High Cholesterol

• 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.

• 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 symptom of heart disease, like chest pain (angina).

• Lowering cholesterol is important for everyone—young, middle-aged, and older adults, and both men and women.

• 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 and low cholesterol diet, exercising, and losing weight if needed.
 
What Is 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. Your body makes all the cholesterol it needs.
• Cholesterol is also found in some of the foods you eat.
• Your body uses cholesterol to make hormones, vitamin D, and substances that help you digest foods.

Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both:
• Low-density lipoprotein (LDL) 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 of getting heart disease.
• High-density lipoprotein (HDL) 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.

Causes

You can control:
• What you eat. Certain foods have types of fat that raise your cholesterol level.
• Saturated fat raises your low-density lipoprotein (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 high-density lipoprotein (HDL) level, and increase your total cholesterol level.
• Your activity. Lack of regular exercise can lead to weight gain, which could 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 may result 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, women have higher levels than men.
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

Treatment
The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) level enough to reduce your risk of having a heart attack or 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.
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There are two 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.
Cholesterol-Lowering Medicines
Along with suggesting that you change the way you eat and exercise 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.

The five major types of cholesterol-lowering medicines are:
• 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
• Help lower LDL cholesterol levels
• Sometimes prescribed with statins
• Not usually prescribed as the only medicine to lower cholesterol
• Nicotinic Acid
• Lowers LDL cholesterol and triglycerides, and raises HDL (good) cholesterol
• Should only be used under a doctor's supervision
• Fibrates
• Lower triglycerides
• May increase HDL (good) cholesterol levels
• When used with a statin, may increase the chance of muscle problems
• Ezetimibe
• Lowers LDL cholesterol
• May be used with statins or alone
• Acts within the intestine to block cholesterol absorption

Written by Dr. Mark Steiner, Cardiologist in Orlando