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For Good Health, Know Your Cholesterol Level

The amount of cholesterol in your blood has a lot to do with your chances of getting cardiovascular disease (CVD). High blood cholesterol is one of the major risk factors for CVD. In fact, the higher your blood cholesterol level, the greater your risk of developing CVD or having a heart attack.

Cholesterol is a fat-like substance made by your liver. You can also get cholesterol from meats and other fats that turn into cholesterol in your body.

Cholesterol is necessary for building cell walls and for making hormones. However, when you have too much cholesterol in your blood, it builds up in the walls of your arteries. Over time, this buildup causes atherosclerosis or plaque in the artery walls. This makes the arteries narrow and stiff, slowing, or even blocking blood flow. If this happens in the arteries supplying blood and oxygen to the heart, it can cause chest pain. If the blood supply to an area of the heart is completely blocked, it can result in a heart attack.

Checking your cholesterol

High blood cholesterol has no symptoms. That's why it's important to get your cholesterol checked. Everyone age 20 or older should have blood cholesterol testing at least once every five years. The test is called a lipoprotein profile or lipid panel, which is done after fasting for 9 to 12 hours. It measures:

  • Total cholesterol

  • LDL ("bad") cholesterol, which is the main source of cholesterol buildup and blockage in the arteries

  • HDL ("good") cholesterol, which helps keep LDL cholesterol from building up in the arteries

  • Triglycerides, which are another form of fat in the blood

VLDL (very low-density lipoproteins) and a cholesterol/HDL ratio may also be included in the profile.

Children also need their cholesterol levels checked. The American Academy of Pediatrics (AAP) and the National Heart, Lung, and Blood Institute (NHLBI) recommend that all children be screened for high cholesterol between ages 9 and 11, and again between ages 17 and 21. The screening should be done regardless of family history, the AAP says. It can also be done without fasting, making it easier to do. If the test results are abnormal, then your child's provider can order a fasting lipid profile. 

Treatment

Your health care provider determines whether you are at risk for CVD and if you need treatment for high cholesterol. The decision is based on several risk factors, including your cholesterol level. Other risk factors for CVD include smoking, obesity, high blood pressure, family history of heart disease, history of artery disease, and age (older than 45 for men and older than 55 for women).

A high HDL ("good") cholesterol level protects you against CVD.

If you need treatment for high cholesterol, the goal is to reduce your LDL level enough to cut your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL should be.

You can help to lower your LDL level and raise your HDL level through lifestyle changes, such as following a diet low in cholesterol and saturated fats, getting regular exercise, and maintaining a healthy weight.

  • A diet that is low in saturated fat and cholesterol has less than 7 percent of calories from saturated fat and less than 200 mg of cholesterol. 

    • If this diet doesn't lower your LDL enough, you can add soluble fiber to your diet.

    • The Mediterranean or DASH diets are good choices for heart-healthy eating.

    • You may need the help of a dietician or nutritionist; ask your provider about these services.

  •  It's important to control your weight in order to control your LDL, especially if your HDL level is low, your triglycerides are high, or your waist measurement is too great (more than 40 inches if you're a man or more than 35 inches if you're a woman). 

  • To get enough exercise, aim for 30 to 60 minutes of moderate physical activity most, if not all, days.

In some people, there are inherited reasons that the LDL level can't be lowered by these methods. In others, these methods just don't work well. In both of these cases, medications may have to be added to the treatment plan.

To reduce your risk for CVD, it's also important to control your blood pressure and to stop smoking. Your doctor may prescribe cholesterol-lowering medication along with lifestyle changes. Several types of drugs are available, by maintaining your lifestyle changes will keep your medication dose as low as possible and lower your risk for CVD disease in other ways.

Cholesterol-lowering drugs

Statins. These drugs lower LDL cholesterol by blocking a liver enzyme that helps to make cholesterol. They may also protect against CVD by decreasing the formation of plaque in artery walls, preventing plaque from breaking off, and reducing clot formation.

Studies have shown that statins can lower LDL cholesterol significantly . In addition, they can lower triglycerides and slightly increase HDL cholesterol.

You should take your statin medication at night, so it can work more effectively with your body, which makes more cholesterol at night than during the day. Be certain to discuss side effects with your provider. 

Bile acid resins. These medications bind to bile from the liver when it enters the small intestine. They prevent bile from being reabsorbed.

Nicotinic acid (niacin). This is a B vitamin that lowers triglyceride and LDL cholesterol levels, and raises HDL cholesterol. 

Fibrates. These drugs mainly reduce triglyceride levels. They might be used if someone has triglycerides rather than high LDL cholesterol. You should not take fibrates and statins together.

Cholesterol absorption inhibitors. This class of drugs block cholesterol absorption in the intestine. They are used when people can’t take statins. And, they are used with statins to help lower LDL levels even more.

Omega-3 fish oil. Some studies have shown that omega-3 fish oil may decrease fatty acid and triglycerides made by the liver. 

If you take cholesterol-lowering medication, it's important to remember that diet and exercise also help to lower cholesterol and are a valuable part of your treatment strategy.