High cholesterol is an excessive level of cholesterol in the blood. Cholesterol is a type of lipid, or fat, that is used as a building block for hormones and for other body processes.
The body produces all the cholesterol it needs. When too much cholesterol and other fats are consumed/produced, the body cannot get rid of the excess. The fats build up in various cells and tissues of the body. Cholesterol can build up on the insides of blood vessel walls. This results in atherosclerosis, or hardening of the arteries.
LDL cholesterol is the main source of build-up on the blood vessel walls. HDL cholesterol carries cholesterol back to the liver and prevents build-up on the blood vessel walls.
A high total cholesterol or high LDL level in the blood causes no symptoms in and of itself. Instead, symptoms occur when cholesterol builds up in a part of the body that is vulnerable. For example, atherosclerosis of the arteries that supply the heart causes coronary artery disease (CAD). The individual may then have chest pain and shortness of breath.
Common causes of high cholesterol include the following: hereditydiet high in cholesterol and saturated fatexcess weightlack of physical activity and exercisesmoking
Until age 45, men tend to have higher total cholesterol levels than women do, and women tend to have higher HDL levels. This is part of the reason shy men in their 40s are four times more likely to die from heart disease than are women the same age.
However, as women age, their risk increases. After menopause, a woman's LDL level rises while her HDL level falls. Thus, her risk of heart disease continues to rise with age. After menopause, women tend to have higher LDL levels than do men of the same age.
These health conditions may increase a person's risk for high cholesterol: alcohol abusediabeteskidney diseaseliver diseaseunderactive thyroid gland, called hypothyroidism
These medicines may raise total cholesterol level: anabolic steroidscertain types of medicine to lower blood pressure, such as clonidine and methyldopasome diuretics, also called water pillsprogestins
These medicines may reduce HDL ('good" or "healthy") cholesterol: anabolic steroidssome beta-blockerssome progestins
Adults 20 years or over should be tested every five years for cholesterol, LDL, HDL, and triglycerides (with a lab test called a lipid profile). Some factors that affect cholesterol cannot be controlled. High cholesterol can run in families, for example, due to genetic factors. Many cases of high cholesterol can be prevented by choosing a healthy lifestyle.
Recommendations include the following: eating a heart-healthy diet low in cholesterol and saturated fatexercising regularlymaintaining a healthy body weightlimiting alcohol intakenot smokingseeking effective treatment for diabetes, hypothyroidism, and other health conditions
A blood cholesterol test is used to diagnose high cholesterol. This test, called a lipid profile, measures total cholesterol, LDL, HDL, and the triglycerides.
Total cholesterol results are evaluated as follows: desirable range is less than 200 milligrams per deciliter or mg/dLborderline-high is 200 to 239 mg/dLhigh cholesterol is 240 mg/dL or greater
LDL results in healthy adults are evaluated as follows:optimal is less than 100 milligrams per deciliter, or mg/dLnear optimal/above optimal is 100 to 129 mg/dLborderline high is 130 to 159 mg/dLhigh is 160 to 189 mg/dLvery high is 190 mg/dL or greater
LDL results are evaluated differently in people with certain risk factors. If a person has diabetes, or already has clinically apparent coronary artery disease, or if he shows other clinical signs of atherosclerosis, such as peripheral arterial disease, abdominal aortic aneurysm, or certain types of carotid artery disease, he should maintain an HDL level below 100 mg/dL.
For people who do not yet have any of the above conditions, their optimal LDL level is based on their computed risk of developing CAD within 10 years, using data from the Framingham heart study. This 10-year risk is calculated from a formula that takes the following into account: agecigarette smokingHDL cholesterolsystolic blood pressure, which is the top number on a blood pressure readingtotal cholesteroltreatment for high blood pressure
LDL results in healthy adults are evaluated as follows: optimal is less than 100 milligrams per deciliter, or mg/dLnear optimal/above optimal is 100 to 129 mg/dLborderline high is 130 to 159 mg/dLhigh is 160 to 189 mg/dLvery high is 190 mg/dL or greater
The LDL targets are: less than 100 mg/dL for people with a combination of the above risk factors that puts their CAD risk at 20% or higher in 10 yearsless than 130 mg/dL for individuals with two or more risk factorsless than 160 mg/dL for people with no or one risk factor
The lower the HDL level, the higher the risk for CAD.
High levels of total and LDL cholesterol greatly increase the risk of atherosclerosis, coronary artery disease, and stroke. High cholesterol levels following a heart attack increase the chance of a second heart attack.
High cholesterol is not contagious. However, some forms of high cholesterol run in families.
Recently, treatment of high cholesterol has shifted from total cholesterol to LDL cholesterol. Treatment focuses on reduction of LDL cholesterol to the optimal level, whenever possible. LDL can be lowered with therapeutic lifestyle changes (TLC). It can also be reduced with medications.
Therapeutic lifestyle changes include regular physical activity and weight reduction. TLC also includes the following dietary guidelines: 20-30 grams of total fiber per day10-25 grams of soluble fiber per daysaturated fat less than 7% of daily caloriespolyunsaturated fat less than 10% of daily caloriesmonosaturated fat up to 20% of daily caloriestotal fat 25-35% of daily caloriescarbohydrates 50-60% of daily caloriesprotein at 15% of daily caloriescholesterol less than 200 mg per day
TLC guidelines also recommend 2 grams of plant sterols/esters per day. Plant sterols are naturally found in fruits, vegetables, nuts, seeds, cereals, legumes, and other plant-based foods. Plant sterol esters are found in food products, such as certain salad dressings and food spreads.
Cholesterol-lowering medications are recommended for people whose short or long-term risk of CAD is high. These medications include:bile acid resins, such as cholestyramine (i.e., Questran) and colestipol (i.e., Colestid)nicotinic acid, also known as niacin (i.e., Niaspan, Slo-Niacin) or vitamin B3fibric acids, such as gemfibrozil (i.e., Lopid) and fenofibrate (i.e., Antara, Libofen, Lofibra, Tricor, Triglide)statins, such as atorvastatin (i.e., Lipitor), fluvastatin (i.e., Lescol, Lescol XL), lovastatin (i.e., Altoprev, Mevacor), pravastatin (i.e., Pravachol), rosuvastatin (i.e., Crestor) and simvastatin (i.e., Zocor)agents that prevent cholesterol absorption from the small intestine such as ezetimibe (i.e., Zetia)omega-three fatty acids (i.e., Omacor)combinations of the above agentsezetimibe and simvistatin (i.e., Vytorin)lovastatin and niacin (i.e., Advicor)
The choice of medications is based on the cholesterol level, the person's age, and any other health conditions.
The side effects depend on the particular medication chosen. Most cholesterol-lowering medicines can have bad effects on the liver. Blood tests are often done to measure the levels of enzymes produced by the liver. Niacin can cause flushing of the skin and itching. It may also cause nausea, vomiting, diarrhea, and high blood glucose.
Treatment of high total and LDL cholesterol is lifelong. Diet, exercise, and a healthy lifestyle are key to quality of life.
The individual will have regular cholesterol tests and visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.
