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High cholesterol



Related terms
Background
Risk factors and causes
Treatment
Author information
Bibliography
Types of cholesterol
Diagnosis and screening

Related Terms
  • Androgen, angina, angina pectoris, angiogenesis, angiogram, arcus senilis, arteriogram, atherosclerosis, blood clot, cholesterol, computerized tomography angiography (CTA), coronary artery bypass graft surgery (CABG), coronary heart disease (CHD), cortisol, C-reactive protein, diabetes, dyslipidemia, embolus, endothelium, enhanced external counter pulsation (EECP), estrogen, high-density lipoprotein (HDL), homocysteine, hypercholesterolemia, hyperlipidemia, hyperlipoproteinemia, lipid disorder, lipid panel, lipid profile, lipoprotein, low-density lipoprotein (LDL), magnetic resonance imaging (MRI), myocardial infarction, obesity, percutaneous transluminal coronary angioplasty(PTCA) platelet, peripheral artery disease (PAD), plaque, Raynaud's disease, saturated fats, silent ischemia, soluble fiber, sterol, stress test, therapeutic lifestyle changes (TLC), thrombus, trans fats, transient ischemic attacks (TIAs),triglyceride, unsaturated fats, very-low-density lipoprotein (VLDL), xanthelasma, xanthoma.

Background
  • High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthily high levels of cholesterol in the blood. It is also called dyslipidemia, hyperlipidemia, and lipid disorder.
  • Too much cholesterol in the blood is a major risk for heart disease, which may lead to a heart attack, heart failure (not being able to pump enough blood to the body), and death. igh cholesterol levels are also a risk factor for stroke (a lack of blood and oxygen to the brain), which causes nerve damage.
  • Cholesterol is a soft, waxy, fat-like substance found in the bloodstream and cells of the body. Cholesterol synthesis is a naturally occurring process that functions to produce membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as androgens and estrogens (the male and female sex hormones) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used in making vitamin D.
  • The body obtains cholesterol in two ways, producing the majority of it in the body and consuming the rest in the diet in the form of animal products, such as meats, poultry, fish, eggs, butter, cheese, and whole milk. Plant foods, like fruits, vegetables, and grains, do not contain cholesterol. Fat that occurs naturally contains varying amounts of saturated and unsaturated fat.
  • High cholesterol can cause the formation and accumulation of plaque deposits in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium, normal substances in the blood that become deposited on the artery walls if the blood does not flow properly. When plaque builds up in the arteries, it results in atherosclerosis (hardening of the arteries) or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries, which increase the risk for heart attack, stroke, and death, as well as circulation problems, such as Raynaud's disease and high blood pressure.
  • The development of plaques and blockages in the arteries involves several steps. When the endothelium (the innermost lining of the arteries) is damaged by oxidation, cholesterol particles, proteins, and other substances are deposited into the damaged wall and form plaques. More cholesterol and other substances are incorporated into the plaque, and the plaque grows, narrowing the artery. Over time, plaque deposits may grow large enough to interfere with blood flow through the artery (this is called a blockage). When coronary arteries (the arteries supplying the heart with blood) are blocked, angina (chest pain) may occur; when arteries in the legs are blocked, leg pain or cramping may occur; and when arteries supplying the brain with blood are blocked, stroke may occur.
  • The platelets collecting on the plaque deposit form a clot as they try to rush by but get caught, because the lining of the artery is rough and the platelets are sticky. Then the clot can break off and travel through the body, getting lodged in vessels of the leg or brain and less commonly the lungs. If a plaque ruptures or tears, a thrombus (blood clot) may develop. If a blood clot completely blocks blood flow through a coronary artery, myocardial infarction (heart attack) occurs; if an artery supplying blood to the brain is completely blocked, stroke occurs.
  • Blood clots (called emboli) can break loose and travel through the bloodstream and lodge in blood vessels in other parts of the body, including the lungs, heart, brain, and legs. A thromboembolus is when the blood clot lodges in vessels.
  • According to current estimates, 71.3 million people in America have one or more forms of heart disease. High cholesterol affects about 20% of adults over the age of 20 in the United States. The highest prevalence occurs in women between the ages of 65 and 74. The World Health Organization (WHO) reports that high cholesterol contributes to 56% of cases of coronary heart disease worldwide and causes about 4.4 million deaths each year.
  • Generally, people who live in countries where blood cholesterol levels are lower, such as Japan, have lower rates of heart disease. Countries with very high cholesterol levels, such as Finland, have very high rates of coronary heart disease. However, some populations with similar total cholesterol levels have very different heart disease rates, suggesting that other factors (such as diet, heredity, and smoking) also influence risk for coronary heart disease.
  • Evidence is accumulating that eating more carbohydrates, especially simpler, more refined carbohydrates such as white breads, sugar, and pasta, may increase levels of triglycerides in the blood, lower high-density lipoprotein (HDL, or "good") cholesterol, and increase low-density lipoprotein (LDL, or "bad") cholesterol. Thus a low-fat diet, which often means a higher carbohydrate intake, may actually be an unhealthy change.

Risk factors and causes
  • Diet: Saturated fat and cholesterol in foods makes total cholesterol and low-density lipoprotein (LDL) levels rise. Cholesterol is consumed in the diet in the form of animal products, such as meats, poultry, fish, eggs, butter, cheese and whole milk. Plant foods, like fruits, vegetables, and grains, do not contain cholesterol. Fat that occurs naturally contains varying amounts of saturated and unsaturated fat.
  • Weight: Being overweight may increase "bad" cholesterol levels and is a risk factor for heart disease. Losing weight may help lower LDL, triglyceride, and total cholesterol levels, as well as raise high-density lipoprotein (HDL) levels. Individuals with a large waist measurement (more than 40 inches for men and more than 35 inches for women) are at high risk for heart disease.
  • Physical activity: A lack of physical activity is a risk factor for heart disease. Exercise helps strengthen the heart and blood vessels. Exercising regularly can help lower LDL ("bad") cholesterol and raise HDL ("good") cholesterol levels. Being physically active for at least 30 minutes on most, if not all, days may help reduce the risk of developing high cholesterol and coronary heart disease.
  • Age and gender: Cholesterol levels rise with age, due to various factors, including hormonal changes, diet, and general health. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise due to hormonal imbalances. As a rule, women have higher HDL cholesterol levels than men do. The female sex hormone estrogen tends to raise HDL cholesterol, which may help explain why premenopausal women are usually protected from developing heart disease. Estrogen production is highest during the childbearing years (20s to 40s). Women also tend to have higher triglyceride levels. As people get older and/or gain weight, their triglyceride and cholesterol levels tend to rise. Evidence reports that the atherosclerotic process (buildup of fatty plaque in arteries) begins in childhood and progresses slowly into adulthood. Then it often leads to coronary heart disease, the single leading cause of death in the United States. Eating patterns and genetics affect blood cholesterol levels in children and increase the risk of developing heart disease later in life.
  • Heredity: Genetics partially determine how much cholesterol is produced endogenously. High blood cholesterol can run in families. If a parent or sibling developed heart disease before age 55, high cholesterol levels place an individual at a greater-than-average risk of developing heart disease.
  • Smoking: Cigarette smoking damages the walls of blood vessels through a process called oxidation, making them prone to build up fatty deposits. Smoking may also lower levels of HDL cholesterol.
  • High blood pressure: Increased pressure on the blood vessel walls damages arteries, which can speed the accumulation of plaque.
  • Diabetes: High blood sugar contributes to high LDL cholesterol and low HDL cholesterol. High blood sugar can also damage the lining of the arteries, making it easier for plaque (protein, fat, and cholesterol) to deposit.
  • Others: Nephrotic syndrome (kidney disease), hypothyroidism (low thyroid levels), anorexia nervosa (an eating disorder), and Zieve's syndrome (a condition that causes high cholesterol during withdrawal from long-term alcohol abuse) can all contribute to high cholesterol.

Treatment
  • The main goal of cholesterol-lowering treatment is to lower low-density lipoprotein (LDL) levels enough to reduce the risk of developing heart disease or having a heart attack. The higher the risk, the lower the LDL goal should be. There are two main ways to lower cholesterol, including therapeutic lifestyle changes (TLC) and drug therapy. TLC includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above his or her target number and goal. Drug treatment with cholesterol-lowering drugs can be used together with TLC treatment to help lower LDL. Prevention of elevated cholesterol is started if the individual is at risk for high cholesterol levels or heart disease, or if a previous heart attack or stroke has occurred.
  • Category I, highest risk: In those with highest risk, the LDL goal is less than 100mg/dL. They will begin the TLC diet to reduce high risk even if the LDL is below 100mg/dL. If the LDL level is 100mg/dL or above, drug treatment will be started at the same time as the TLC diet. If the LDL level is below 100mg/dL, drug treatment may also be started together with the TLC diet if the doctor finds the risk is very high, for example, if the individual has had a recent heart attack or has both heart disease and diabetes.
  • Category II, next highest risk: The LDL goal is less than 130mg/dL. If the LDL level is 130mg/dL or above, treatment with the TLC diet should be started. If the LDL level is 130mg/dL or more after three months on the TLC diet, drug treatment should be started along with the TLC diet. If the LDL level is less than 130mg/dL, individuals should follow the heart-healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.
  • Category III, moderate risk: The LDL goal is less than 130mg/dL. If the LDL level is 130mg/dL or above, the TLC diet is started. If the LDL is 160mg/dL or more after having tried the TLC diet for three months, drug treatment may be started along with the TLC diet. If the LDL is less than 130mg/dL, the heart-healthy diet for all Americans (low saturated fat and cholesterol) is used.
  • Category IV, low-to-moderate risk: The LDL goal is less than 160mg/dL. If the LDL level is 160mg/dL or above, the TLC diet is started. If the LDL level is still 160mg/dL or more after three months on the TLC diet, drug treatment may be started along with the TLC diet to lower LDL, especially if the LDL level is 190mg/dL or more. If the LDL level is less than 160mg/dL, the heart-healthy diet for all Americans is used.
  • Diet: Individuals with high risk associated with developing heart disease will be started on the therapeutic lifestyle changes (TLC) diet. The TLC diet is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories to come from saturated fat (such as in animal products) and less than 200 milligrams of dietary cholesterol daily. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If the LDL level is not lowered enough by reducing saturated fat and cholesterol intakes, the amount of soluble fiber, such as psyllium, oat bran, and beta-glucan, in the diet can be increased (in cereals, breads, and supplements), thereby helping to raise HDL levels and lower LDL levels. Certain food products that contain plant sterols (a cholesterol-lowering component in many plants) can also be added to the TLC diet to boost its LDL-lowering power. Examples include cholesterol-lowering margarines (containing Benecol®, a plant sterol) and sterol supplements in capsule and tablet form. Plant sterols are found naturally in fruits, vegetables, nuts, seeds, cereals, legumes (beans), and vegetable oils (particularly soybean oil).
  • Weight management: When the body mass index (BMI, or fat content) is greater than 25, an individual is considered overweight. BMI uses an equation based on height and weight to determine the level of obesity. Losing weight can help lower LDL levels and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels.
  • Physical activity: Regular physical activity (at least 30 minutes on most, if not all, days) is recommended for those that can tolerate exercise. Taking a brisk 30-minute walk, 3-4 times per week, can positively impact cholesterol levels. Patients with chest pain and/or known or suspected heart disease should talk to their doctor before beginning any exercise program. Exercise can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement. Individuals with a large waist measurement (more than 40 inches for men and more than 35 inches for women) are at high risk for heart disease.
  • Medication therapy: There are several medications that may help lower cholesterol, including total cholesterol, lipoproteins, and triglycerides. Medications can reduce LDL ("bad") cholesterol levels by 20-40%. They also can modestly increase HDL ("good") cholesterol levels, usually by about 5-10%. Available drugs include 5-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors), bile acid-binding resins, cholesterol absorption inhibitors, fibrates, and niacin.
  • 5-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors, or statins): Statins have significantly advanced the treatment of high cholesterol. Statins block a substance (HMG-CoA reductase) that the liver needs to make cholesterol. This decreases cholesterol in hepatocytes (liver cells), which causes the liver to remove cholesterol from the blood, thereby lowering cholesterol levels. Statins may also help the body reabsorb cholesterol from accumulated deposits on artery walls, potentially reversing coronary artery disease. Commonly prescribed statins include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacor®), pravastatin (Pravachol®), rosuvastatin calcium (Crestor®), and simvastatin (Zocor®). Statins may also be added to blood pressure-lowering drugs for use in protection from coronary heart disease (e.g., Caduet®, a combination of atorvastatin (Lipitor®) and amlodipine (Norvasc®)). Results from statin treatment should be seen after several weeks, with a maximum effect in 4-6 weeks. After about 6-8 weeks, a doctor will check the LDL cholesterol levels while the individual is on the statin. Serious side effects are rare, and they include liver problems and muscle soreness, pain, and weakness. If this happens, or if there is brown urine present, contact a doctor immediately. Although rare, muscle breakdown, known as rhabdomyolysis, can occur. This is a medical emergency, and a doctor should be contacted immediately. Other recent updates that are being added to safety labels are memory loss, confusion, forgetfulness, possible elevation in blood sugar, and type 2 diabetes.
  • Bile-acid-binding resins (sequestrants): The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite®, Questran®), colesevelam (WelChol®), and colestipol (Colestid®) lower cholesterol indirectly by binding to bile acids (this is called sequestrant therapy). This causes the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood. Bile acid sequestrant powders must be mixed with water or fruit juice and must be taken once or twice (rarely, three times) daily with meals. Tablets must be taken with large amounts of fluids to avoid stomach and intestinal problems. Sequestrant therapy may produce a variety of symptoms, including constipation, bloating, nausea, and gas. Although sequestrants are not absorbed, they may interfere with the absorption of other medicines if taken at the same time. Other medications should be taken at least one hour before or 4-6 hours after taking the sequestrant.
  • Cholesterol absorption inhibitors: The small intestine absorbs cholesterol from the diet and releases it into the bloodstream. The drug ezetimibe (Zetia®) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia® can cause headaches, nausea, fever, and muscle weakness. Zetia® by itself lowers LDL cholesterol levels similarly to statins, but when combined with a statin, Zetia® works better to control elevated LDL levels. There is a combination of ezetimibe and simvastatin on the market, called Vytorin®.
  • Fibrates: The medications fenofibrate (Lofibra®, TriCor®) and gemfibrozil (Lopid®) decrease triglycerides by reducing the liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from the blood. VLDL cholesterol contains mostly triglycerides. Some people taking fibrates may have side effects such as stomach or intestinal discomfort. Fibrates may increase the likelihood of developing gallstones and can increase the effect of medications that thin the blood. The dose of fibrates should be reduced if kidney function declines.
  • Niacin: Niacin, also known as nicotinic acid or vitamin B3, decreases triglycerides by limiting the liver's ability to produce low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol. There are two types of niacin: immediate-release and extended-release (or slow-release). Niacin can reduce LDL cholesterol levels by 10-20%, reduce triglycerides by 20-50%, and raise HDL cholesterol levels by 15-35%. A common and troublesome side effect of immediate-release niacin is flushing or hot flashes, which are the result of blood vessels opening wide. The causes of this flushing are not well known. Most people develop a tolerance to flushing, which can sometimes be decreased by taking the drug during or after meals or by the use of aspirin 30 minutes prior to taking niacin; a doctor will guide the individual. The extended-release form (Niaspan®) may cause less flushing than the other forms. Individuals will be started on regular niacin therapy to see how well it is tolerated, then the individual can be started on the extended-release products if needed. Blood pressure may also be reduced while taking niacin. Niacin can cause a variety of gastrointestinal symptoms, including nausea, indigestion, gas, vomiting, diarrhea, and the irritation of peptic ulcers.
  • Other: If there are other symptoms of coronary heart disease (CHD) besides high cholesterol, other medications may be used to decrease the risk of stroke (lack of blood and oxygen to the brain) and heart attack. These include platelet inhibitors (which "thin" the blood) such as aspirin (81-325 milligrams daily, which may cause bleeding) or Plavix® (clopidogrel), beta-blockers (these decrease the heart rate and blood pressure, reducing the heart's demand for oxygen, and may cause fatigue) such as metoprolol (Lopressor®, Toprol®), nitroglycerin (which increases the oxygen available to the heart by dilating coronary arteries, and which may cause headache), calcium channel blockers (which slow the heart rate and dilate coronary blood vessels, and which may cause slow heart rate) such as amlodipine (Norvasc®) or diltiazem (Cardizem®), angiotensin-inhibiting drugs or ACE inhibitors (which dilate blood vessels and increase oxygen to the heart, and which may cause cough) such as lisinopril (Prinivil®, Zestril®) or ramipril (Altace®), and statins or HMG-CoA reductase inhibitors (which help lower cholesterol levels and may cause liver problems or muscle pain) such as atorvastatin (Lipitor®) or lovastatin (Mevacor®). Interventional procedures may also be used to treat CHD, including balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA)) and stent (a wire mesh that opens blocked blood vessels) placement. Coronary artery bypass graft (CABG) surgery may be required to restore normal blood flow to the heart. CABG is a serious surgery, with complications including infection, lowered immunity, memory loss, "fuzzy" thinking, and even death.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Heart Association. .
  2. Boekholdt SM, Sandhu MS, Day NE, et al. Physical activity, C-reactive protein levels and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study. Eur J Cardiovasc Prev Rehabil. 2006;13(6):970-6.
  3. Duffey KJ, Gordon-Larsen P, Jacobs DR Jr, et al. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. Am J Clin Nutr. 2007;85(1):201-8.
  4. Harris WS, Assaad B, Poston WC. Tissue omega-6/omega-3 fatty acid ratio and risk for coronary artery disease. Am J Cardiol. 2006 Aug 21;98(4A):19i-26i. Epub 2006 May 30.
  5. National Heart, Lung, and Blood Institute. .
  6. National Institutes of Health. .
  7. Natural Standard: The Authority on Integrative Medicine. .
  8. U.S. Food and Drug Administration. .

Types of cholesterol
  • Saturated fats: Saturated fats are solid at room temperature, Foods that contain a high proportion of saturated fat are butter, lard, coconut oil, cottonseed oil and palm oil, dairy products (such as cream and cheese), meat, skin, and some prepared foods. People with diets high in saturated fat are reported to have an increased incidence of atherosclerosis (hardening of the arteries) and coronary heart disease. Saturated fats are popular with manufacturers of processed foods because they are less vulnerable to rancidity and are generally more solid at room temperature than unsaturated fats.
  • Unsaturated fats: Unsaturated fats are liquid at room temperature. Unsaturated fats include monounsaturated and polyunsaturated fats. Monounsaturated fat remains liquid at room temperature but may start to solidify in the refrigerator. Foods high in monounsaturated fat include olive, peanut, and canola oils. Avocados and most nuts also have high amounts of monounsaturated fat. Polyunsaturated fat is usually liquid at room temperature and in the refrigerator. Foods high in polyunsaturated fats include vegetable oils, such as safflower, corn, sunflower, soy, and cottonseed oils. The use of monounsaturated and polyunsaturated fats instead of saturated fat can help to lower blood cholesterol levels.
  • Trans fats: Trans-fatty acids (trans fats) are a type of unsaturated fat. Trans fat is formed when liquid vegetable oils go through a chemical process called hydrogenation, in which hydrogen is added to make the oils more solid. Hydrogenated vegetable fats are utilized in food production because they allow longer shelf life and give food desirable taste, shape and texture. Trans fat can be found in shortenings (e.g., Crisco®), margarine, cookies, crackers, snack foods, fried foods (including fried fast food), doughnuts, pastries, baked goods, and other foods processed with partially hydrogenated oils. Some trans fat is found naturally in small amounts in dairy products and some meats. The primary health risk associated with trans fat consumption is an increased risk of coronary heart disease (CHD). Effective January 1, 2006, the U.S. Food and Drug Administration (FDA) requires food companies to list trans fat content separately on the nutrition facts panel of all packaged foods.
  • Lipoproteins: Cholesterol and other fats cannot dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are two main types of lipoproteins, including low-density lipoprotein (LDL, or "bad") cholesterol and high-density lipoprotein (HDL, or "good") cholesterol. Another type, very-low-density lipoprotein (VLDL) is converted to LDL in the bloodstream. Each form of lipoprotein contains a specific combination of cholesterol, protein, and triglyceride (a blood fat). VLDL cholesterol contains the highest amount of triglyceride.
  • Too much LDL cholesterol can block the arteries, increasing the risk of heart attack and stroke. LDL takes cholesterol into the bloodstream, and HDL takes it back to the liver for storage. It is also believed that HDL removes excess cholesterol from plaque in arteries, thus slowing the buildup. Studies suggest that high levels of HDL cholesterol reduce the risk of heart attack.
  • Lipoprotein (a) (Lp(a)) cholesterol: Lp(a) is a lipoprotein (fat-protein molecule) found in the body that is a genetic variation of LDL cholesterol. A high level of Lp(a) is an important risk factor for developing fatty deposits in arteries. The way increased Lp(a) contributes to disease is not understood, but Lp(a) may attract substances that increase inflammation, such as interleukins (IL-1, IL-6, TNF-alpha) and prostaglandins (PG2), leading to the buildup of fatty deposits.
  • Triglycerides: Triglycerides are the body's storage form for fat. Most triglycerides are found in adipose (fat) tissue. Some triglycerides circulate in the blood to provide fuel for muscles to work. Extra triglycerides are found in the blood after eating a meal, when fat is being sent from the intestines to fat tissue for storage. People with high triglyceride levels often have high LDL cholesterol and low HDL cholesterol levels. Many people with heart disease also have high triglyceride levels. People with diabetes or who are overweight are also likely to have high triglyceride levels.

Diagnosis and screening
  • Recommendations for cholesterol screening and treatment have been provided by the National Institutes of Health (NIH) and are summarized in the National Cholesterol Education Program (NCEP). The guidelines recommend that all adults have their cholesterol levels checked at least once every five years. Patients with coronary heart disease or other forms of atherosclerosis are at the highest risk for heart attack and stroke (lack of blood and oxygen to the brain). These patients may benefit the most from cholesterol-reduction therapy and should have a full lipid profile (lipid panel) performed annually. This includes measuring total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Very-low-density lipoproteins (VLDL) and lipoprotein (a) (Lp(a)) levels can also be taken. For the most accurate measurements, there is no eating or drinking anything (other than water) for 9-12 hours before the blood sample is taken.
  • There is no formula to determine what cholesterol level is considered "safe" and what cholesterol level requires treatment for each individual. General recommendations are based on ongoing research regarding future risk for heart attack. In a person with established coronary heart disease, the risk for heart attack (or subsequent heart attack) and death is much higher, so even mildly elevated cholesterol levels must be treated aggressively.
  • Total cholesterol levels: The total blood cholesterol will fall into one of three categories, including desirable (less than 200mg/dL, or milligrams per deciliter), borderline high-risk (200-239mg/dL), and high-risk (240mg/dL and above).
  • If the total cholesterol is less than 200mg/dL, the risk of heart attack risk is relatively low, unless there are other risk factors, such as smoking, a previous heart attack, or high blood pressure.
  • If the total cholesterol level is 200-239mg/dL, individuals are classified as borderline high-risk. About one-third of American adults are in this group, whereas almost one-half of adults have total cholesterol levels below 200mg/dL. Not every person whose cholesterol level is in the 200-239mg/dL range is at increased risk.
  • If the total cholesterol level is 240mg/dL or more, an individual is at high risk of heart attack and stroke. In general, people who have a total cholesterol level of 240mg/dL have twice the risk of coronary heart disease as people whose cholesterol level is 200mg/dL. About 20% of the U.S. population has high blood cholesterol levels.
  • Lipoprotein levels: LDL, or "bad" cholesterol, is a major risk factor for developing atherosclerosis (hardening of the arteries) and coronary artery disease (CAD). LDL levels are reported in several categories. An LDL level below 100mg/dL is best for people at risk for heart disease. If an individual is at very high risk for heart disease, such as having had a previous heart attack, an LDL level less than 70mg/dL is optimal. LDL levels can also be near optimal (100-129mg/dlL, borderline high (130-159mg/dL), high (160-189mg/dlL, or very high (190mg/dL and above).
  • HDL ("good") cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40mg/dL is low and is considered a major risk factor for developing heart disease. HDL levels of 60mg/dL or more help to lower the risk for developing heart disease.
  • Triglyceride levels: High levels of triglycerides can increase heart disease risk. Levels that are borderline high (150-199mg/dL) or high (200mg/dL or more) may need treatment.
  • Children: Total cholesterol levels in children and adolescents (2-19 years old) are classified as acceptable (less than 170mg/dL), borderline (170-199mg/dL), and high (200mg/dL and greater). LDL cholesterol levels for children are classified as acceptable (less than 110mg/dL, borderline (110-129mg/dL), and high (130mg/dL or greater).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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