High Blood Cholesterol
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- 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 can stop or slow down the flow of blood to your
heart. When the arteries narrow, the amount of oxygen-carrying
blood is decreased. This is called coronary artery disease
(CAD). Large plaque areas can lead to chest pain called
angina. Angina happens when the heart does not receive enough
blood and the oxygen it carries. Angina is a common sign of
CAD.
Some plaques have a thin covering and burst
(rupture), releasing fat and cholesterol into the bloodstream.
The release of fat and cholesterol may cause your blood to
clot. A clot can block the flow of blood. This blockage can
cause angina or a heart attack.
Lowering your
cholesterol level decreases your chance for having a plaque
burst and cause a heart attack. Lowering cholesterol may also
slow down, reduce, or even stop plaque from building up.
Plaque and resulting health problems can also occur in
arteries elsewhere in the body.
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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.
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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.
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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.
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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
If you have 2 or
more of the risk factors in the list above, use the NHLBI 10-Year
Risk Calculator to find your risk
score. Risk score refers to the chance of having a heart
attack in the next 10 years, given as a percentage.
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:
- 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.
- 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
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.
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