Cholesterol: What You Should Know

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High Cholesterol 101
By Becky Mollenkamp

Find out what you need to know about high cholesterol risk factors, treatment, and prevention.

By reducing your cholesterol, you can lower your risk of heart attack and stroke. Here is what you need to know to make smart decisions about cholesterol.

High cholesterol: Cholesterol is found in every cell of the body and is essential for many processes, including digesting fat and producing hormones. However, an excess of cholesterol, either through overproduction by the liver or through too much dietary cholesterol, can cause serious health problems.

There are two types of cholesterol:

* HDL: This “good” cholesterol stands for high-density lipoproteins. They help carry cholesterol through the body so it can be broken down. A higher number is better.
* LDL: This “bad” cholesterol is short for low-density lipoproteins. They are one of the components of artery-clogging plaque. A lower number is better.

Total cholesterol
Normal: below 200 mg/dL
Borderline high: 200–239 mg/dL
High: 240 mg/dL and higher

LDL cholesterol
Normal: below 100 mg/dL
Borderline high: 100–129 mg/dL
High: 130 mg/dL and higher

HDL cholesterol
Normal: 60 mg/dL and higher
Borderline low: 40–59 mg/dL
Low: 40 mg/d and lower

Triglycerides
Normal: 150 mg/dL and lower
Borderline high: 150–199 mg/dL
High: 200 mg/dL and higher

What Causes High Cholesterol?
Every person inherits genes that influence his or her cholesterol level. A diet high in saturated fat and trans fat can also increase blood cholesterol, as can obesity and a sedentary lifestyle.

The problem with high cholesterol: Deposits of cholesterol (called plaque) can form inside the arteries and block blood flow. This buildup (called atherosclerosis) can block coronary arteries, which increases the risk of a heart attack. Plaque can also decrease blood flow to the brain, which can cause a stroke. In addition, ruptured plaque can cause blood clots that that may lead to stroke, heart attack, or sudden cardiac death.

Risk Factors

There are some risk factors for high cholesterol you can’t control:

* Age: Cholesterol levels rise with age. After age 20, you should get a cholesterol test at least once every five years. Your doctor may recommend more frequent testing if you have other risk factors.
* Gender: After menopause, women’s LDL levels tend to rise.
* Heredity: If high cholesterol runs in the family, you're at greater risk.

Risk factors for high cholesterol you can control:

* Excess Weight: Being overweight can increase your cholesterol.
* Sedentary Lifestyle: Regular physical activity helps lower LDL and raise HDL.
* Diabetes: High blood sugar increases cholesterol levels and damages the lining of your arteries.
* Smoking: Cigarette smoking lowers HDL and increases the likelihood of blood clots.
* Medications: Certain medications can cause high cholesterol. Talk to your doctor about any medications you are taking.

Treatment

Cholesterol reduction begins with lifestyle and dietary changes. If these aren’t effective enough, your doctor may recommend medication.

Common cholesterol medications include:
Statins: The most commonly prescribed medications for lowering cholesterol, statins block a substance the liver needs to make cholesterol. (Lipitor, Crestor, Zocor)

Bile-acid sequestrants: These drugs bind with bile acids, which prompts the liver to use excess cholesterol to make more bile acids, thus reducing the level of cholesterol in the blood. (Prevalite, WelChol, Colestid)

Cholesterol absorption inhibitors: They reduce cholesterol by inhibiting its absorption from the intestinal tract. (Zetia)

Fibrates: These medications activate an enzyme that speeds the breakdown of triglycerides in the blood. (Atromid, Tricor, Lopid)

Niacin: Reduces the liver’s ability to produce very-low-density lipoprotein, the precursor of LDL. (Niaspan, Slo-Niacin)

Your doctor may recommend periodic liver-function tests to monitor the effect of medication on your liver.

Prevention

To reduce your risk of high cholesterol, take these steps:

* Quit smoking.
* Exercise regularly.
* Eat a heart-healthy diet rich in whole grains, fruits, and vegetables, and low in saturated and trans fats.
* Maintain a healthy weight.

Pay special attention to diet: Fewer than 30 percent of your total daily calories should come from fat, and fewer than 7 percent should come from saturated fat.