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Introduction

High cholesterol occurs when there is too much or an unhealthy balance of cholesterol in the blood.  Your body needs some cholesterol for healthy functioning but too much is dangerous to your health.  High cholesterol has no symptoms.  The only way to find out if you have high cholesterol is to get tested with a simple blood test.  High cholesterol is treated with lifestyle changes, dietary changes, and medications.  Untreated high cholesterol increases the risk for heart and blood vessel disease, including heart attack and stroke.

 

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Anatomy

Cholesterol is a fat-like substance that is essential to your health.  You obtain cholesterol from the foods that you eat, but the majority of cholesterol is produced by your liver.  Cholesterol is a component in your blood, cells, and body tissues.  Your brain, nerves, muscles, skin, liver, intestines, and heart use it to function.  Your body uses cholesterol to produce hormones, vitamin D, and bile that helps to digest fat.  Cholesterol helps your nerves and brain send messages.  Cholesterol is also a component of body fat.  Your body needs cholesterol to be healthy; however, too much cholesterol is dangerous to your health.
 
A total cholesterol test shows the total amount of cholesterol in your blood.  A more detailed test, a lipid profile, includes lipoprotein measurements that are more useful and reflective of your health.  Cholesterol travels out from your liver and into your bloodstream on fat and protein carriers called lipoproteins.  The two main types are low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.  
 
Most cholesterol is LDL.  LDLs transport cholesterol away from the liver and into the bloodstream.  LDLs contain more fat than protein.  LDLs are more likely to collect on the walls of blood vessels, which can contribute to heart disease, including heart attack and stroke.  LDLs are the “bad” cholesterol.  To help people remember, the “L” in LDL is commonly referred to as “lousy.”  You want your LDL numbers to be low.
 
HDL cholesterol contains more protein than fat.  HDLs carry cholesterol away from your arteries and out of your body. High HDL levels can reduce the risk of heart attack.  HDLs are the “good” cholesterol.  The “H” in HDL is commonly referred to as “healthy.”  You want your HDL levels to be high.

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Causes

High cholesterol occurs when there is too much or an unhealthy balance of cholesterol in the blood.  High cholesterol can lead to narrowed and clogged arteries and contribute to heart disease, including heart attack and stroke.  Eating high-fat or high-cholesterol foods and inherited factors are believed to be the primary causes of high cholesterol.

Your genes control how fast LDL is produced and removed from your body.  This is a factor for high cholesterol that you have no control over.  Some people have familial hypercholesterolemia, a specific form of high cholesterol that is inherited. 

Certain medical conditions, such as liver disease, diabetes, Cushing’s syndrome, kidney disease, or an underactive thyroid, can contribute to high cholesterol.  Certain medications including birth control pills, estrogen, corticosteroids, some diuretics, and beta-blockers can increase your cholesterol levels. 

Lifestyle factors, such as smoking, excessive alcohol consumption, and lack of exercise, are associated with high cholesterol.  Your weight is another factor.  Excess weight can increase your LDL level. 

Both children and adults can have high cholesterol.  Cholesterol levels tend to increase with age.  For women, cholesterol typically increases around menopause.

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Symptoms

High cholesterol has no symptoms.  The only way to find out if you have high cholesterol is to have your cholesterol tested.  Regular cholesterol testing should begin at age twenty, unless otherwise specified by your doctor.

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Diagnosis

Your total cholesterol level can be identified with a blood test.  If your test reveals high cholesterol, another blood test called a lipid panel is used to determine your LDL, HDL, and triglyceride levels.  Triglycerides are fats that are used to build cholesterol.  High levels of triglycerides can contribute to heart disease.

A total cholesterol of 200 mg/dL or lower is desirable and puts you at a lower risk for heart disease.  The higher your total cholesterol, the greater your risk for heart disease.  A total cholesterol of 200-239 mg/dL is considered borderline high.  High total cholesterol readings are 240 mg/dL and greater.  Optimally, you want your LDL results to be low, your HDL rates to be high, and your triglyceride rates to be low to reduce your risk for heart disease. 

 

The following table is from the American Heart Association.

 

Total Cholesterol (mg/dL)                                                   Status                                           

Less than 200                                                                  Desirable

200-239                                                                            Borderline High

Greater than 240                                                             High 

LDL Cholesterol (mg/dL)   

Less than 100                                                                  Optimal 

100-129                                                                            Near Optimal/Above Optimal

130-159                                                                            Borderline High

160-189                                                                            High

Greater than 190                                                             Very High

HDL Cholesterol (mg/dL)  

Less than 40 for men, Less than 50 for women          Low 

Greater than 60                                                               High/Desirable

Triglycerides (mg/dL)  

Less than 150                                                                  Normal

150-199                                                                            Borderline High

200-499                                                                            High

500 or Higher                                                                  Very High

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Treatment

The goal of treatment for high cholesterol is to lower cholesterol levels into the healthy ranges to reduce the risk of heart disease.  High cholesterol is treated with lifestyle changes, special diets, and medications.  Your doctor will make specific recommendations for you based on the results of your lipid profile.

You should make lifestyle changes to reduce the risk factors that you can control.  This includes not smoking, losing weight, maintaining a healthy weight, and exercising regularly.  Exercise can help raise HDL and lower LDL. 

You should eat a low fat, low cholesterol, high fiber diet.  The National Cholesterol Education Program, a division of the National Heart, Lung, and Blood Institute, has eating guidelines for people with high cholesterol.  The American Heart Association’s Cholesterol Low Down is another good resource for eating and exercise guidelines.  Your doctor may make specific recommendations or refer you to a nutritionist for healthy meal planning.

If lifestyle and dietary changes alone do not lower your cholesterol into healthy ranges, your doctor will prescribe cholesterol lowering medications.  There are several types of prescription medications that work in different ways to lower cholesterol.  It is common to use more than one type of medication and for your medication to change over time.

After being diagnosed with high cholesterol, you will receive regular monitoring by your doctor.  Your doctor will evaluate your cholesterol levels, the effectiveness of your medications, and check for any medication side effects (some medications may affect liver function).  It is important that you take your medications per your doctor’s instructions and that you make and keep all of your follow up appointments.

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Prevention

You may be able to reduce the risk factors for high cholesterol that you can control.  Lifestyle changes, such as not smoking; eating a low fat, low cholesterol, and high fiber diet; maintaining a healthy weight; and getting regular exercise can help reduce your risk for high cholesterol.  Cholesterol lowering medications can reduce your cholesterol to healthy levels and lower your risk for heart disease.  You should make and attend all of your follow up appointments with your doctor.

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Am I at Risk

There are risk factors for high cholesterol that you can and cannot control. You can reduce your risk for high cholesterol by eliminating the risk factors that you can control.

Risk factors for high cholesterol:

_____ You cannot control the genes that you inherited from your parents.  Your genes determine how fast your body produces and removes LDL.  
_____ Some people have familial hypercholesterolemia, a specific form of high cholesterol that is inherited.  
_____ Cholesterol levels tend to rise with age.  Cholesterol levels tend to rise for men at age 45.
_____ Females tend to experience higher levels of cholesterol after menopause.
_____ Being overweight or obese is associated with an increased risk of high cholesterol.
_____ Smoking can increase cholesterol.  People that smoke and have high cholesterol have a greater risk for heart disease and stroke.
_____ Excessive alcohol consumption can raise cholesterol levels.
_____ A sedentary lifestyle or a lack of exercise increases the risk for high cholesterol.
_____ Certain medications, including birth control pills, estrogen, corticosteroids, some diuretics, and beta-blockers, may cause cholesterol levels to rise.
_____ Some medical conditions, such as liver disease, diabetes, Cushing’s syndrome, kidney disease, or an underactive thyroid, may contribute to high cholesterol.
_____   Eating food that is high in cholesterol or fat can increase your risk of developing high cholesterol.  Foods that come from animals have cholesterol, including meat, fish, poultry, shellfish, eggs, butter, cheese, and milk—plus products that contain these ingredients.  Foods that contain saturated fats and trans fats can raise your cholesterol levels.  Fats are most often found in high-cholesterol foods, margarines, baked goods, and processed foods, such as chips, crackers, and snack items.

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Complications

The major concern about high cholesterol is that it is a major risk factor for heart disease and stroke.  High cholesterol can cause deposits on artery walls that lead to arterial narrowing and blockages.  High cholesterol is associated with an increased risk for heart attack and stroke.

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Advancements

Cholesterol lowering medications, especially statin drugs, have improved the treatment of high cholesterol.  Lowering cholesterol is useful for preventing heart and blood vessel disease.