such as high blood
pressure. Get help with quitting smoking and losing weight if
they are risk factors for you.
Summary
Too much cholesterol in the blood is called
high blood cholesterol or hypercholesterolemia. High blood cholesterol increases the chance of
having a heart attack or some other sign of heart disease like chest
pain (angina). Cholesterol lowering is important for
everyone-young, middle-aged, and older adults, and both men and
women. Cholesterol is a fat-like substance that is
made in your body. Cholesterol is also in some foods that you eat.
Your body needs some cholesterol to work the right way. Your body
makes all the cholesterol it needs. Eating too much saturated fat and cholesterol
raises the level of cholesterol in your blood. Too much cholesterol in your blood can build up
in the walls of arteries. This is called plaque. There are no signs or symptoms of high blood
cholesterol.
Many people don't know that their cholesterol level is
too high. High blood cholesterol is diagnosed by checking
cholesterol levels in your blood. A blood test called a lipoprotein profile
measures the cholesterol levels in your blood and is the recommended
test. It is important that everyone age 20 and older
get their cholesterol checked at least once every 5 years. Many people are able to lower their cholesterol
levels by eating a low saturated fat and low cholesterol diet,
exercising, and losing weight if needed. Some people will need to take medicines
prescribed by their doctor to lower their cholesterol in addition to
eating a low saturated fat diet, losing weight if needed, and
exercising. High Blood Pressure
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substance that is found in all cells
of the body. Your body needs some cholesterol to work the right way
and makes all the cholesterol you need. Cholesterol is also found in
some of the foods you eat. You use cholesterol to make hormones,
Vitamin D, and substances that help you digest foods. 
