Cholesterol, what is it and why is this a problem?
High blood cholesterol is a major risk factor for heart disease, the leading cause of death in the United States. About 17% of adult Americans have high blood cholesterol (240 mg/dL or more total cholesterol).
Cholesterol is a waxy, fat-like substance found in your body. In fact, it is needed for the body to function normally. Your body makes enough cholesterol for its needs. When there is too much cholesterol in your body, it is deposited in arteries, including those of the heart, which can lead to narrowing of the arteries and to heart disease.
High blood cholesterol does not produce symptoms, so many people may not know that their blood cholesterol is too high. However, blood cholesterol can be easily checked and can be controlled. Also, there are things that you can do to help keep your blood cholesterol levels in the normal range.
About High Blood Cholesterol
Cholesterol is a waxy, fat-like substance found in your body. It is needed for the body to function normally and is found in all cells of the body. Your body makes enough cholesterol for its needs.
Cholesterol is carried in the blood in particles called lipoproteins. These particles are made up of cholesterol on the inside and protein on the outside. There are two kinds of lipoproteins:
Low-density lipoproteins (LDL): These are the major type of lipoprotein that carries cholesterol in the bloodstream to the body. These are the type that can lead to a buildup of cholesterol in the arteries and lead to heart disease.
High-density lipoproteins (HDL): These particles carry cholesterol back to the liver to remove it from the body. Higher levels of HDL are considered good.
An excess of either total or LDL cholesterol in the blood is a risk for heart disease and atherosclerosis. People can have an excess of cholesterol because of diet and because of the rate at which cholesterol is processed in the body. Most of the excess cholesterol comes from diet. Cholesterol can build up on the artery walls of your body. This buildup is called plaque. Over time, plaque can cause the arteries to become narrow, which is called atherosclerosis. As a result, less oxygen–rich blood can pass through. When the arteries that carry blood to the heart are affected, coronary artery disease can result. A heart attack occurs when a coronary artery becomes completely blocked. A coronary artery can become blocked either by plaque buildup or by a plaque that ruptures or bursts which causes a clot. Angina can also develop because of plaque buildup. Angina happens when the heart does not receive enough oxygen–rich blood.
High blood cholesterol itself does not cause symptoms, so many people may not know that their cholesterol level is too high. Simple blood tests can be done to check your total, LDL and HDL cholesterol levels and other types of fats in the blood (such as triglycerides). If it is found that your cholesterol is high, your doctor may prescribe various treatments depending on your risk for developing heart disease. These include lifestyle changes such as diet, weight control, and physical activity. Certain drugs can also be prescribed to manage your cholesterol. Lifestyle changes are usually still recommended with medications. All people can do things to help keep cholesterol within the normal range.
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Facts and Statistics about Cholesterol
High blood cholesterol is a major risk factor for heart disease.
About 17% of adult Americans aged 20 years and older have high total cholesterol (240 mg/dL or above).
The average blood cholesterol level in adult Americans is about 203 mg/dL.
In 2004, there were 6.5 million visits to doctors’ offices that included a cholesterol test being done or ordered.2
Among African Americans, about 16.6% of women and 12.5% of men have high total cholesterol.
Among Mexican Americans, about 12.7% of women and 17.6% of men have high total cholesterol.
Among whites, 17.4% of women and 17.0% of men have high cholesterol.
The percentage of persons aged 20–74 years with high cholesterol dropped from 33% in 1960–1962 to 17% in 1999–2002. During that same time period, the average blood cholesterol levels in adults dropped from 222 mg/dL to 203 mg/dL.
The National Cholesterol Education Program recommends that all adults have their cholesterol checked once every 5 years.
In 2005, 73% of adults reported that that they had their cholesterol checked within the previous 5 years, according to data from CDC’s Behavioral Risk Factor Surveillance System. Some 23% reported that they never had their cholesterol checked.
According to data from CDC’s Behavioral Risk Factor Surveillance System (2005), 75.7% of whites, 73.7% of African Americans, and 52% of Hispanics reported having had their cholesterol checked within the previous 5 years.
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High Blood Cholesterol Prevention
High blood cholesterol is a major risk factor for heart disease. There are a number of things that can be done to maintain normal cholesterol levels and reduce the risk of developing heart disease. All people at any age can take steps to keep normal cholesterol levels. People with high total cholesterol, high LDL cholesterol, or low HDL cholesterol should talk with their doctor about the best way to control or improve their cholesterol.
What affects cholesterol levels?
A number of things can affect the cholesterol levels in your blood. These include the following:
Diet. Certain foods have types of fat that raise your cholesterol level. These types of fats include saturated fat, trans fatty acids or trans fats, and dietary cholesterol. Saturated fats come largely from animal fat in the diet, but also some vegetable oils such as palm oil. Trans fats are made when vegetable oil is hydrogenated to harden it. Research suggests that trans fatty acids can raise cholesterol levels. Dietary cholesterol is found in foods that come from animal sources such as egg yolks, meat, and dairy products.
Weight. Being overweight tends to increase LDL levels, lowers HDL levels, and increases total cholesterol level.
Physical Inactivity. Lack of regular physical activity can lead to weight gain, which could raise your LDL cholesterol level.
Heredity. High blood cholesterol can run in families. An inherited genetic condition results in very high LDL cholesterol levels. This condition is called familial hypercholesterolemia.
Age and Sex. As people get older, their LDL cholesterol levels tend to rise. Men tend to have lower HDL levels than women. Younger women tend to have lower LDL levels than men, but higher levels at older ages (after age 55 years).
What can you do?
Have your cholesterol checked. There are usually no signs or symptoms of high blood cholesterol, so it is important to have your blood cholesterol checked. A simple blood test can be done by your doctor to check your blood cholesterol level. A lipoprotein profile can be done to measure several different kinds of cholesterol as well as triglycerides (another kind of fat found in the blood).
Desirable or optimal levels for adults with or without existing heart disease are
Total cholesterol: Less than 200 mg/dL.
Low Density Lipoprotein (LDL) cholesterol (”bad” cholesterol): Less than 100 mg/dL.
High Density Lipoprotein (HDL) cholesterol (”good” cholesterol): 40 mg/dL or higher.
Triglycerides: Less than 150 mg/dL.
If a full lipoprotein panel is not done, you doctor may check your total and HDL cholesterol with a simpler blood test. The National Cholesterol Education Program recommends that healthy adults have their cholesterol levels checked once every 5 years.
Maintain a Healthy Diet. An overall healthy diet can help to maintain normal blood cholesterol levels. Saturated fat, trans fats, and dietary cholesterol tend to raise blood cholesterol levels. Other types of fats, such as monounsaturated and polyunsaturated fats can help to lower blood cholesterol levels. Getting enough soluble fiber in the diet can also help to lower cholesterol. For some people, a diet that has too many carbohydrates can lower HDL (the good cholesterol) and raise triglycerides. Alcohol can also raise triglycerides, and excessive alcohol use can lead to high blood pressure, another risk factor for heart disease and stroke. For more information on healthy diet and nutrition, see CDC’s Nutrition and Physical Activity Program Web site.
Maintain a Healthy Weight. Being overweight or obese can raise your bad cholesterol levels. Losing weight can help you lower your blood cholesterol levels. Healthy weight status in adults is usually assessed by using weight and height to compute a number called the “body mass index” (BMI). BMI is used because it relates to the amount of body fat for most people. An adult who has a BMI of 30 or higher is considered to be obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18.5 to 24.9. Proper diet and regular physical activity can help to maintain a healthy weight. Other measures of excess body fat may include waist measurements or waist and hip measurements. If you know your weight and height, you can compute your BMI at the CDC’s Nutrition and Physical Activity Program Web site.
Be Active. Physical activity can help to maintain a healthy weight and lower blood cholesterol levels. The Surgeon General recommends that adults should engage in moderate–level physical activities for at least 30 minutes on most days of the week. For more information, see the CDC’s Nutrition and Physical Activity Program Web site.
No Tobacco. Smoking injures blood vessels and speeds up the process of hardening of the arteries. Further, smoking is a major risk for heart disease and stroke. If you don’t smoke, don’t start. Quitting smoking lowers one’s risk of heart attack and stroke. Your doctor can suggest programs to help you quit smoking. For more information about tobacco use and quitting, see CDC’s Tobacco Intervention and Prevention Source Web site.
Medications. If you are found to have high blood cholesterol, your doctor may prescribe medications, in addition to lifestyle changes, to help bring it under control. The primary focus of treatment is to get LDL cholesterol under control. Your treatment plan and goal will depend on your LDL level and your level of risk for heart disease and stroke. Your risk for heart disease and stroke will be based on whether you also have other risk factors and may include your blood pressure level or high blood pressure treatment, smoking status, age, HDL level, family history of early heart disease, and existing cardiovascular disease or diabetes. People with existing cardiovascular disease or diabetes are considered high risk. You can compute your 10-year risk for heart disease by using the 10-year risk calculator of the National Cholesterol Education Program at the National Heart, Lung, and Blood Institute’s Web site.*
Several types of medicines help to lower cholesterol:
Statin drugs lower LDL cholesterol by slowing down the production of cholesterol and by increasing the liver’s ability to remove the LDL–cholesterol already in the blood.
Bile acid sequestrants help to lower LDL cholesterol by binding with cholesterol-containing bile acids in the intestines, and are then eliminated in the stool.
Niacin, or nicotinic acid, is a B vitamin that can improve all lipoproteins. Nicotinic acid lowers total cholesterol, LDL-cholesterol, and triglyceride levels, while raising HDL-cholesterol levels. Because the levels needed are well above recommended dietary intake levels, niacin treatment for cholesterol should only be done only under medical supervision because of possible adverse side effects.
Fibrates are used mainly to lower triglycerides and, to a lesser extent, to increase HDL levels.
All drugs may have adverse side effects, so their use needs to be checked by your doctor on a usual basis. Once your blood cholesterol level is controlled, your doctor will want to monitor it. The lifestyle changes that your doctor recommends are just as important as taking your medicines as prescribed.
Genetic Factors. Genes can play a role in high blood cholesterol. Very high blood cholesterol levels can be related to a condition known as familial hypercholesterolemia. It is also possible that high blood cholesterol levels within a family are due to factors such as common diet.
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