High Cholesterol [What you need to know and do]

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High Cholesterol

Why Is Cholesterol Important?

Your blood cholesterol level has a lot to do with
your chances of getting heart disease. High blood
cholesterol is one of the major risk factors for heart
disease. A risk factor is a condition that increases
your chance of getting a disease. In fact, the higher
your blood cholesterol level, the greater your risk
for developing heart disease or having a heart
attack. Heart disease is the number one killer of
women and men in the United States. Each year,
more than a million Americans have heart attacks,
and about a half million people die from heart
disease.

How Does Cholesterol Cause Heart Disease?

When there is too much cholesterol (a fat-like substance)
in your blood, it builds up in the walls of
your arteries. Over time, this buildup causes “hardening
of the arteries” so that arteries become narrowed
and blood flow to the heart is slowed down
or blocked. The blood carries oxygen to the heart,
and if enough blood and oxygen cannot reach your
heart, you may suffer chest pain. If the blood supply
to a portion of the heart is completely cut off by a
blockage, the result is a heart attack.
High blood cholesterol itself does not cause symptoms,
so many people are unaware that their cholesterol
level is too high. It is important to find out
what your cholesterol numbers are because lowering
cholesterol levels that are too high lessens the risk
for developing heart disease and reduces the chance
of a heart attack or dying of heart disease, even if
you already have it. Cholesterol lowering is important
for everyone–younger, middle age, and older
adults; women and men; and people with or without
heart disease.

What Do Your Cholesterol Numbers Mean?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have
a blood test called a “lipoprotein profile” to find out your cholesterol numbers. This blood test is done after a
9- to 12-hour fast and gives information about your:
■ Total cholesterol
■ LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries
■ HDL (good) cholesterol – helps keep cholesterol from building up in the 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. 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.
See how your cholesterol numbers compare to the tables below.


*Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better.
A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk
for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.
Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL)
or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels?

A variety of things can affect cholesterol levels. These are things you can do something about:
■ Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up.
Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of
saturated fat and cholesterol in your diet helps lower your blood cholesterol level.
■ Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol.
Losing weight can help lower your LDL and total cholesterol levels, as well as raise your
HDL and lower your triglyceride levels.
■ Physical Activity. Not being physically active is a risk factor for heart disease. Regular
physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol
levels. It also helps you lose weight. You should try to be physically active for 30 minutes
on most, if not all, days.
Things you cannot do anything about also can affect cholesterol levels. These include:
■ Age and Gender. As women and men get older, their cholesterol levels rise. Before the age
of menopause, women have lower total cholesterol levels than men of the same age. After the age
of menopause, women’s LDL levels tend to rise.
■ Heredity. Your genes partly determine how much cholesterol your body makes. High blood
cholesterol can run in families.

Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC)

TLC is a set of things you can do to help lower your
LDL cholesterol. The main parts of TLC are:
■ The TLC Diet. This is a lowsaturated-
fat, low-cholesterol
eating plan that calls for less
than 7 percent of calories from
satrated fat and less than 200
mg of dietary cholesterol per
day. The TLC diet recommends
only enough calories to maintain
a desirable weight and avoid weight gain. If your LDL is
not lowered enough by reducing saturated fat and cholesterol
intakes, the amount of soluble fiber in your diet
can be increased. Certain food products that contain
plant stanols or plant sterols (for example, cholesterollowering
margarines) can also be added to the TLC diet
to boost its LDL-lowering power.
■ Weight Management. Losing weight if you are overweight
can help lower LDL and is especially important
for those with a cluster 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 activity (30 minutes
on most, if not all, days) is 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.

Drug Treatment

Even if you begin drug treatment to lower your cholesterol,
you will need to continue your treatment with
lifestyle changes. This will keep the dose of medicine as
low as possible, and lower
your risk in other ways as well.
There are several types of
drugs available for cholesterol
lowering including statins, bile
acid sequestrants, nicotinic
acid, fibric acids, and cholesterol
absorption inhibitors.
Your doctor can help decide which type of drug is best
for you. The statin drugs are very effective in lowering
LDL levels and are safe for most people. Bile acid
sequestrants also lower LDL and can be used alone or
in combination with statin drugs. Nicotinic acid lowers
LDL and triglycerides and raises HDL. Fibric acids
lower LDL somewhat but are used mainly to treat high
triglyceride and low HDL levels. Cholesterol absorption
inhibitors lower LDL and can be used alone or in
combination with statin drugs.
Once your LDL goal has been reached, your doctor
may prescribe treatment for high triglycerides and/or
a low HDL level, if present. The treatment includes
losing weight if needed, increasing physical activity,
quitting smoking, and possibly taking a drug.

 

Source : https://www.nhlbi.nih.gov/files/docs/public/heart/wyntk.pdf

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