High Blood Cholesterol

Cholesterol is a type of fat found in your blood. Your body needs some cholesterol to make healthy cells. However, too much cholesterol can be harmful. When you have high cholesterol, fatty deposits can build up in the blood vessels that carry blood throughout your body. Imagine these deposits like plaque forming inside the pipes of your house. Over time, this plaque can narrow the blood vessels, making it harder for blood to flow freely. If a piece of this plaque breaks off, it can create a blood clot. This clot can block blood flow to your heart, leading to a heart attack, or to your brain, causing a stroke.

High cholesterol can sometimes run in families, but it's often linked to lifestyle choices. This means it's usually preventable and treatable. Making healthy choices, like eating a balanced diet, getting regular exercise, and possibly taking medicine, can help lower your cholesterol levels and keep your heart healthy.

High cholesterol often has no noticeable signs. The only way to know if you have it is through a blood test. The National Heart, Lung, and Blood Institute (NHLBI) suggests that everyone should get their first cholesterol check between the ages of 9 and 11. After that, they recommend getting checked every five years.

For men between 45 and 65, and women between 55 and 65, the NHLBI advises getting a cholesterol test every one to two years. This is because high cholesterol can be a risk factor for heart problems, and regular checks can help catch potential issues early. For people over 65, yearly cholesterol tests are recommended.

If your cholesterol levels aren't healthy, your doctor might suggest checking your cholesterol more often. Similarly, if you have a family history of high cholesterol, heart disease, or other health problems like diabetes or high blood pressure, you might need more frequent tests. These risk factors increase your likelihood of having high cholesterol, making regular monitoring crucial. Your doctor will help you determine the best schedule for your individual needs.

Getting your cholesterol checked is important for your heart health. The National Heart, Lung, and Blood Institute (NHLBI) suggests starting cholesterol screenings between the ages of 9 and 11. After that, you should get checked every five years.

For men aged 45 to 65, and women aged 55 to 65, the NHLBI advises getting a cholesterol test every one to two years. This is a good way to stay on top of your heart health.

If you're over 65, you should have your cholesterol checked yearly. This regular monitoring is important for everyone, but especially those in these age groups.

Your doctor might recommend more frequent tests if your cholesterol levels aren't healthy. They might also suggest more frequent checkups if you have a family history of high cholesterol, heart problems, or other health issues like diabetes or high blood pressure. These factors increase your risk of needing more frequent monitoring. Essentially, your doctor will tailor the frequency of your cholesterol checks to your individual needs and risk factors.

Your blood carries cholesterol attached to proteins called lipoproteins. Different lipoproteins carry different types of cholesterol.

One type is low-density lipoprotein, or LDL. This is often called "bad" cholesterol because it carries cholesterol throughout your body. Over time, LDL cholesterol can build up in the walls of your arteries, making them stiff and narrow. This can restrict blood flow, which increases your risk of heart problems.

Another type is high-density lipoprotein, or HDL. This is often called "good" cholesterol. It helps remove extra cholesterol from your body and takes it back to your liver to be processed.

Your blood also contains triglycerides, a type of fat. High levels of triglycerides can also increase your risk of heart disease.

Many things affect your cholesterol and triglyceride levels. Things you can control include your lifestyle choices, like how active you are, your weight, and what you eat. A healthy diet and regular exercise can help keep your cholesterol healthy.

However, some factors are beyond your control. Your genes can influence how your body handles cholesterol. Some medical conditions, like chronic kidney disease, diabetes, HIV/AIDS, and hypothyroidism, can also affect cholesterol levels. Even certain medications, such as those used to treat acne, cancer, high blood pressure, HIV/AIDS, irregular heart rhythms, or organ transplants, can sometimes raise cholesterol levels.

It's important to understand that your cholesterol levels are affected by a combination of lifestyle choices, genetics, and underlying health conditions. Talking to your doctor about your cholesterol levels and any concerns you have is crucial for maintaining good heart health.

High cholesterol can be a problem for many people. Several factors can increase your risk. One key factor is your diet. Eating too much saturated fat, found in fatty meats and whole milk products, and trans fats, often in processed foods like snacks and desserts, can lead to unhealthy cholesterol levels.

Being overweight also plays a role. A body mass index (BMI) of 30 or higher puts you at risk for high cholesterol. This means your weight is significantly higher than what's healthy for your height.

Not getting enough exercise can also contribute. Exercise helps your body produce more HDL cholesterol, often called "good" cholesterol. This "good" cholesterol helps remove harmful cholesterol from your body.

Smoking can also be a problem. Smoking can decrease the amount of HDL cholesterol in your body, making it harder for your body to remove unhealthy cholesterol.

Drinking too much alcohol can increase your overall cholesterol level. It's important to drink alcohol in moderation.

Age can also be a factor. While children can have high cholesterol, it's more common in adults over 40. As we get older, our livers may not be as effective at removing the bad cholesterol, called LDL. This can increase the risk of high cholesterol.

High cholesterol can build up harmful deposits in your artery walls. This buildup, called atherosclerosis, is like plaque forming on the inside of your pipes. This plaque makes it harder for blood to flow smoothly. When this happens, it can lead to several serious problems:

Chest Pain (Angina): If the arteries that carry blood to your heart (coronary arteries) are affected by plaque buildup, you might feel chest pain. This pain, called angina, is a sign that your heart isn't getting enough blood. Angina can also be a symptom of coronary artery disease, a condition where the coronary arteries are narrowed.

Heart Attack: Imagine the plaque in your arteries as a weak spot. Sometimes, this plaque can break open (rupture). When this happens, a blood clot can form at the break. This clot can block blood flow to part of your heart, cutting off the oxygen supply. If blood flow stops, you have a heart attack. A heart attack can also occur if a blood clot formed elsewhere in the body travels to a narrowed coronary artery and blocks it.

Stroke: A stroke is similar to a heart attack, but it affects your brain. A blood clot, caused by plaque rupture or elsewhere in the body, can block blood flow to a part of your brain. When blood flow to a part of the brain stops, that area can't get the oxygen it needs, leading to a stroke. Strokes can cause lasting disabilities.

A healthy lifestyle can help you avoid high cholesterol. The same habits that lower cholesterol can also prevent it from becoming a problem in the first place. Here's how:

Diet: Focus on foods that are good for your heart. This means eating plenty of fruits, vegetables, and whole grains. These foods are naturally low in salt and packed with nutrients. Limit foods high in animal fats. While some fats are healthy (like those found in avocados, nuts, and olive oil), it's important to use them in moderation.

Weight Management: Carrying extra weight can raise your cholesterol levels. Losing any extra pounds and maintaining a healthy weight is a crucial step in preventing high cholesterol.

Quit Smoking: Smoking damages your blood vessels and can significantly raise your cholesterol. Quitting smoking is a major step towards better overall health and preventing high cholesterol.

Regular Exercise: Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This could include brisk walking, swimming, cycling, or other activities you enjoy. Physical activity helps improve cholesterol levels and overall health.

Alcohol in Moderation (if at all): If you choose to drink alcohol, do so in moderation. Too much alcohol can increase your risk of high cholesterol and other health problems.

Stress Management: Chronic stress can also affect your cholesterol levels. Finding healthy ways to manage stress, such as meditation, yoga, or spending time in nature, is important for overall well-being and preventing high cholesterol.

By making these lifestyle changes, you can significantly reduce your risk of developing high cholesterol and improve your overall health. Remember, consistency is key. Making small, sustainable changes over time is more effective than trying to overhaul your entire lifestyle overnight.

Understanding Your Cholesterol Test Results

A cholesterol test, also called a lipid panel, measures the amount of different fats in your blood. This test typically checks four key things:

• Total cholesterol: This is the overall amount of cholesterol in your blood.
• LDL cholesterol (bad cholesterol): LDL cholesterol can build up in your arteries, increasing your risk of heart disease.
• HDL cholesterol (good cholesterol): HDL cholesterol helps remove cholesterol from your arteries, reducing your risk of heart disease.
• Triglycerides: Another type of fat in your blood; high levels can also increase heart disease risk.

Before the Test:

You usually need to fast (not eat or drink anything but water) for 9 to 12 hours before a cholesterol test. However, some tests don't require fasting. Always follow your doctor's instructions.

Understanding Your Numbers:

Cholesterol levels are measured in different units depending on where you live. The United States uses milligrams (mg) of cholesterol per deciliter (dL) of blood, while Canada and many European countries use millimoles per liter (mmol/L).

Interpreting Your Results (General Guidelines):

The following guidelines are a general guide. Your doctor will interpret your results in the context of your overall health and medical history.

| Type of Cholesterol | US Units (mg/dL) | European Units (mmol/L) | Interpretation | |---|---|---|---| | Total Cholesterol | < 200 | < 5.2 | Desirable (healthy) | | | 200-239 | 5.2-6.2 | Borderline High | | | ≥ 240 | ≥ 6.2 | High | | LDL Cholesterol | < 70 | < 1.8 | Best for people with heart disease | | | < 100 | < 2.6 | Optimal for those at risk for heart disease or with diabetes | | | 100-129 | 2.6-3.3 | Near Optimal | | | 130-159 | 3.4-4.1 | Borderline High | | | 160-189 | 4.1-4.9 | High | | | ≥ 190 | ≥ 4.9 | Very High (often indicates a genetic condition) | | HDL Cholesterol | < 40 (men) | < 1.0 (men) | Poor | | | < 50 (women) | < 1.3 (women) | Poor | | | 40-59 (men) | 1.0-1.5 (men) | Better | | | 50-59 (women) | 1.3-1.5 (women) | Better | | | ≥ 60 | ≥ 1.5 | Best | | Triglycerides | < 150 | < 1.7 | Desirable | | | 150-199 | 1.7-2.2 | Borderline High | | | 200-499 | 2.3-5.6 | High | | | ≥ 500 | ≥ 5.6 | Very High |

Children and Cholesterol:

The National Heart, Lung, and Blood Institute recommends a cholesterol screening for most children between ages 9 and 11, then every five years. Children with a family history of early heart disease or those with obesity or diabetes may need more frequent testing.

Important Note: These are general guidelines. Always discuss your results with your doctor to get personalized advice and recommendations. Your doctor will consider your overall health, family history, and other factors when interpreting your cholesterol levels.

Managing High Cholesterol: Understanding Medications

High cholesterol can be a serious health concern. Fortunately, lifestyle changes are often the first step in managing it. These changes include regular exercise and a healthy diet. If lifestyle changes aren't enough to lower your cholesterol levels, your doctor might recommend medication.

Choosing the Right Medication

The best medication, or combination of medications, depends on several factors:

• Your personal risk factors: This includes things like your family history, age, and any other health conditions.
• Your age: Older adults may have different needs than younger individuals.
• Possible side effects: Different medications have different potential side effects, and your doctor will consider these when making a recommendation.

Common Types of Cholesterol Medications:

• Statins: These are frequently prescribed medications that work by reducing the amount of cholesterol your liver produces. They help the liver remove cholesterol from your blood. Common statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor).

• Cholesterol Absorption Inhibitors: These medications, like ezetimibe (Zetia), work by reducing the absorption of cholesterol from the food you eat. This helps lower the amount of cholesterol entering your bloodstream. Ezetimibe can be used alongside a statin.

• Bempedoic Acid: A newer medication that works similarly to statins but may be less likely to cause muscle pain. It can be added to a maximum dose of a statin to significantly lower LDL cholesterol. A combination pill containing both bempedoic acid and ezetimibe (Nexlizet) is also available.

• Bile-Acid-Binding Resins: These medications, including cholestyramine (Prevalite), colesevelam (Welchol), and colestipol (Colestid), work by binding to bile acids in your intestines. This forces your liver to use cholesterol to make more bile acids, which reduces the amount of cholesterol in your blood.

• PCSK9 Inhibitors: These medications help your liver absorb more LDL cholesterol, reducing the amount circulating in your blood. They are typically used for people with very high LDL cholesterol levels due to genetics or those with coronary artery disease who can't tolerate other cholesterol medications. These medications are usually injected under the skin every few weeks and can be expensive.

Medications for High Triglycerides:

If you have high triglycerides alongside high cholesterol, your doctor might prescribe:

• Fibrates: These medications, such as fenofibrate (Tricor, Fenoglide, and others) and gemfibrozil (Lopid), decrease your liver's production of VLDL (very-low-density lipoprotein) cholesterol and help remove triglycerides from your blood. Combining fibrates with statins can increase the risk of side effects from the statins.

• Niacin: This medication limits your liver's production of LDL and VLDL cholesterol. However, it is not generally recommended as a first-line treatment because it doesn't offer significant additional benefits over statins and is associated with potential risks like liver damage and stroke.

• Omega-3 Fatty Acid Supplements: These supplements can help lower triglycerides. If you choose to use them, check with your doctor first. They may interact with other medications.

Important Considerations:

• Medication Tolerance: Everyone reacts to medication differently. Side effects can vary.

• Statin Side Effects: Common statin side effects include muscle pain and damage, memory problems, and changes in blood sugar levels.

• Monitoring: Your doctor might recommend regular blood tests (like liver function tests) to monitor how the medication is affecting your health.

• Children and Cholesterol: A healthy diet and exercise are the best initial treatments for children aged 2 and older with high cholesterol or obesity. Children aged 10 and older with very high cholesterol may need medication, such as statins.

If you have concerns about high cholesterol or are considering medication, talk to your doctor. They can help you understand your options and create a personalized treatment plan.