High Cholesterol
High cholesterol
Definition
Cholesterol is a waxy substance that’s found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease.
When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.
High cholesterol (hypercholesterolemia) can be inherited, but is often preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.
Symptoms
High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.
When to see a doctor
Ask your doctor for a baseline cholesterol test at age 20 and then have your cholesterol retested at least every five years. If your test results aren’t within desirable ranges, your doctor may recommend more frequent measurements. Your doctor may also suggest you have more frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, like smoking, diabetes or high blood pressure.
Causes
Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:
Factors within your control — such as inactivity, obesity and an unhealthy diet — contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.
Risk factors
You’re more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:
Complications
High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits — called plaques — can reduce blood flow through your arteries, which can cause complications, such as:
Tests and diagnosis
A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:
For the most accurate measurements, don’t eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.
Interpreting the numbers
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your lipid panel (cholesterol test) results back to see if your cholesterol falls in ideal levels.
Total cholesterol (U.S. and some other countries)
LDL cholesterol (U.S. and some other countries)
HDL cholesterol (U.S. and some other countries)
Triglycerides (U.S. and some other countries)
The American Heart Association (AHA) recommends that a triglyceride level of 100 mg/dL (1.3 mmol/L) or lower is considered “optimal.” The AHA says this optimal level would improve your heart health. However, the AHA doesn’t recommend drug treatment to reach this level. Instead, for those trying to lower their triglycerides to this level, lifestyle changes such as diet, weight loss and physical activity are encouraged. That’s because triglycerides usually respond well to dietary and lifestyle changes.
LDL targets differ
Because LDL cholesterol is a major risk factor for heart disease, it’s the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.
Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you’re at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L). In general, the lower your LDL cholesterol level is, the better.
You’re considered to be at a high risk of heart disease if you:
In addition, two or more of the following risk factors might also place you in the high-risk group:
Treatments and drugs
Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you’ve made these important lifestyle changes and your total cholesterol — and particularly your LDL cholesterol — remains high, your doctor may recommend medication.
The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:
Medications for high triglycerides
If you also have high triglycerides, your doctor may prescribe:
Effectiveness varies
Most cholesterol medications are well tolerated, but effectiveness varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend liver function tests every few months to monitor the medication’s effect on your liver.
Lifestyle and home remedies
Lifestyle changes are essential to improve your cholesterol level. To bring your numbers down, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit.
Lose extra pounds
Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss — and ways to overcome them. Set long-term, sustainable goals.
Eat heart-healthy foods
What you eat has a direct impact on your cholesterol level. In fact, a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people.
You may have noticed more food labels now market their products as “trans fat-free.” But don’t rely only on this label. In the United States, if a food contains less than 0.5 grams of trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the ingredients list. If a food contains a partially hydrogenated oil, that’s a trans fat, and you should look for an alternative.
Exercise regularly
Regular exercise can help improve your cholesterol levels. With your doctor’s OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group. And, you don’t need to get all 30 to 60 minutes in one exercise session. If you can squeeze in three to six 10-minute intervals of exercise, you’ll still get some cholesterol-lowering benefits.
Don’t smoke
If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don’t end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker’s. Within 15 years, your risk of heart disease is similar to that of someone who’s never smoked.
Alternative medicine
Few natural products have been proven to reduce cholesterol, but some might be helpful. With your doctor’s OK, consider these cholesterol-lowering supplements and products:
You may have also heard of another supplement to reduce cholesterol, red yeast rice. Some brands of red yeast rice contain lovastatin, the active ingredient in the drug Mevacor. This can be unsafe, since there’s no way to determine the quantity or quality of the lovastatin in the supplement.
If you choose to take cholesterol-lowering supplements, remember the importance of a healthy lifestyle. If your doctor prescribes medication to reduce your cholesterol, take it as directed. Make sure your doctor knows which supplements you’re taking as well.
Prevention
The same heart-healthy lifestyle changes that can lower your cholesterol can help prevent you from having high cholesterol in the first place. To help prevent high cholesterol, you can:
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