high cholesterol

Cholesterol, high

 

Definition

Cholesterol is a waxy substance made by the liver and also acquired through diet. It is found in the blood and in all cells in the body. The body uses cholesterol to produce bile, some hormones, vitamin D, cell membranes, and myelin (the material that surrounds nerves). A high level of cholesterol in the blood is called hypercholesterolemia. High levels of blood cholesterol have been linked to heart disease.

Description

Cholesterol in small quantities is necessary for the body to function properly, but the liver is able to synthesize about 1,000 mg of cholesterol a day, which is all the body needs. However, because cholesterol is found in animal products- meat, fish, shellfish, egg yolks, and dairy products-people also get cholesterol through their diet, and too much cholesterol can be harmful.
Cholesterol does not dissolve in blood. Instead it moves through the circulatory system in combination with carrier substances called lipoproteins. There are two carrier-cholesterol combinations, low-density lipoprotein (LDL) or "bad" cholesterol and high-density lipoprotein or "good" cholesterol.
Most of the cholesterol in the body is LDL cholesterol. An excessive amount of LDL cholesterol is a major contributing factor to the development of heart disease. LDL picks up cholesterol in the liver and carries it through the circulatory system. When too much LDL cholesterol is present, it begins to drop out of the blood and stick to the walls of the arteries. The sticky material on artery walls is called plaque. (It is different from dental plaque that accumulates on teeth.) Plaque can reduce the amount of blood flowing through the arteries, and when bits of plaque break open, they can stimulate the formation of blood clots. If plaque or a blood clot block the coronary arteries that carry blood to the heart, heart attack (myocardial infarction) can occur. A stroke occurs if arteries carrying blood to the brain are blocked. In adults, a desirable LDL reading is less than 100 mg/dL.
High-density lipoprotein (HDL) or "good" cholesterol appears to carry excess LDL cholesterol away from the walls of the arteries to the liver where it can be processed and removed from the body. High levels of HDL cholesterol are helpful; they seem to help protect the body from heart disease and heart attack. Low levels seem to increase the risk of heart disease. In adults, a desirable level of HDL is greater than 60 mg/dL.
A desirable total cholesterol level (LDL + HDL) is less than 200 mg/dL. According to the United States Centers for Disease Control and Prevention (CDC), the average total cholesterol level in American adults is 203 mg/dL, and 17% of Americans over age 20 have total cholesterol levels of 240 mg/dL or higher. This percentage has decreased from a high of 33% in 1960 as people have become more aware of the connection between high cholesterol levels and heart disease.
Specific risk factors include a high-fat, high-calorie diet, family history of high cholesterol, obesity, alcoholism, and lack of regular exercise. Because cholesterol also is produced naturally in the liver, overproduction may occur in even in people who limit their intake of high-cholesterol food. The chance of developing high cholesterol increases after the age of 45, ans women are at higher risk of for developing high cholesterol levels than men. Both genetic inheritance and lifestyle factors affect cholesterol level.

Causes and symptoms

There are no readily apparent symptoms that indicate high LDL or low HDL cholesterol levels. The only way to determine cholesterol levels is through a simple blood test. According to the CDC, almost 75% of Americans reported in 2005 that they had had their cholesterol level checked within the previous five years.

Cholesterol Levels
Types	Levels
Total Cholesterol
Low/Desirable	<200
Borderline	200 to 240
High/Undesirable	>240
HDL cholesterol
High/Desirable	>60
Borderline	40 to 59
Low/Undesirable	<40
LDL cholesterol
Low/Desirable	<100
Close to Desirable	120 to 129
Borderline High	130 to 159
High/Undesirable	160 to 189
Very High/Very Undesirable	>189

Diagnosis

High cholesterol often is diagnosed from blood tests that are part of a routine physical examination. The condition usually is treated by general practitioners or family practice physicians unless other conditions concerns complicate the patient's health status. Total cholesterol, LDL, HDL, and triglycerides (another type of blood fat that plays a role in heart disease) are measured by a blood test called a lipid panel. The cost of a lipid panel is moderate and routinely is covered by health insurance and HMO plans, including Medicare. Home cholesterol testing kits are sold over the counter (without prescription), but these test only for total cholesterol. The results of a home test should be used only as a guide, and if the total cholesterol level is high, a physician should perform a lipid panel. The generally recommended levels of LDL, HDL, and total cholesterol are listed in the table above. However, physician recommendations for individuals may vary depending on the individual's risk factors such as hypertension (high blood pressure), a family history of heart disease, current heart disease, diabetes, age, alcoholism, and smoking.

Treatment

Treatment normally begins with lifestyle changes unless the individual already has heart disease and/or has high cholesterol and additional risk factors. In such situations drug therapy may begin at the same time lifestyle changes are implemented. Drug therapy is not a substitute for lifestyle changes; the two must be used together to effectively reduce blood cholesterol levels.

Lifestyle changes

The main lifestyle changes used to treat high cholesterol are diet, exercise, weight loss, and stopping smoking. The National Heart, Lung, and Blood Institute has developed a diet called the Therapeutic Lifestyle Changes (TLC) diet designed to help lower cholesterol and control weight. TLC diet recommendations include the following:

• Fewer than 7% of daily total calories should come from saturated fat.


• No more than 25-35% of total daily calories should come from any type of fat.


• Daily intake of cholesterol should be no more than 200 mg. (In 2007, the average American man ate 337 mg of cholesterol daily and the average woman ate 217 mg daily.)


• Daily sodium intake should be no more than 2,400 mg.


• Daily total calories should be limited to what will maintain or reduce weight.

In addition to reducing cholesterol and fat, increasing the amount of fiber in the diet helps lower total blood cholesterol. High-fiber foods include products made with whole wheat (e.g., pasta, bread), brown rice, lentils, dried beans, and raw vegetables (e.g., celery, carrots, apples, pears). In the United States, food labels are required to list in the nutrition information panel calories, calories from fat, total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron. In addition, the following words have specific legal meanings on food labels.

• Cholesterol-free: Less than 2 mg of cholesterol and 2 g of saturated fat per serving.


• Low cholesterol: no more than 20 mg of cholesterol and 2 grams of saturated fat per serving.


• Fat-free: less than 0.5 grams of fat per serving.


• Low fat: no more than 3 grams or less of fat per serving.


• Less fat: A minimum of 25% less fat than the comparison food.


• Light (fat): A minimum of 50% less fat than the comparison food.

A calculator that factors in height, weight, age, and activity level to determine an individualized daily calorie and fats level can be found at http://www.nhlbisupport.com/cgi-bin/chd1/step2intro.cgi.
A vegetarian or vegan diet also may be effective in lowering cholesterol, since most cholesterol comes from eating cholesterol-containing animal products, which are reduced (vegetarian) or eliminated (vegan) in these diets. Vegetarians typically get up to 100% more fiber and up to 50% less cholesterol from food than non-vegetarians. The vegetarian low-cholesterol diet consists of at least six servings of whole grain foods, three or more servings of green leafy vegetables, two to four servings of fruit, two to four servings of legumes, and one or two servings of non-fat dairy products daily.
Exercise also is an important part of lowering LDL cholesterol and raising HDL cholesterol. Ideally, exercise should consist of 20-30 minutes of vigorous aerobic exercise (e.g., fast walking, bicycling, jogging, roller skating, swimming, walking up stairs) at least three times a week. Nevertheless, any regular exercise is helpful, especially for overweight individuals. Individuals should not avoid exercising simply because they cannot meet the ideal exercise regimen. Instead, they should make gentle exercise a part of their regular daily routine, gradually working up to more vigorous, sustained exercising.

Drug therapy

A variety of drugs may be prescrived to reduce cholesterol levels. All of these drugs have side effects that may make them unsuitable for certain individuals. Cholesterol-lowering medications include:

• Statins. These are the most frequently prescribed cholesterol-lowering class of drugs. Statins are effective in lowering LDL (bad) cholesterol by slowing the production of cholesterol in the body. However, some statins have been shown to cause a rare type of serious muscle damage (rhabdomyolysis). Other research suggests that statins benefit only to those at high risk for heart attack and not people at low to moderate risk. Examples of statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altocor, Mevacor), pravastatin (Pravachol), and simvastatin (Zocor).


• Bile acid sequestrants, also called resins. These drugs increase the amount of bile excreted in feces. This forces the liver to make more bile, and since cholesterol is used in making bile, more cholesterol is used and less enters the bloodstream, thus lowering cholesterol levels. Bile acid sequestrants are prescribed along with other cholesterol-lowering drugs such as statins. Examples include acid sequestrants include cholestyramine (Prevalite, Questran), colesevelam (Welchol), and colestipol (Colestid).


• Niacin (nicotinic acid.) A dietary supplement that should be used only under supervision of a physician. It helps to lower LDL cholesterol.


• Cholesterol absorption inhibitors. These drugs reduce the amount or cholesterol in food that is absorbed by the intestines. Examples include Ezetimibe (Zetia) and a combination of ezetimibe and the statin simvastatin (Vytorin).


• Fibrates also called fibric acid derivatives. These mainly lower triglycerides, but also may raise HDL (good) cholesterol. They rarely used alone to treat high cholesterol. Examples include gemfibrozil (Loprid), clofibrate (Atromid-S), and fenofibrate (Tricor).

Alternative treatment

Alternative practitioners also recommend diet and exercise as first-line treatment to lower high cholesterol levels. Some herbal supplements are also recommended by alternative practitioners to reduce cholesterol levels. Individuals using any herbal remedy or alternative therapy should discuss its use with a physician. Harmful interactions between herbal remedies and conventional medicines are possible. The following are some of the alternative therapies that have been investigated.

• Garlic. As of 2009, the National Center for Complementary and Alternative Medicine (NCCAM) reported several studies that have shown short term (up to 3 months) reduction in total blood cholesterol levels when garlic (standardized dehydrated tablets, aged garlic extract, oil macerates, distillates, raw garlic) was compared to placebo treatments, but these reductions were not found in longer (6 month) studies. Research is ongoing to clarify these results.


• Soy. According to NCCAM, research suggests that soy may slightly lower levels of LDL cholesterol.


• Green tea. Some alternative practitioners suggest that green tea can lower LDL cholesterol. NCCAM finds that there is not yet enough reliable data to evaluate this claim.


• Red clover, grape seed extract, flaxseed oil, blue-green algae. Although these may be recommended by alternative practitioners, there is little evidence that they affect cholesterol levels.


• Cholestin (red yeast rice). This dietary supplement is a processed form of red yeast fermented with rice. It is a remedy used for centuries in traditional Chinese medicine. Cholestin is not approved or regulated by the United States Food and Drug Administration (FDA). It may reduce LDL cholesterol and increase HDL cholesterol, but should not be taken in place of prescription cholesterol-lowering drugs. Before using, discuss this supplement cholestrin with a physician.

Prognosis

High cholesterol a major risk factors for heart disease. Left untreated, too much LDL cholesterol may clog the blood vessels, leading to chest pain (angina), blood clots, and heart attacks. By reducing LDL and total cholesterol levels, people with heart disease may prevent further heart attacks and strokes, prolong and improve their quality of life, and slow or reverse cholesterol build up in the arteries. In people without heart disease, lowering cholesterol levels may decrease the risk of a first heart attack or stroke.

Prevention

The habit of eating a low-fat, low-cholesterol, high-fiber diet and regular exercise is the healthiest and least expensive way control cholesterol levels and reduce the risk of heart disease. Other preventative measures include not smoking, limiting alcohol consumption, and maintaining an optimal weight. In a small 2003 Canadian study, people who ate a low-fat vegetarian diet consisting of foods that are found to help lower cholesterol dropped their levels of LDL cholesterol as much as some individuals taking statin drugs. For people with high risk factors for heart disease or pre-existing heart disease, such as a family history of heart disease, diabetes, and being over the age of 45, cholesterol-lowering medication may be effective. However, as of 2009, there was some question about whether these drugs had a preventative effect in individuals with no pre-existing heart disease and low to moderate risk.

Key Terms

Dietary supplement

a product, such as a vitamin, mineral, herb, amino acid, or enzyme, that is intended to be consumed in addition to an individual's diet with the expectation that it will improve health

Fiber

Also known as roughage or bulk. Insoluble fiber moves through the digestive system almost undigested and gives bulk to stools. Soluble fiber dissolves in water and helps keep stools soft.

Feces

The solid waste that is left after digestion. Feces form in the intestines and leave the body through the anus.

Fiber

Also known as roughage or bulk. Insoluble fiber moves through the digestive system almost undigested and gives bulk to stools. Soluble fiber dissolves in water and helps keep stools soft.

Hypertension

Abnormally high blood pressure in the arteries.

Placebo

a pill or liquid given during the study of a drug or dietary supplement that contains no medication or active ingredient. Usually study participants do not know if they are receiving a pill containing the drug or an identical-appearing placebo.

Triglycerides

a type of fat found in the blood. High levels of triglycerides can increase the risk of coronary artery disease

For Your Information

Resources

Books

• American Heart Association. American Heart Association Low-Fat, Low-Cholesterol Cookbook: Delicious Recipes to Help Lower Your Cholesterol., 3rd ed. New York: Clarkson Potter, 2004.

Websites

• "Cholesterol." MedlinePlus. February 3, 2009 [cited February 6, 2009]. http://www.nlm.nih.gov/medlineplus/cholesterol.html.


• "High Blood Cholesterol." National Heart, Lung, and Blood Institute. September 2008 [cited February 6, 2009]. http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC_WhatIs.html.


• "Introducing the TLC Diet." national Heart, Lung, and Blood Institute. [cited February 9, 2009]. http://www.nhlbisupport.com/cgi-bin/chd1/step2intro.cgi.


• "Nutrition Fact Sheet: Dietary Cholesterol." Northwestern University Feinberg School of Medicine. July 28, 2007 [cited February 6, 2009]. http://www.feinberg.northwestern.edu/nutrition/factsheets/cholesterol.html .

Organizations

• American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, Illinois 60606-6995. Telephone: (800) 877-1600. http://www.eatright.org.


• American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. Toll-free:(800) 242-8721. http://www.americanheart.org .


• National Cholesterol Education Program. National Heart, Lung, and Blood Information Center, P.O. Box 30105, Bethesda, MD 20824-0105. http://www.nhlbi.nih.gov/about/ncep.

Anticholesteremic agents
Low density lipoproteins
Diet therapy
Blood cholesterol
High density lipoproteins
Dietary fiber

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

high cholesterol

Hypercholesterolemia, see there.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Patient discussion about high cholesterol

Q. I have high cholesterol. What I need to do in order to reduce him?

A. How to Eat to Lower Your Cholesterol
Things You’ll Need:
Flaxseed
Fruits
Garlic
Kidney Beans
Oatmeal
Soy Foods Like Tofu
Vegetables
White Beans
Step1Eat more garlic. Add it to pasta, soups and vegetables.
Step2Increase your intake of soy foods. Enjoy more tofu, green soybeans (edamame), tempeh and TVP (texturized vegetable protein).
3Add beans to your diet three to five times a week. Try lentil soup, black beans and rice, and hummus, and toss kidney beans into green salads.
Step4Include a serving of fiber-rich fruit or vegetables at every meal and snack.
For full article: http://www.ehow.com/how_12776_eat-lower-cholesterol.html?ref=fuel&utm_source=yahoo&utm_medium=ssp&utm_campaign=yssp_art Hope this helps.

Q. How to lower high cholesterol? The Doctor told my husband that his cholesterol levels are very high and that he has to lower them immediately. What foods are low in cholesterol and what foods should I be cooking for him to eat?

A. Any treatment of high cholesterol first begins with some lifestyle changes. This involves three simple, yet often difficult to execute, steps: improved diet, increased physical activity, and weight management.
Make sure your Husband is eating unsaturated fats instead of saturated and trans fats, avoiding cholesterol, increasing dietary fiber, and consuming more plant sterols/stanols. Increase his vegetables and whole grains intake, but decrease the fat, salt and sugar intakes.
Also, it will be easier for him to stick to his diet if the whole family changes their eating habits and eats healthier too. Start cooking healthy meals for the whole family and not just for him.

Q. Which cholesterol is the bad cholesterol and what level is considered high cholesterol? I keep on hearing about cholesterol and how it is bad for you though I understand that there are two kinds of cholesterol and that only one of them is bad, which is it? Also, what level is considered high cholesterol?

A. Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test. If your total cholesterol is 200 mg/dL or greater, or if your HDL is less than 40 mg/dL, then you will probably need treatment.

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