CHOLESTEROL CONTENT CREATED BY. Learn more at

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1 CHOLESTEROL CONTENT CREATED BY Learn more at

2 TALK WITH YOUR DOCTOR Table of Contents what is cholesterol? 4 Whether this is your first visit or a follow-up, asking your doctor these questions might be helpful: cardiovascular disease 6 cholesterol testing 8 cardiovascular risk 10 lowering cholesterol 11 statins 14 genetic disorders 15 The human body needs some cholesterol. This type of fat is a building block for cell membranes, vitamin D, hormones like estrogen and testosterone, and more. Too much cholesterol in the bloodstream, though, can lead to clogged arteries around the body. Lowering high cholesterol with lifestyle changes, and medications if needed, can help you protect yourself from heart attack, stroke, and other cardiovascular problems. How often should I have my cholesterol checked? What do my cholesterol numbers mean? Could other health problems, or the medications I am taking, give me high cholesterol? What are the dangers of having high cholesterol? What is the best diet for lowering cholesterol? Can exercise help me control my cholesterol? Do I need to take a cholesterol-lowering medication? How do I know if my cholesterol-lowering medication is working? What side effects of cholesterol-lowering medications should I be on the lookout for? 2 cholesterol cholesterol 3

3 from food to cholesterol Some cholesterol comes from food; some is made by the body. what is cholesterol? Cholesterol is a type of fat found in some foods. It also circulates in the bloodstream. Cholesterol isn t entirely the health villain it s made out to be. Our bodies need cholesterol to make cell membranes, vitamin D, the bile acids needed to digest and absorb fats, and key hormones like testosterone and estrogen. Cholesterol is so important that the liver and intestines make it from scratch. What is bad about cholesterol isn t the substance itself in fact, we can t live without it but how much of it ends up in the bloodstream. The body packages cholesterol with protein into two main particles: Low-density lipoprotein (LDL), bad cholesterol: Too much LDL in the bloodstream helps create cholesterolfilled deposits, called plaques, that grow inside arteries. These are responsible for angina (chest pain with exertion or stress), heart attacks, and most types of stroke. High-density lipoprotein (HDL), good cholesterol: HDL grabs cholesterol from plaque and from cholesterolcarrying particles in the bloodstream, and takes it to the liver for removal. 4 cholesterol 1 3 Eating What you eat and drink contains fats, carbohydrates, proteins, and other nutrients. Processing The liver and the small intestine reassemble some of these digested components into a type of fat known as triglycerides. 4 Packaging Digesting Your stomach and small intestine break down these nutrients into smaller components. Triglycerides get packaged with a small amount of cholesterol and some protein to form various types of cholesterolcarrying particles called lipoproteins. Two key types are harmful LDL and protective HDL. These lipoproteins get released into the bloodstream. 2 cholesterol 5

4 from cholesterol to crisis When a cholesterol-filled plaque breaks open, the result can be a heart attack. The process plays out in these stages: CHOLESTEROL AND CARDIOVASCULAR DISEASE Cholesterol is a key cause of narrowed and blocked arteries. A buildup of cholesterol in an artery is called plaque. When plaque grows inside an artery, it shrinks the open space through which blood flows. A decrease in blood flow means the artery can t deliver enough oxygen-rich blood to the tissue or organ it supplies. When plaque builds up in coronary arteries, which nourish hard-working heart muscle, it can cause two major problems: angina: chest pain when the heart needs to work harder, for example, during physical activity or stress heart attack when a plaque breaks open. The buildup of plaque in arteries supplying the brain can cause a stroke. Plaque can also cause: intermittent claudication: leg pain that comes on with walking or exercising and goes away with rest sexual problems, such as erectile dysfunction in men and difficulty with arousal, lubrication, or orgasm in women 6 cholesterol 1 Plaque builds up in the artery LDL cholesterol lodges in the artery wall. White blood cells engulf this LDL cholesterol. As they fill with cholesterol, the white blood cells are transformed into fat-laden foam cells. 2 A fibrous cap covers the plaque Foam cells die, releasing soft, fatty gruel that triggers more inflammation. Smooth muscle cells in the artery wall form a cap over the whole mess. 3 The plaque ruptures Most heart attacks occur because a plaque breaks apart. The contents of the plaque begin spewing into the bloodstream. The body tries to seal the break, in much the same way that it heals a cut. 4 A clot blocks the artery White blood cells and LDL Foam cells Blood cells called platelets travel to the rupture. They clump together with red blood cells and other material. If this clot blocks the artery, and prevents blood from reaching the heart cells downstream, that portion of the heart muscle dies. This is a heart attack. cholesterol 7

5 CHOLESTEROL LEVELS FOR ADULTS Here is a general guide to help you understand what your numbers mean. your cholesterol test A blood test is the only way to know if your cholesterol is in the healthy range. That s because high cholesterol usually doesn t cause any symptoms. A cholesterol test is also known as a full lipid panel because it measures the amounts of several lipids (fats) in the bloodstream. You will get the most accurate results if you don t eat or drink anything except water from bedtime the night before until you have the test. Eating can temporarily change the amount of triglycerides in the blood. (After a meal or snack, triglycerides can be so abundant they make the blood look milky.) Getting the test is easy. It is a simple blood draw. A full lipid panel measures: LDL cholesterol HDL cholesterol triglycerides total cholesterol (the sum of all cholesterolcarrying particles in your blood) Total cholesterol level Less than 200 milligrams per deciliter of blood (mg/dl) Category Desirable mg/dl Borderline high 240 mg/dl and above High LDL cholesterol level Less than 100 mg/dl LDL cholesterol category Desireable mg/dl Above desireable mg/dl Borderline high mg/dl High 190 mg/dl and above Very high HDL cholesterol level Less than 40 mg/dl 60 mg/dl and above Triglyceride level Less than 150 mg/dl HDL cholesterol category Low (likely to increase heart disease risk) High (likely to decrease heart disease risk) Triglyceride category Normal mg/dl Borderline high mg/dl High 500 mg/dl and above Very high Your goal numbers may be different based on your estimated personal risk of heart attack and stroke. 8 cholesterol cholesterol 9

6 WHAT S YOUR CARDIOVASCULAR RISK? Many other things besides cholesterol contribute to the health of your heart and blood vessels. Some of them you can't control, like your age, your sex, or your genes and family history. But there are many you can control. You can help control the following factors that increase your chances of developing heart disease, having a heart attack or stroke, or developing some other form of cardiovascular disease: high cholesterol or triglycerides high blood pressure high blood sugar or diabetes Factors that lower your chances of getting heart disease include: A healthy diet Regular exercise High HDL The best ways to estimate your odds of having a heart attack or stroke are to talk with your doctor and to use the risk calculator developed by the American Heart Association and American College of Cardiology. You can find it at: 10 cholesterol being overweight or obese not exercising smoking an unhealthy diet benefits of lowering cholesterol If your cholesterol is high, lowering it has many benefits especially if lifestyle changes are part of the solution. Lowering the amount of harmful LDL in your bloodstream by just 10% reduces your odds of developing heart disease or having a heart attack by 20% to 30%. But wait (as they say on late-night TV), there s more. Reducing your total and LDL cholesterol levels also decreases your risk of stroke. It helps protect the arteries feeding your brain from plaque buildup, which can cut off blood supply to part of the brain. When cholesterol-clogged arteries cause chest pain (angina) during physical activity or stress, lowering cholesterol along with exercise, stress management, and medications can shrink the plaque causing the problem. This medical therapy can be as effective as artery-opening angioplasty or bypass surgery without the risks. These lifestyle changes also help with weight management. A healthy weight helps protect against many diseases and can help you live longer. cholesterol 11

7 HOW TO LOWER CHOLESTEROL You can do many things to lower your cholesterol and improve the health of your heart and arteries. Lifestyle changes If your total cholesterol, LDL cholesterol, or triglycerides are high, making changes to your lifestyle is the best place to start. These changes not only help you control your lipids, but are good for your entire body. Medications If lifestyle changes aren't doing enough to improve your cholesterol and triglyceride levels, or if you have an above-average risk of heart attack or stroke, you may benefit from taking medication. Statins. These drugs, which are taken by mouth, are the most widely used cholesterol-lowering medication. Statins lower harmful LDL cholesterol levels. Even more importantly, they also reduce the amount of plaque buildup in arteries and greatly decrease the risk of heart attack and stroke. Cholesterol-absorption inhibitor. This medication is often used in combination with a statin. PCSK9 inhibitors. These are a type of biologic therapy that reduces LDL cholesterol to lower levels than even high-dose statins can. They need to be injected every few weeks. Studies are under way to determine who will get the most benefit from PCSK9 inhibitors. Fibrates. These medications are used to lower high triglycerides. Fish oil. Fish oil is another option to help lower triglyceride levels. 12 cholesterol Some helpful lifestyle changes can include: Eat for heart health Switching to a healthier diet should be a cornerstone of your efforts to lower cholesterol and prevent heart disease. Here are some healthy eating strategies: Fill up on whole foods, including vegetables, fruits, and whole grains. They are full of nutrients and fiber, and tend to have fewer calories and sodium than processed foods. Cut back on sugar and refined carbohydrates, such as white bread, white rice, bagels, soda, ice cream, and the like. Sugary and processed foods quickly boost blood sugar and insulin (the hormone needed to use sugar), and don t deliver as many nutrients as whole foods. Focus on good fats from fish and plants, such as avocados, nuts, olive oil, and vegetable oils. Go easy on processed meats such as bacon, sausage, and hot dogs. Lose weight if needed Modest weight loss, even just 5% to 10% of your starting weight, can significantly improve cholesterol and triglyceride levels. Get going with exercise Being more active can lower harmful LDL and raise protective HDL. A good goal is 150 minutes of moderateintensity exercise, like brisk walking, each week. That s just 30 minutes a day, five days each week. cholesterol 13

8 WHEN HIGH CHOLESTEROL RUNS IN THE FAMILY Some people have a genetic disorder that significantly increases heart disease risk. Familial combined hyperlipidemia WHO SHOULD TAKE A STATIN? An individual s cardiovascular risk is used to determine if he or she should take a cholesterol-lowering statin. According to new guidelines from the American Heart Association and American College of Cardiology, a daily statin is recommended for: anyone ages 21 and older with an LDL level above 190 mg/dl anyone who has been diagnosed with cardiovascular disease; has had a heart attack, stroke, or transient ischemic attack ( ministroke ); has peripheral artery disease; or has had bypass surgery or angioplasty anyone ages 40 to 75 who has diabetes anyone ages 40 to 75 who doesn't have cardiovascular disease but has a greater than 7.5% chance of having a heart attack or stroke in the next 10 years To determine your risk of developing cardiovascular disease, use the calculator developed by the American Heart Association and American College of Cardiology, found at 14 cholesterol This inherited disorder causes the liver to make too much harmful LDL. That leads to very high LDL levels, often beginning during the teenage years. Familial hypercholesterolemia In familial hypercholesterolemia, the liver can't remove LDL particles from the blood. That causes LDL levels to soar, often at an early age. Symptoms of these disorders include: an early heart attack or diagnosis of heart disease (early means before age 55 in men and before age 65 in women) LDL level as high as 400 mg/dl in familial combined hyperlipidemia; as high as 1,000 mg/dl in familial hypercholesterolemia small nodules filled with cholesterol that form over various parts of the body Treating these disorders Treating either of these conditions is like treating regular high cholesterol a combination of lifestyle changes and medication only more intense. Some people need a procedure called LDL apheresis to filter LDL out of the bloodstream. cholesterol 15

9 CONTENT CREATED BY Harvard Health Publications and Harvard Medical School content should not be used for diagnosis or treatment, or as a substitute for visits to your medical provider. Always seek the advice of your health care provider if you have questions regarding your health or any medical condition Harvard University. All Rights Reserved. Harvard Health Publications and Harvard Medical School do not endorse drug products. CHO-H0416 cholesterol