Cholesterol is a waxy, fat-like substance that your liver makes. It is also found in some foods.
Cholesterol is found in all parts of your body. It plays a vital role in your body. It makes hormones, helps you digest food, and supports workings of all the cells in your body. But your liver makes all the cholesterol that your body needs to do this.
Cholesterol circulates in your blood stream. But it's fatty while your blood is watery. Just like oil and water, the two do not mix. As a result, cholesterol travels through your bloodstream in small packages called lipoproteins. The packages are made of fat (lipids) on the inside and proteins on the outside.
Two kinds of lipoproteins carry cholesterol through your bloodstream. It's important to have healthy levels of both:
- low-density lipoproteins (LDL)
- high-density lipoproteins (HDL).
Low-density lipoproteins (LDL) carry cholesterol to all the cells in your body, including the arteries that supply blood to your heart. LDL cholesterol is sometimes called bad cholesterol because it can build up in the walls of your arteries.
The higher the level of LDL cholesterol in your blood, the greater your chances of getting heart disease.
High-density lipoproteins (HDL) carry cholesterol away from the cells in your body. HDL cholesterol is sometimes called good cholesterol because it helps remove cholesterol from your artery walls. The liver then removes the cholesterol from your body.
The higher your HDL cholesterol level, the lower your chances of getting heart disease.
Too much cholesterol in your blood is called high blood cholesterol. It can be serious. It increases your chances of having a heart attack or getting heart disease.
When the cholesterol level in your blood is too high, it can build up in the walls of your arteries. This buildup of cholesterol is called plaque. Over time, the plaque can build up so much that it narrows your arteries. This is called atherosclerosis, or hardening of the arteries. It can slow down or block the flow of blood to your heart.
This can happen to blood vessels anywhere in your body, including the ones that bring blood to your heart. They are called the coronary arteries. If plaque builds up in these arteries, the blood may not be able to bring enough oxygen to the heart muscle. This is called coronary heart disease (CHD).
The build up of plaque can lead to chest pain called angina. Angina is a common symptom of CHD. It happens when the heart does not receive enough oxygen-rich blood from the lungs.
Some plaques have a thin covering, so they may rupture or break open. A blood clot can then form over the plaque. A clot can block the flow of blood through the artery. This blockage can cause a heart attack.
Lowering your cholesterol level reduces your chances of having a plaque rupture and cause a heart attack. It may also slow down, reduce, or even stop plaque from building up. And it reduces your chances of dying from heart disease.
High blood cholesterol itself does not cause symptoms, so many people don't know that they have it. It is important to find out what your cholesterol numbers are because if you have high blood cholesterol, lowering it reduces your chances of getting heart disease or having a heart attack.
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CAUSES OF HIGH BLOOD CHOLESTEROL
Many things can affect the level of cholesterol in your blood. You can control some of these things but not others.
You can control
- what you eat
- your weight
- your activity level.
Certain foods have several types of fat that raise your cholesterol level. Saturated fat increases your LDL cholesterol level more than anything else in your diet. Saturated fat is found mostly in foods that come from animal sources such as egg yolks, meat, and milk products, including butter, cream and cheese. These foods also contain cholesterol.
Trans fatty acids, or trans fats, also raise your LDL cholesterol level. These mostly come from vegetable oil that has gone through a process called hydrogenation to make it hard. Examples of foods containing trans fats include many convenience foods such as doughnuts, French fries, cookies, cakes and pastries.
Being overweight tends to
*increase your LDL level
*lower your HDL level
*increase your total cholesterol level.
If you don't exercise regularly, you may gain weight. This could increase your LDL cholesterol level. Regular exercise can help you lose weight and lower your LDL level. It can also help you increase your HDL level. You cannot control some things that can affect the level of cholesterol in your blood, including
- your heredity
- your age
- your sex.
High blood cholesterol can run in families. For most people, their cholesterol level is the result of an interaction between their genes and their lifestyles.
As we get older, our cholesterol levels rise.
- Before menopause, women tend to have lower total cholesterol levels than men of the same age.
- After menopause, women's LDL (bad) cholesterol levels tend to increase.
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SYMPTOMS & DIAGNOSIS
High blood cholesterol usually does not have any signs or symptoms. Many people don't know that their cholesterol levels are too high.
Everyone age 20 and older should have their cholesterol levels checked at least once every 5 years. If your cholesterol level is high, you will have to be tested more often. You and your doctor should discuss how often you should be tested.
Your doctor will take a sample of blood from a vein in your arm and send it to the laboratory to find out the level of cholesterol in your blood.
The recommended test is called a lipoprotein profile. It will show your
- total cholesterol
- LDL (bad) cholesterol, the main source of cholesterol buildup and blockage in your arteries
- HDL (good) cholesterol, which helps keep cholesterol from building up in your arteries
- triglycerides, another form of fat in your blood.
You should not eat or drink anything except water or black coffee for 9 to 12 hours before taking the test.
If you can't have a lipoprotein profile done, a different blood test will tell you your total cholesterol and HDL (good) cholesterol levels. You do not have to fast before this test.
If this test shows that your total cholesterol is 200 mg/dL or higher, or that your HDL (good) cholesterol 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. The levels of blood cholesterol that are most important to know are listed on the next three pages.
Here are the ranges for total cholesterol levels. Do you know how your cholesterol numbers compare?
| Total Cholesterol Level | Category |
|---|---|
| Less than 200 mg/dL | Desirable |
| 200 to 239 mg/dL | Borderline high |
| 240 mg/dL and above | High |
Here are the ranges for LDL cholesterol levels. Do you know how your LDL cholesterol level compares?
| LDL Cholesterol Level | Category |
|---|---|
| Less than 100 mg/dL | Optimal |
| 100 - 129 mg/dL | Near optimal |
| 130 - 159 mg/dL | Borderline high |
| 160 - 190 mg/dL | High |
| 190 mg/dL and above | Very high |
Here are the ranges for HDL cholesterol levels. Do you know how your HDL cholesterol level compares?
| HDL Cholesterol Level | 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 |
A lipoprotein profile will also show the level of triglycerides in your blood. Triglycerides are another kind of fat that your liver makes. They can also signal an increased chance of developing heart disease. Normal levels of triglycerides are less than 150 mg/dl. If your triglyceride levels are borderline high (150-199 mg/dL) or high (200 mg/dL or more), you may need treatment.
Things that can increase your triglyceride levels include
- overweight
- physical inactivity
- cigarette smoking
- excessive alcohol use
- diabetes.
Other things that can increase your triglyceride levels include
- a very high carbohydrate diet
- certain diseases and drugs
- genetic disorders. TOP OF PAGE
TREATMENT
The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) or bad cholesterol level enough to reduce your chances of having a heart attack or developing a disease caused by narrowing of the arteries.
There are two main ways to lower your cholesterol -- through Therapeutic Lifestyle Changes (TLC) or with medicines.
Studies have shown that lowering LDL (bad) cholesterol can prevent heart attacks and reduce deaths from heart disease in both men and women. It can slow, stop, or even reverse the buildup of plaque. It can also lower the cholesterol content in some plaques. This makes the plaques more stable and less likely to burst and cause a heart attack.
Lowering LDL cholesterol is especially important for people who already have heart disease or have had a heart attack -- it will reduce the chances of having another heart attack and can actually prolong life.
You and your doctor will decide on your goal LDL level. Your goal LDL cholesterol level depends on your level of risk for developing heart disease or for having a heart attack at the time you start treatment. The higher your risk, the lower your goal LDL should be.
Major risk factors that affect your LDL goal include
- cigarette smoking
- high blood pressure (140/90 mmHg or higher), or being 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).
Based on your LDL-lowering goal and your LDL level, you and your doctor will develop a plan for treating your high blood cholesterol. When you are under treatment, your doctor will check you regularly to make sure your cholesterol level is controlled and see if you have developed any side effects.
While under treatment, you should continue to take any other medicines that your doctor has prescribed for other health problems -- for example, high blood pressure or diabetes. It is important that you take ALL medicines as your doctor prescribes. The combination of medicines may lower your risk for heart disease or heart attack.
Also, get help with quitting smoking and losing weight if they are risk factors for you.
Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if you have them. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking medicines.
Therapeutic Lifestyle Changes, or TLC, is a set of lifestyle changes that can help you lower your LDL cholesterol. TLC is the foundation of LDL-lowering treatment for everyone whose LDL is higher than their goal LDL. TLC includes
- a cholesterol-lowering diet (the TLC diet)
- weight management
- physical activity
The TLC diet recommends
- limiting the amount of saturated fat, trans-fat, and cholesterol you eat
- eating only enough calories to achieve or maintain a healthy weight
- increasing the soluble fiber in your diet by eating foods such as oatmeal, kidney beans, and apples
- adding cholesterol-lowering foods, such as juices or margarines that contain plant sterols or stanols.
Weight management is an important part of TLC. If you are overweight, losing weight can help lower your LDL cholesterol. Weight management is especially important for people who have high triglyceride and/or low HDL levels and for people who are overweight and/or have a large waist measurement. Too large a waist is defined as a waist measurement of 40 or more inches for men and 35 or more inches for women.
Physical activity is another important part of TLC. Regular physical activity is recommended for everyone. It can help raise HDL (good) cholesterol levels, and it can help lower LDL (bad) cholesterol levels.
Physical activity is especially important for people who have high triglyceride and/or low HDL levels, and for people who are overweight and/or have a large waist measurement.
The second way to lower your cholesterol is with drug treatment. If TLC (Therapeutic Lifestyle Changes) cannot lower your LDL cholesterol level enough by itself, you may need to add cholesterol-lowering drugs. These medicines are used together with TLC to help lower your LDL (bad) cholesterol level.
Even if you begin drug treatment, you will need to continue the TLC lifestyle changes. TLC can not only lower your cholesterol, it can also do other things that reduce your risk of coronary heart disease (CHD). And, it can let you use a lower dose of your cholesterol-lowering medicine.
Drug treatment does not "cure" high blood cholesterol. It simply controls it. You must continue taking your medicine to keep your cholesterol level in the recommended range.
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