High Cholesterol Disease

What is Cholesterol?



Also called: HDL, Hypercholesterolemia, Hyperlipidemia, Hyperlipoproteinemia, LDL.

Cholesterol is a fatty molecule that is manufactured by your liver. You need cholesterol in order to help you manufacture certain types of hormones. Cholesterol is a waxy, fatlike substance that your body needs to function normally. Cholesterol is naturally present in cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart.

Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess may be deposited in arteries, including the coronary (heart) arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.

The main risk associated with high cholesterol is coronary heart disease (CHD). Your blood cholesterol level has a lot to do with your chances of getting heart disease. If cholesterol is too high, it builds up in the walls of your arteries. Over time, this buildup (called plaque) causes hardening of the arteries (atherosclerosis). Atherosclerosis causes arteries to become narrowed, slowing blood flow to the heart. Reduced blood flow to the heart can result in angina (chest pain) or in a heart attack in cases when a blood vessel is blocked completely.

A simple blood test checks for high cholesterol. Simply knowing your total cholesterol level is not enough. A complete lipid profile measures your LDL (low-density lipoprotein [the bad cholesterol]), total cholesterol, HDL (high-density lipoprotein [the good cholesterol]), and triglycerides—another fatty substance in the blood. Government guidelines say healthy adults should have this analysis every 5 years.

From The American Heart Association:
What’s the Difference Between LDL and HDL Cholesterol?

Why is LDL cholesterol considered “bad”?

When too much LDL cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke. The levels of HDL cholesterol and LDL cholesterol in the blood are measured to evaluate the risk of having a heart attack. LDL cholesterol of less than 100 mg/dL is the optimal level. Less than 130 mg/dL is near optimal for most people. A high LDL level (more than 160 mg/dL or 130 mg/dL or above if you have two or more risk factors for cardiovascular disease) reflects an increased risk of heart disease. That’s why LDL cholesterol is often called “bad” cholesterol.

Why is HDL cholesterol considered “good”?

About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as the “good” cholesterol because a high level of it seems to protect against heart attack. (Low HDL cholesterol levels [less than 40 mg/dL] increase the risk for heart disease.) Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe that HDL removes excess cholesterol from plaque in arteries, thus slowing the buildup.



What is Lp(a) cholesterol?

Lp(a) is a genetic variation of plasma LDL. A high level of Lp(a) is an important risk factor for developing fatty deposits in arteries prematurely. The way an increased Lp(a) contributes to disease isn’t understood. The lesions in artery walls contain substances that may interact with Lp(a), leading to the buildup of fatty deposits.

The triglyceride connection

Triglyceride is a form of fat. It comes from food and is also made in your body. People with high triglycerides often have a high total cholesterol, a high LDL cholesterol and a low HDL cholesterol level. Many people with heart disease also have high triglyceride levels. People with diabetes or who are obese are also likely to have high triglycerides. Triglyceride levels of less than 150 mg/dL are normal; levels from 150–199 are borderline high. Levels that are borderline high or high (200–499 mg/dL) may need treatment in some people. Triglyceride levels of 500 mg/dL or above are very high. Doctors need to treat high triglycerides in people who also have high LDL cholesterol levels.

High Cholesterol Causes and Risk.

Causes :

Several drugs and diseases can bring about high cholesterol, but, for most people, a high-fat diet and inherited risk factors may be the main causes. Your doctor will rule out the possibility that you have an underactive thyroid or kidney or liver disease.

* Heredity: Your genes influence how high your LDL (bad) cholesterol is by affecting how fast LDL is made and removed from the blood. One specific form of inherited high cholesterol that affects 1 in 500 people is called familial hypercholesterolemia, which often leads to early heart disease. But even if you do not have a specific genetic form of high cholesterol, genes play a role in influencing your LDL cholesterol level.

* Weight: Excess weight may modestly increase your LDL (bad) cholesterol level. If you are overweight and have a high LDL cholesterol level, losing weight may help you lower it. Weight loss especially helps to lower triglycerides and raise HDL (good) cholesterol levels.

* Physical activity/exercise: Regular physical activity may lower triglycerides and raise HDL cholesterol levels.

* Age and sex: Before menopause, women usually have lower total cholesterol levels than men of the same age. As women and men age, their blood cholesterol levels rise until about 60-65 years of age. After about age 50 years, women often have higher total cholesterol levels than men of the same age.

* Alcohol use: Moderate (1-2 drinks daily) alcohol intake increases HDL (good) cholesterol but does not lower LDL (bad) cholesterol. Doctors don't know for certain whether alcohol also reduces the risk of heart disease. Drinking too much alcohol can damage the liver and heart muscle, lead to high blood pressure, and raise triglyceride levels. Because of the risks, alcoholic beverages should not be used as a way to prevent heart disease.

* Mental stress: Several studies have shown that stress raises blood cholesterol levels over the long term. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they console themselves by eating fatty foods. The saturated fat and cholesterol in these foods contribute to higher levels of blood cholesterol.

Risk Factor:

You're more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

* Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or "good," cholesterol.
* Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
* Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your numbers.
* Lack of exercise. Exercise helps boost your body's HDL "good" cholesterol while lowering your LDL "bad"cholesterol. Not getting enough exercise puts you at risk of high cholesterol.
* High blood pressure. Increased pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
* Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
* Family history of heart disease. If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

Risk Factor Information

Rare cases of memory loss have been reported in people taking cholesterol-lowering statin drugs, such as Lipitor. But these reports were anecdotal and have not been substantiated by formal testing of cognitive function. In most of these cases, memory improved after the individuals stopped taking the statins. However, it's not clear whether the statin drugs caused the memory loss.

Decreased metabolism associated with underactive thyroid (hypothyroidism) causes high cholesterol. Treatment of hypothyroidism with thyroid hormone may improve cholesterol levels. If you have high cholesterol — especially if you have no previous history of high cholesterol — your doctor may recommend checking your thyroid hormone levels to see if an underactive thyroid is causing or contributing to the problem.

LDL contains the highest amount of cholesterol. HDL contains the highest amount of protein. VLDL contains the highest amount of triglyceride, a blood fat. Like LDL cholesterol, VLDL cholesterol is considered a type of "bad" cholesterol because elevated levels are associated with an increased risk of coronary artery disease.
By lowering your triglyceride levels, you also lower your VLDL cholesterol levels. Healthy lifestyle changes such as losing excess weight and exercising regularly can help lower triglyceride levels. Also, avoid sugary foods and alcohol, which have a particularly potent effect on increasing triglycerides.

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High Cholesterol Symptoms and Signs



High cholesterol is usually discovered on routine screening and has no symptoms. It is more common if you have a family history of it, but lifestyle factors (such as eating a diet high in saturated fat) clearly play a major role.

If you have a routine blood test during a physical exam or while attending a health fair or screening at a shopping center, your blood may reveal a high total cholesterol level, which would require further testing to determine your LDL, HDL, and triglyceride levels (this is known as a lipid panel).

The National Cholesterol Education Program guidelines suggest that everyone aged 20 years and older should have their blood cholesterol level 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 the following items:

Your Total Blood (or Serum) Cholesterol Level

Less than 200 mg/dL: Desirable
If your LDL, HDL and triglyceride levels are also at desirable levels and you have no other risk factors for heart disease, total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease. Even with a low risk, however, it’s still smart to eat a heart-healthy diet, get regular physical activity and avoid tobacco smoke. Have your cholesterol levels checked every five years or as your doctor recommends.

200–239 mg/dL: Borderline-High Risk
If your total cholesterol falls between 200 and 239 mg/dL, your doctor will evaluate your levels of LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. It's possible to have borderline-high total cholesterol numbers with normal levels of LDL (bad) cholesterol balanced by high HDL (good) cholesterol. Work with your doctor to create a prevention and treatment plan that's right for you. Make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke. Depending on your LDL (bad) cholesterol levels and your other risk factors, you may also need medication. Ask your doctor how often you should have your cholesterol rechecked.

240 mg/dL and over: High Risk
People who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (200 mg/dL). If your test didn’t show your LDL cholesterol, HDL cholesterol and triglycerides, your doctor should order a fasting profile. Work with your doctor to create a prevention and treatment plan that's right for you. Whether or not you need cholesterol-regulating medication, make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke.

Your HDL (Good) Cholesterol Level

With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.

People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL cholesterol levels. Female sex hormones raise HDL cholesterol levels.

Your LDL (Bad) Cholesterol Level

The lower your LDL cholesterol, the lower your risk of heart attack and stroke. In fact, it's a better gauge of risk than total blood cholesterol. In general, LDL levels fall into these categories:

LDL Cholesterol Levels
Less than 100 mg/dL	Optimal
100 to 129 mg/dL	Near Optimal/ Above Optimal
130 to 159 mg/dL	Borderline High
160 to 189 mg/dL	High
190 mg/dL and above	Very High

Your Triglyceride Level

Triglyceride is a form of fat. People with high triglycerides often have a high total cholesterol level, including high LDL (bad) cholesterol and low HDL (good) cholesterol levels.

Your triglyceride level will fall into one of these categories:

* Normal: less than 150 mg/dL
* Borderline-High: 150–199 mg/dL
* High: 200–499 mg/dL
* Very High: 500 mg/dL

A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic syndrome increases the risk for heart disease and other disorders, including diabetes.

By : American Heart Association

Medical Treatment

Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.

Statins (also called HMG-CoA reductase inhibitors) slow down your body's production of cholesterol. These drugs also remove cholesterol buildup from your arteries (blood vessels). Examples of statins include atorvastatin (brand name: Lipitor), fluvastatin (brand name: Lescol), lovastatin (brand names: Altocor, Mevacor), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor) and simvastatin (brand name: Zocor).

Resins (also called bile acid sequestrants) help lower your LDL cholesterol level. Some examples of bile acid sequestrants include cholestyramine (brand names: Prevalite, Questran), colesevelam (brand name: Welchol) and colestipol (brand name: Colestid).

Fibrates (also called fibric acid derivatives) help lower your cholesterol by reducing the amount of triglycerides (fats) in your body and by increasing your level of "good" cholesterol (also called HDL, or high-density lipoprotein). Some examples of fibrates include fenofibrate (brand names: Antara, Lofibra, Tricor) and gemfibrozil (brand name: Lopid).

Niacin (also called nicotinic acid) is a B vitamin. When given in large doses, it can lower your levels of triglycerides and LDL cholesterol, and increase your HDL cholesterol level. Even though you can buy niacin without a prescription, you should not take it to lower your cholesterol unless your doctor prescribes it for you. It can cause serious side effects. There are 2 types of nicotinic acid: immediate release and extended release.

Cholesterol absorption inhibitors help lower your cholesterol by reducing the amount that is absorbed by your intestines. Ezetimibe (brand name: Zetia) is a cholesterol absorption inhibitor. This type of medicine is often given in combination with a statin. The combination of ezetimibe and simvastatin (brand name: Vytorin) is an example.

Hormone replacement therapy: The risk of heart disease is increased in women after menopause. The increasing risk may be related to loss of estrogen that comes with menopause. Previously, women might have been treated with hormone replacement therapy (replacing the estrogen and perhaps progestin).

Source:
Written by familydoctor.org editorial staff.

Cholesterol: The top 5 foods to lower your numbers



Can a bowl of oatmeal help prevent a heart attack? How about a handful of walnuts, or even your baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet — like these — may be enough to lower your cholesterol to a healthy level and help you stay off medications.

1. Oatmeal and oat bran

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, psyllium, barley and prunes.

Soluble fiber appears to reduce the absorption of cholesterol in your intestines. Ten grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

2. Walnuts, almonds and more

Studies have shown that walnuts can significantly reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy and elastic. Almonds appear to have a similar effect, resulting in a marked improvement within just four weeks.

A cholesterol-lowering diet in which 20 percent of the calories come from walnuts may reduce LDL cholesterol by as much as 12 percent. But all nuts are high in calories, so a handful (no more than 2 ounces or 57 grams) will do. As with any food, eating too much can cause weight gain, and being overweight places you at higher risk of heart disease. To avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

3. Fish and omega-3 fatty acids

Research has supported the cholesterol-lowering benefits of eating fatty fish because of its high levels of omega-3 fatty acids. Omega-3 fatty acids also help the heart in other ways such as reducing blood pressure and the risk of blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — significantly reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in mackerel, lake trout, herring, sardines, albacore tuna and salmon. However, to maintain the heart-healthy benefits of fish, bake or grill it. If you don't like fish, you can also get omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the beneficial effects, but you won't get all the other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

4. Olive oil

Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched.

The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat.

Some research suggests that the cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But avoid "light" olive oils. This label usually means the oil is more processed and lighter in color, not fat or calories.

5. Foods fortified with plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Margarines, orange juice and yogurt drinks fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237 milliliters) servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of "good" high-density lipoprotein (HDL) cholesterol. Nor do they interfere with the absorption of the fat-soluble vitamins — vitamins A, D, E and K.

The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

Consider your diet first

Before you make other changes to your diet, think about cutting back on the types and amounts of fats you eat, which can raise your cholesterol. That way, you'll improve your cholesterol levels and health overall.

When cutting fat from your diet, focus on saturated and trans fats. Saturated fats, like those in meat and some oils, raise your total cholesterol. Trans fats, which are sometimes used to make store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels because they raise low-density lipoprotein (LDL), the "bad" cholesterol and lower high-density lipoprotein (HDL), "good" cholesterol. You should try to limit the number of calories you eat daily to less than 10 percent from saturated fat, and eliminate as many trans fats from your diet as possible.

By Mayo Clinic Staff
May 10, 2008