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High Cholesterol

High Cholesterol

Cholesterol is a type of lipid, or fat-like particle, that is a vital nutrient for bodily functions. If cholesterol levels get too high (>200 in adults), however, they can increase your risk of heart attack and stroke. This is because high levels of cholesterol result in fatty deposits and hardening of the arteries, known as atherosclerosis. These deposits also narrow the size of the arteries, obstructing blood flow. Without proper blood circulation, organs in your body, such as your heart and brain, can suffer permanent damage. This can result in a heart attack or certain types of strokes.

What are the different types of cholesterol?

Lipoproteins, such as LDL and HDL, help to carry cholesterol to and from cells. Lipoproteins are bundles of both protein and cholesterol molecules. There are two types of lipoproteins:

1) LDL, or low density lipoprotein, is a type of “bad” cholesterol that can lead to hardening of the arteries. Levels should be less than 160 mg/dL, or even lower depending on how many risk factors you have for heart disease. Risk factors include smoking, family history of heart disease, older age (male >45 yrs or post-menopausal female), smoking, or high blood pressure. If you have heart disease or have diabetes, levels should be1ess than 100 mg/dL.

2) HDL, or high-density lipoprotein, is a type of “good” cholesterol that transports cholesterol away from the blood and may possibly help to remove plaques from your arterial wall. This is why higher levels of HDL are good for you and help to prevent heart attacks. Levels should optimally be greater than 40 mg/dL in men and >50mg/dL in women.

Your Total Cholesterol is the overall estimate of your cholesterol level, including subtypes such as LDL, HDL, and other lipids. This number should ideally be less than 200 mg/dL in adults. If your level is between 200-239, you have moderately increased levels. Greater than 240 indicates that you are at risk for heart disease.

Triglycerides are another type of fat that your doctor may check with a cholesterol panel. Normal levels should be less than150mg/dL. Having a high triglyceride levels may also increase your risk of heart disease.

Risk factors:

1) Diet
2) Obesity
3) Family history
4) Physical inactivity
5) Older age (male >45 yrs or post-menopausal female)
6) Certain medications, such as steroids, diuretics, and progestins.

Why do many Americans suffer from high cholesterol?

A typical American diet contains too much fat and cholesterol, which is a major factor in high cholesterol levels. The main source of cholesterol in the diet is from saturated fat, which is found in foods such as red meat, egg yolks, and whole milk dairy products. You should keep your cholesterol intake to 200-300 mg/day.

Many Americans are also physically inactive, and this can cause lower levels of HDL. HDL is a type of “good” cholesterol that can lower your risk of heart disease. Smoking can also lower HDL levels. Moderate amounts of alcohol (1-2 drinks/day for men, 1 drink/day for women) have been shown to also elevate HDL levels, but since alcohol carries other risks so it is not recommended that you drink if you don’t already.

How often should I get my cholesterol checked?

Cholesterol can be checked in children if there is a family history of heart disease or high cholesterol. All overweight, diabetic patients or those with other risk factors should have their cholesterol checked as recommended by your doctor.

If you do not have any risk factors for high cholesterol, you should have your cholesterol checked by the time you are 20 years old. Cholesterol levels should then be repeated every 3-5 yrs if you have normal cholesterol levels.

Your levels will need to be checked more often if you have been elevated in the past or if you are on cholesterol lowering medicine, based on your doctor’s recommendations. Make sure that you fast for 12 hrs prior to your cholesterol test.

Why it is necessary to keep your cholesterol under control?

High cholesterol is related to many diseases, such as heart attacks and stroke. This is because high levels of cholesterol result in fatty deposits and hardening of the arteries, known as atherosclerosis. These deposits also narrow the size of the arteries, obstructing blood flow through the arteries. Without proper blood circulation, organs in your body can suffer permanent damage.

Diabetics also tend to have higher cholesterol and triglyceride levels, and are more vulnerable to plaque formation in their arteries. It is therefore especially important for diabetics to control levels so that their total cholesterol is less than 100mg/dL, or some experts say even lower.

How do you lower cholesterol levels?

Cholesterol can be controlled by diet, exercise, and medication. You should also stop smoking. Your doctor will usually recommend diet and exercise for 3-6 months or longer to begin with, depending on your risk factors and how high your cholesterol levels are initially.

What changes should I make in my diet?

Diet modifications can include:

Avoiding “Bad” Fats:
-Saturated fats—these are found in fatty red meats, pork, butter, whole milk products, egg yolks.
-coconut oils, palm oil, hydrogenated oils such as Crisco.

Healthier Fats
-If you use oils, choose monounsaturated oils instead, such as olive oil, sesame oil, peanut oil, canola oil.
-Avocados are also a healthy source of monounsaturated fat.
-Polyunsaturated fats are found in grain products, fish oil, soybeans, fish such as herring, salmon, mackerel, halibut.

Some general guidelines to follow:

1) Decrease saturated fats—these are found in fatty red meats, pork, butter, whole milk products, egg yolks.
2) Avoid fried foods, or using coconut oils, and oils made of vegetable fats. If you use oils, choose monounsaturated oils instead, such as olive oil, sesame oil, peanut oil, canola oil. Avocados also contain monounsaturated fat, which is more healthy than saturated fats.
3) Avoid fast foods
4) Avoid potato chips or other fried snacks. Choose baked snacks instead.
5) Eat leaner meats, skinless poultry, fish, tofu, legumes (beans). Fish such as herring, salmon, mackerel, halibut are high in monounsaturated fats.
6) Eat plenty of fresh vegetables and fruits.
7) Choose whole grain breads and other whole grain products
8) Try to bake, grill, steam foods
9) Cut down on sweets in general. Keep in mind that many desserts have high cholesterol ingredients.

You may want to talk to a dietitian if your need further advice on a low cholesterol diet.

How much should I exercise?

A regular exercise program is also important to lower your cholesterol. Try to exercise 30 minutes a day most days of the week, and select activities that you enjoy. Keep in mind that even moderate increases in exercise or increasing you activity level (such as taking the stairs rather than the elevator, gardening) can help to improve your health. Talk to your doctor before starting any exercise program.
If lifestyle changes are not effective, medication might be recommended. Types of medications include:

1) Statins—these act to lower total cholesterol, LDL and triglycerides levels; and increase HDL. Examples are atorvastatin, fluvastatin, lovastatin,
2) Fibrates—these lower triglycerides and total cholesterol, and increase HDL. Examples include gemfibrozil, fenofibrate
3) Niacin—this lowers total cholesterol, LDL and triglycerides, and increases HDL. Also called nicotinic acid
4) Cholesterol absorption inhibitors—these decrease absorption of cholesterol in your digestive track. An example of this is ezetimibe.

These drugs have different mechanisms of action and side effects. The most commonly used cholesterol pill are the statins, and they are generally well-tolerated by most people. Please consult your doctor if you have further questions about your medications.