Cholesterol is
a type of fat (lipid) in your blood. Your cells need
cholesterol, and your body makes all it
needs. But you also get cholesterol from the food you eat.
If you have too much cholesterol, it starts to build up in your arteries.
(Arteries are the blood vessels that carry blood away from the heart.) This is
called hardening of the arteries, or
atherosclerosis. It is usually a slow process that
gets worse as you get older.
To understand what happens, think
about how a clog forms in the pipe under a kitchen sink. Like the buildup of
grease in the pipe, the buildup of cholesterol narrows your arteries and makes
it harder for blood to flow through them. It reduces the amount of blood that
gets to your body tissues, including your heart. This can lead to serious
problems, including
heart attack and
stroke.
Your cholesterol is measured by a blood test:
High cholesterol is 240 or above.
Borderline-high is
200 to 239.
Best is less than 200.
What are the different kinds of cholesterol?
LDL is the
"bad" cholesterol, the kind that can clog your arteries if you have too much of it. This is the
cholesterol you need to lower, if you have high cholesterol.
HDL is the "good" cholesterol. HDL helps clear fat from your blood. You want your HDL to be high. A high HDL level is linked to a lower risk of heart disease.
Triglycerides are another type of fat
in your blood. If you have high triglycerides and high LDL, your
chances of having a heart attack are higher.
What are the symptoms?
High cholesterol doesn't
make you feel sick. By the time you find out you have it, it may already be
narrowing your arteries. So it is very important to start treatment even though
you may feel fine.
What causes high cholesterol?
Many things can
cause high cholesterol, including:
The foods you eat. Eating too
much
saturated fat, trans fat, and cholesterol can raise
your cholesterol.
Being overweight.
Being inactive.
Age. Cholesterol starts to rise after age 20.
Family history. If family members have or had high cholesterol, you may also have it.
Overall health. Diseases such as
hypothyroidism can raise cholesterol.
How is high cholesterol diagnosed?
You
need a blood test to check your cholesterol. There are
several kinds of tests:
A fasting cholesterol test is the most
complete test because it measures all of the fats in your blood,
including
LDL and
HDL cholesterol and
triglycerides.
A direct LDL test measures your LDL level
only.
A simple cholesterol test can measure total cholesterol
and HDL.
How is it treated?
If you have high cholesterol, you need treatment to lower your risk of heart attack and stroke. The two main treatments are
lifestyle changes and medicine.
Some lifestyle changes are important for
everyone with high cholesterol. Your doctor will probably want you to:
Eat a heart-healthy diet that
includes plenty of fish, fruits, vegetables, beans, high-fiber grains and
breads, and healthy fats like olive oil.
Lose weight, if you need to. Losing just 5 lb to 10
lb (2.3 kg to 4.5 kg) can lower your cholesterol. Losing
weight can also help lower your blood pressure.
Get regular exercise on most, if not
all, days of the week. Walking is great exercise that most people can do. A
good goal is 30 minutes or more a day.
Don't smoke. Quitting can help raise your HDL and
improve your heart health.
Changing old habits may not be easy, but it is very
important to help you live a healthier and longer life. Having a plan can help.
Start with small steps. For example, commit to adding one fruit or one vegetable a day for a week. Instead of having dessert, take a short walk.
If these lifestyle changes don't lower your
cholesterol enough, or if your risk of heart attack is
high, you may also need to take a cholesterol-lowering medicine, such as a statin. Knowing your heart attack risk is
important, because it helps you and your doctor decide how to treat your
cholesterol.
What you eat. Eating
too much
saturated fat,
trans fat, and cholesterol can cause high cholesterol.
Saturated fat and
cholesterol are in foods that come from animals, such as meats, whole milk, egg
yolks, butter, and cheese.
Trans fat is found in fried foods and packaged
foods, such as cookies, crackers, and chips.
Your weight. Being overweight may increase
triglycerides and decrease
HDL (good cholesterol).
Your activity level. Lack of physical activity can lower your HDL.
Your age and gender. After you reach age 20, your cholesterol
naturally begins to rise.
In men, cholesterol generally levels off after
age 50.
In women, it stays fairly low until
menopause. Then it rises to about the same
level as in men.
Some diseases. Certain diseases may raise your risk of high cholesterol. These include
hypothyroidism,
chronic kidney disease, and some types of liver disease.
Your family history. High cholesterol may run in your family. If family members have or had high cholesterol, you may also
have it.
Cigarette smoking. Smoking can
lower your HDL cholesterol.
Certain medicines. Some medicines can
raise triglyceride levels and lower HDL (good) cholesterol levels. These
medicines include thiazide
diuretics,
beta-blockers,
estrogen, and
corticosteroids.
Symptoms
High cholesterol does not cause symptoms. It is usually found during a
blood test that measures cholesterol levels.
Some people with rare lipid disorders may have symptoms such as bumps in the skin, hands, or feet, which are caused by deposits of extra cholesterol and other types of fat.
Atherosclerosis can cause these problems because it:
Narrows your arteries. When enough plaque builds up, it starts to narrow your arteries. This happens slowly over many years. In time, the plaque can limit blood flow throughout your body, including the heart and brain.
Hardens your arteries. A healthy artery can widen (dilate) so that more blood can flow through when needed, such as during activity. When hard plaque forms in the walls of an artery, it can make the artery too stiff to widen. This "hardening" of your arteries can also limit blood flow in your body.
Blocks your arteries. When a blood clot forms around a crack or rupture in the plaque, it can block the artery. This can cause a heart attack or stroke.
Some things that increase
your risk for
high cholesterol are things you can change, but some are
not. It's important to lower your risk as much as possible.
Things you can change include:
Eating foods high in
saturated fat, trans fat, and cholesterol.
Being overweight.
Not being active every day.
Smoking.
Each of these things can raise your LDL, lower your HDL, or both.
Things you cannot change include:
Family history. If high cholesterol
runs in your family, you may have it, and it may be harder to treat.
High cholesterol usually has no symptoms. Sometimes the first sign that you
have high cholesterol or other risk factors for heart disease is a
heart attack, a
stroke, or a
transient ischemic attack (TIA). If you have any
symptoms of these, call 911 or other emergency services.
Heart attack symptoms include:
Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.
After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.
Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.
Stroke and TIA symptoms include:
Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble understanding simple statements.
Sudden problems with walking or balance.
A sudden, severe headache that is
different from past headaches.
Who to see
Any of the following doctors,
nurses, or specialists can order a cholesterol test and treat high
cholesterol:
People who have rare
lipid disorders, which can be hard to treat,
may need to see a specialist, such as a lipidologist or an endocrinologist.
Exams and Tests
A blood test tells you if you have
high cholesterol.
A simple cholesterol test can measure total cholesterol. You can eat before this test. Sometimes doctors do this test first.
A
fasting cholesterol test is a more thorough test. It
measures your total cholesterol plus your
LDL,
HDL, and
triglyceride levels. It is called a fasting test
because you don't eat for 9 to 12 hours before the test.
A direct LDL test measures your LDL level only. You can
have this test done at any time, no matter when you last ate.
What do your cholesterol numbers mean?
Your numbers help your doctor know your risk of getting heart disease or having a heart attack or stroke.
Your total cholesterol level is important. But your levels of
LDL, HDL, and triglycerides help your doctor decide if you need treatment for high cholesterol. Your doctor
will also consider your overall health and your risk of heart
attack. For more information, see the topic High Cholesterol Treatment Guidelines Based on Heart Attack Risk.
If you have high cholesterol, your doctor will want
to know your LDL and HDL levels before deciding whether you need treatment and
what sort of treatment you need.
LDL (bad) cholesterol
You want your LDL level to be low. But how low your LDL should be depends
on your risk of heart attack.
Your doctor will help decide what your LDL goal is. The higher your risk of heart attack,
the lower your LDL goal.
HDL (good) cholesterol
You want your HDL level to be high. An HDL level of 60 or higher is linked to a lower risk of heart disease. A high HDL number also can help
offset a high LDL number.
Your risk level
When you visit your doctor to talk about your cholesterol
test, you will talk about other things that increase your risk for heart
problems. These include:
You may need
other tests to find out if another health problem, such as
hypothyroidism, is causing your high cholesterol.
A
C-reactive protein (CRP) test may be done for some
people who are at risk for getting
coronary artery disease. A special type of CRP test,
the high-sensitivity CRP test, can help find out your chance of having
a sudden heart problem, such as a
heart attack. This test may be done even if you have a
normal or low level of LDL cholesterol.
When to have a cholesterol test
Most doctors recommend that everyone older than 20 be checked for high
cholesterol. How often you need to be checked depends on whether you have other
health problems and your overall chance of heart disease.
Your child's doctor may suggest a cholesterol test based on your child's age, family history, or a physical exam. A cholesterol test can help a doctor find out early if your child has a cholesterol level that could affect his or her health.
Many people try lifestyle changes first. But if lifestyle changes aren't enough to reach your cholesterol goal, you will need to take medicine too. Even if you take medicine for high cholesterol, keeping healthy lifestyle habits is still important.
Some people need to start taking medicine right away because their risk of heart attack is higher than average. Your doctor will base your need for medicine on your risk level.
Some people may not be able to prevent high cholesterol with lifestyle changes. Family history or certain conditions that cause the body to make too much cholesterol can raise levels even with lifestyle changes. In these cases, medicine can help.
Remember that high cholesterol is just
one of the things that increase your risk for
heart attack and stroke.
Controlling other health problems, such as
high blood pressure and
diabetes, can also help reduce your overall
risk.
Making Lifestyle Changes
Lifestyle changes are important to help control
high cholesterol, especially if you have other risk
factors for
heart disease and
stroke.
Even if your doctor has
prescribed medicine for you, you may still need to make changes at home to lower
your cholesterol and reduce your risk. Some people can even take less
medicine after making these changes.
What changes do you need to make?
One Man's Story:
Joe, 61
"The walking was the easy part for me. I get out every evening for a walk. The food part took some thought. Each week, I added a food that was good for me and took something away that was bad for me."—Joe
Make these
lifestyle changes to help lower your cholesterol:
Eat healthy foods
Making healthy eating habits a part of your daily life is one of the best things you can do to lower your cholesterol. Your doctor may recommend that you follow the Therapeutic Lifestyle Changes (TLC) diet. The diet's main focus is to reduce the amount of saturated fat you eat, because saturated fat raises your cholesterol.
Regular
physical activity raises "good" HDL cholesterol. Getting active has many other benefits too. It can help you lose weight. And it can lower your blood pressure.
If high cholesterol runs in your family, these lifestyle changes may not be enough. You may need to take medicine too. But no matter what treatment you use, you can lower your high cholesterol.
How do you make lifestyle changes?
One Man's Story:
Joe, 61
"I'm just not that type of person who can change everything at once."—Joe
You can learn simple steps to help you make lifestyle changes, like setting goals. Work on one small goal at a time. Expect slip-ups. Get support from others. Reward yourself for each success. To find out more about making healthy lifestyle changes, see Change a Habit by Setting Goals.
When changing a lifestyle habit, barriers can sometimes get in your way. Figuring out what those barriers are and how you can get around them can help you reach your healthy eating goals.
"I've learned to not beat myself up [when I slip up]. Instead, I refocus on my plan and get right back to eating healthy food. What keeps me going is the results—I've lost weight, my cholesterol's getting better, and I feel younger every day."—Joe
Statins are the
medicines used the most often to treat
high cholesterol, and they often work the best. They can
reduce the risk for
heart attack,
stroke, and early death in people who are at high risk for a
heart attack or stroke. Other medicines also lower
cholesterol, and some may be used to lower
triglycerides or raise
HDL.
Doctors may also prescribe
aspirin therapy if you have had a heart attack or
a stroke, or you have a high risk for heart attack or stroke.
Do you need to take medicine? That depends. The decision to use medicine to treat high cholesterol is usually based on your cholesterol goal, LDL level, and your risk for heart attack and stroke.
Medicine is
always used along with a diet and exercise plan, not instead of it.
Some people can try diet and exercise for at
least 3 months before they decide if they need medicines.
Some people find it hard to take their
medicines properly. If you do take medicine, it is important to use it the right way.
Some people don't see why they should take medicines every day
when they don't feel sick. High cholesterol doesn't make you feel sick. But it's important to treat
it, because it damages your blood vessels and eventually your heart, even though you don't have symptoms.
Some side effects are more likely and may be worse when you use higher
doses of statins. If you're having side effects, tell your doctor. You may be able to take a different medicine or a different dose.
Be sure to tell your doctor everything you take for high cholesterol, even herbs or other supplements or treatments. Sometimes they can interact with other medicines and cause problems.
If you have trouble taking your medicine for any reason, talk to your doctor.
Other Treatment
Some plant products can help lower high cholesterol. But don't use them to replace your doctor's treatment. Whether
or not you use such products, be sure to continue your diet, exercise,
and prescription medicines.
As with any new form of treatment, make sure to talk with your doctor first. This is especially important if you take statins. Combining statins and some supplements can cause dangerous side effects.
Psyllium
Psyllium is an ingredient in some dietary supplements—Metamucil, for example. It's a fiber from fleawort and plantago seeds.
Doctors aren't sure how it helps cholesterol levels. It may make the small intestine absorb less cholesterol, so less of it enters your blood.
Psyllium is approved by the U.S. Food and Drug Administration (FDA). The main side effect is increased bowel movements. Products
containing psyllium aren't recommended to replace foods as a source of
fiber.
Sterol or stanol esters
Sterol and stanol esters are used in cholesterol-lowering margarine spreads.
Sterol esters might limit how much cholesterol the small intestine can absorb. Cholesterol-lowering margarines can help lower cholesterol levels, particularly in people who have high cholesterol levels or who consume too much fat in their diets. These margarines are used along with a healthy diet to lower cholesterol.
Red yeast rice
Red yeast rice contains a natural form of lovastatin, a statin medicine. This supplement may keep your body from producing too much cholesterol. But this supplement can cause dangerous side effects.
Talk to your doctor before you try red yeast rice. Serious side effects include rhabdomyolysis and hepatitis. Red yeast rice is not regulated by the U.S. Food and Drug Administration (FDA), so you cannot be sure of the amount of red yeast in a supplement. This means you cannot be sure of its dose and safety.
If you take red yeast rice, call your doctor right away if you have a bad reaction to it such as severe muscle pain or symptoms of hepatitis.
Do not take red yeast supplements if you are taking statins. Combining them can cause dangerous side effects.
Not recommended for lowering cholesterol
Coenzyme Q10. This supplement does not lower cholesterol.
Fish oil supplements. Fish oil supplements do not lower cholesterol. But eating fish is a part of a heart-healthy diet.
Garlic. Eating lots of garlic or taking garlic supplements does not
effectively lower cholesterol. And eating too much garlic can have side
effects, including allergic reaction, gas, heartburn, garlic odor
from the skin, interference with some drugs, and longer blood-clotting
time.
Policosanol.
Policosanol, which is made from sugar cane, hasn't been shown to lower
cholesterol.2
Very low-fat diets. Although very
low-fat diets may indeed lower cholesterol levels, they are not recommended.
Very low-fat diets usually allow less than 15% of total calories from fat. In
comparison, a
cholesterol-reducing diet allows 25% to 35% of
calories to come from total fat, with 7% from saturated fat. A diet with less
than 25% of its calories from fat can increase triglycerides and decrease HDL
(good) cholesterol. Such a diet may deplete your body of other important
nutrients and vitamins.
Other Places To Get Help
Organizations
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.heart.org
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
Food and Drug Administration (FDA): Consumer Health
Information
10903 New Hampshire Avenue
Silver Spring, MD 20993
Phone:
1-888-INFO-FDA (1-888-463-6332)
Web Address:
www.fda.gov/ForConsumers/default.htm
This website has health information for
people of all ages. Topics include the following: medicines, food and nutrition, medical
devices, cosmetics, and animal health. Spanish materials are also
available.
HeartHub for Patients
Web Address:
www.hearthub.org
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
KidsHealth for Parents, Children, and
Teens
10140 Centurion Parkway
Jacksonville, FL 32256
Phone:
(904) 697-4100
Fax:
(904) 697-4220
Web Address:
www.kidshealth.org
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
National Cholesterol Education Program (NCEP)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
Email:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov/about/ncep
The National Cholesterol Education Program (NCEP) provides education and tips for patients about how to lower high cholesterol. The NCEP provides clinical practice guidelines for health professionals to treat high cholesterol. The goal of the NCEP is to help people lower high cholesterol because this can lower their risk of coronary artery disease. The NCEP is part of the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH).
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
Email:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.
Berthold HK, et al. (2006). Effect of policosanol on
lipid levels among patients with hypercholesterolemia or combined
hyperlipidemia. JAMA, 295(19): 2262–2269.
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Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.
Drugs for lipids (2011). Treatment Guidelines From The Medical Letter, 9(103): 13–20.
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.
Genest J, Libby P (2008). Lipoprotein disorders and
cardiovascular disease. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 975–995. Philadelphia: Saunders.
Grundy S, et al. (2002). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (NIH Publication No. 02–5215). Bethesda, MD: National
Institutes of Health. Also available online:
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on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
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Miller M, et al. (2011). Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 123(20): 2292–2333.
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National Heart, Lung, and Blood Institute (2005). Your Guide to Lowering Your Cholesterol With TLC (NIH Publication No. 06-5235). Available online: http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf.
Pearson TA, et al. (2003). Markers of inflammation and
cardiovascular disease: American Heart Association and the Centers for Disease
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Sacks FM, et al. (2006). Soy protein, isoflavones, and
cardiovascular health: An American Heart Association science advisory for
professionals from the Nutrition Committee. Circulation,
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U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
Credits
By
Healthwise Staff
Primary Medical Reviewer
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer
Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486–2497.
Berthold HK, et al. (2006). Effect of policosanol on
lipid levels among patients with hypercholesterolemia or combined
hyperlipidemia. JAMA, 295(19): 2262–2269.
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