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 this illness. 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 produced by your liver. It is necessary for building cell walls and in the production of hormones. Cholesterol is also found in some foods. It is not found in plant-based foods.
When you have too much cholesterol in your blood, it builds up in the walls of your arteries. Over time, this buildup causes "hardening of the arteries." This means the lining of the arteries becomes narrow, affecting blood flow to the heart. Blood carries oxygen to your heart and other vital organs. If not enough blood and oxygen reaches your heart, you may feel chest pain. If the blood supply to an area of the heart is completely blocked, the result is a heart attack.
High blood cholesterol shows no symptoms, so many people are unaware that their cholesterol level is too high until it has caused a heart attack, stroke, or leg pains when walking. That's why it's important to find out what your cholesterol level is. If your level is high, you can take steps to reduce it, and thus reduce your risk of developing CVD, or of dying of a heart attack if you already have heart disease.
Keeping your cholesterol within healthy limits is important for you no matter what your age or gender, whether you have CVD or not. Everyone age 20 or older should have a blood cholesterol test at least once every five years. The most accurate test is the "lipoprotein profile," which is done after fasting for 9 to 12 hours.
A lipoprotein profile measures:
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 by helping transport it out of the body
Triglycerides, which are another form of fat in your blood
VLDL (very low-density lipoproteins) and a cholesterol/HDL ratio may also be included in the profile.
If it's not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol level.
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 doctor can order a fasting lipid profile to be done.
Understanding treatment guidelines
Current guidelines for treatment of high cholesterol come from the National Cholesterol Education Program III, overseen by the NHLBI. The guidelines are used to determine a person's risk of experiencing a heart attack within 10 years by considering factors such as age, gender, and whether he or she smokes and has high blood pressure or diabetes.
Your cholesterol level is one part of the equation for determining your risk for CVD. Other risks 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 is a protective factor against CVD and actually removed a risk factor.
Treatment for high cholesterol depends on how many other risk factors are present.
If you have high cholesterol, your 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 for these illnesses, the lower your LDL should be.
You can lower your LDL level and raise your HDL level through lifestyle changes, such as a low-saturated-fat and low cholesterol diet, exercise, and weight management. A low-saturated-fat, low-cholesterol diet 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. 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 circumference 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 genetic 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. Specific eating plans such as the Mediterranean diet or DASH diet can reduce your risk of CVD. Your doctor may prescribe cholesterol-lowering medication along with lifestyle changes. Maintaining your lifestyle changes will keep your medication dose as low as possible and lower your risk for CVD disease in other ways. Several types of drugs are available for lowering cholesterol, including statins, bile acid sequestrants, nicotinic acid (niacin), fibric acids, and cholesterol absorption inhibitors. This last class of drugs blocks cholesterol absorption in the intestine and lowers LDL and triglyceride levels.
How statins work
Statins 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 open, 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. Your doctor will check your blood about six to eight weeks after you start taking a statin medication to check its effectiveness.
You will be instructed to 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.
Initially, your doctor may watch you for liver and muscle toxicity, the most serious side effect of statins. But such side effects are uncommon. The FDA issued a warning in 2012 about statins and memory loss with diabetes (elevated blood sugar). Be certain to discuss side effects with your doctor before starting any medication.
Other potential side effects include constipation, headache, and nausea. But most people don't experience them.
Bile acid resins
This class of medication binds to bile from the liver when it enters the small intestine. It prevents bile from being reabsorbed. Because bile is made largely from cholesterol, these drugs work by forcing the body to make more bile, which depletes the body's supply of cholesterol. Side effects can be constipation, gas, and an upset stomach.
Nicotinic acid (niacin)
Another cholesterol-lowering medication is nicotinic acid (niacin). This is a B vitamin that works in the liver to affect the production of blood fats, lower triglyceride and LDL cholesterol levels, and raise HDL cholesterol. Unfortunately, many people don't tolerate niacin well because of the common side effects of flushing, itching, upset stomach, dizziness, and headache.
A class of drugs called fibrates is another option. They mainly act by reducing triglyceride levels. They might be the better drug to use if someone has more of a triglyceride disorder than high LDL cholesterol. You should not take fibrates and statins together.
Cholesterol absorption inhibitors
Yet another option is the newest drug category called cholesterol absorption inhibitors, which block cholesterol absorption in the intestine. They are useful for people who can’t take statins or can be taken 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.
Maintain a heart-healthy lifestyle
No matter which cholesterol-lowering medication you take, it's important to remember that diet and exercise also lower cholesterol and are a valuable part of your treatment strategy. Don't think you can just take a pill.