Cholesterol Overview

Cholesterol is a waxy substance that is made in the liver and is in many foods, especially meat, milk, cheese and egg yolks. The body uses cholesterol to build cell walls and produce hormones and vitamins, such as vitamin D. However, too much cholesterol can increase your risk of heart disease or stroke.

What Exactly is High Cholesterol?

High cholesterol can come from the food you eat as well as from the cholesterol that is made naturally by your liver. The condition is often complicated by an imbalance between the most harmful types of cholesterol and its more beneficial forms. Many factors can contribute to high cholesterol, including family history, obesity, lack of exercise and a poor diet rich in saturated fat.

If you have too much cholesterol in your blood, it builds on the walls of your arteries, which is known as plaque, and can lead to the blockage of blood flow. Likewise, plaque can burst at any time, causing a blood clot that can block critical vessels. When blood flow becomes completely blocked in an artery of the heart or brain, a heart attack or stroke occurs.

Understanding the cause of elevated cholesterol is important, because it helps to determine the best way to lower it. In some cases, high total cholesterol levels may not need treatment.

What are the Specific Types of Cholesterol?

Total Cholesterol

Total cholesterol is the measure of low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and other fatty parts of the blood. The measurement of “total cholesterol” provides only limited information about your overall high cholesterol risk. Total cholesterol should be less than 200 mg/dL.

Low-Density Lipoprotein Cholesterol (LDL-C)

LDL cholesterol floats in the blood stream and transports cholesterol from one cell in your body to another cell. LDL-C is known as the “bad” cholesterol because it carries cholesterol to the walls of the arteries. For most people, the LDL-C level should be less than 100 mg/dL. For someone who has had a heart attack or stroke, the LDL-C goal is less than 70 mg/dL.

High-Density Lipoprotein Cholesterol (HDL-C)

HDL-C is known as the “good” cholesterol because HDL-C helps take cholesterol away from the walls of the arteries and return it to the liver where it is cleared from the body. The higher your HDL-C, the more cholesterol your body can get rid of. HDL-C levels should be 40 mg/dL or higher.

Triglycerides

Triglycerides are another blood fat measured in the lipid panel. They are stored in fat cells and used as a source of energy. A normal triglyceride level is less than 150 mg/dL.

A breakdown of healthy lipid levels is included below:

Lipids and Fats Healthy Levels
LDL-C < 100 mg/dL
HDL-C > 40 mg/dL
Triglycerides < 150 mg/dL
Total Cholesterol < 200 mg/dL

How Do You Know if You have High Cholesterol?

High cholesterol is considered a silent condition because it has no symptoms. It can be diagnosed with a series of blood tests called a lipid profile. This test measures cholesterol in milligrams per deciliter of blood—or mg/dL. An amount between 200-240 mg/dL is considered “borderline high risk” and levels over 240 mg/dL “high risk” for heart disease, the leading cause of death in the U.S.

How Common is High Cholesterol?

High cholesterol is common in our country. Approximately 71 million people have high cholesterol in the U.S. Women are more likely to have high cholesterol than men, although men usually suffer from cardiovascular disease caused by high cholesterol earlier than women. According to a 2010 study conducted by the Centers for Disease Control and Prevention (CDC), non-Hispanic, white females are most likely to experience high cholesterol with a rate nearing 18%.

High cholesterol is least common in African American patients, yet they have a much higher risk of heart disease in general. This disturbing trend increases the importance of controlling cholesterol and other established risks, such as high blood pressure, that affect African Americans more often than other races.

The risk of high cholesterol increases with age. Among people who are 65 years of age or older, nearly 60% have high LDL-C levels—more than triple the amount of people in their 20s and 30s. For women, the risk for high LDL-C increases after menopause.

Do Cholesterol Levels Vary by Ethnicity and Age?

According to the Centers for Disease Control and Prevention and the American Heart Association, below are the percentages of people with high cholesterol (> 240 mg/dL) in the U.S.

Race or Ethnic Group Men (%) Women (%)
African Americans 9.7 13.3
Mexican Americans 16.9 14.0
Whites 13.7 16.9
All 13.5 16.2
Age Men (%) Women (%)
20-34 9.5 10.3
35-44 20.5 12.7
45-54 20.8 19.7
55-64 16.0 30.5
65-74 10.9 24.2
75 and older 9.6 18.6

(2012 Centers for Disease Control and Prevention, analyzing estimates from 2005-2008)

How is High Cholesterol Treated?

If you have high cholesterol, your doctor will likely recommend changes to your diet to reduce the amount of saturated fat and cholesterol you normally eat. This includes eating less red meat and more poultry and fish, switching to low-fat dairy products, and eating more fruits, vegetables and whole grains. Your doctor may also recommend that you exercise more. Physical activity may lower LDL-C and triglyceride levels and raise HDL-C. A healthier diet and regular exercise will also help you to lose weight which can help control cholesterol and other risk factors, such as high blood pressure. If you smoke, quitting this habit can further protect you from high cholesterol, which can cause heart disease.

Unfortunately for some people, all of these changes may not lower cholesterol enough. This is particularly true of those who inherited genes from parents that make them susceptible to high cholesterol. For these people, medication is often needed, along with lifestyle changes, to lower LDL-C levels.

Your doctor can talk to you about medication options to help manage your high cholesterol.

What are Statins?

Dietary fiber supplements may help improve cholesterol. Prescription treatments are also available, including niacin (a B vitamin) and statins, which are the most commonly prescribed medications to treat high cholesterol. Statins work by slowing cholesterol production in the liver. They can lower total cholesterol and LDL-C, and have been shown to help prevent heart attacks, most forms of stroke and death due to death heart disease.

Approximately one in four Americans age 45 and older are taking a statin. However, studies have shown that nearly 75% of patients discontinue their therapy by the end of the first year. As a result, many patients are not getting to their cholesterol goals.

In order to reach your LDL-C goal, it is important to take your medicine every day, as prescribed by your healthcare professional, without skipping doses. If you think you are having a side effect from the medicine, talk to your doctor, nurse, or pharmacist right away.

As with all medications there are important safety considerations with the use of statins. Prior to starting on statin therapy it is important for patients to discuss their medical history including medical conditions and medications with their healthcare provider. Patients should also talk to their doctor about any issues they may experience that may be related to statin treatment.

In addition, as with most drugs, some statins may interact with other drugs. If your doctor recommends a statin, tell your doctor about any other medications you take.