High Cholesterol
High Cholesterol Overview
Cholesterol is a waxy substance that helps the body make hormones, Vitamin D, bile acids and cell membranes. It is carried through the blood in lipoproteins, which are protein orbs filled with fat. Our bodies naturally produce cholesterol in the liver. We also ingest cholesterol through our diets.
Not all cholesterol is the same. When physicians talk about high cholesterol, also known as hypercholesterolemia, they are typically describing high levels of the kind carried in low-density lipoproteins (LDL). This cholesterol combines with fat, fibrin, calcium and cell debris to form plaque in the arteries. Over time, the plaque causes atherosclerosis, a narrowing and hardening of the arteries that deliver oxygen-rich blood to the heart and the brain. Restriction of the blood flow to the heart may result in angina, or chest pain. A complete blockage occurs when plaque buildup is severe or when the thin top layer of the plaque ruptures, releasing material that clots the blood in an already restricted artery. If such a blockage deprives the heart of oxygen, a heart attack occurs. If it deprives the brain of oxygen, a stroke occurs. If it deprives the extremities of oxygen, gangrene can occur. Pieces of plaque or clots also can travel through the arteries, ultimately causing a heart attack, stroke or pulmonary embolism.
Good cholesterol is found in high-density lipoproteins (HDL). Research suggests that HDL may carry cholesterol to the liver to be discarded by the body. HDL also may collect excess cholesterol from arterial plaque, slowing buildup of the dangerous substance.
When your Wellstar physician measures the LDL and the HDL in your bloodstream, he or she will also look for triglycerides, blood fats that are common in people with diabetes or heart disease. A high count of triglycerides is sometimes genetically determined, but is often seen in people who smoke, eat a high-carbohydrate diet (60% or more of total calories), are overweight, are sedentary or consume excessive alcohol. People with high triglycerides usually have lower HDL (good cholesterol) and are at a higher risk of heart attack or stroke.
Wellstar recommends a lipoprotein profile to measure the amount of HDL, LDL and triglycerides in the blood every five years starting at age 20. Men should be screened more frequently after age 35. Women should be screened more frequently after age 45. Children at risk of developing premature heart disease may be tested as early as 2 years of age. Your Wellstar physician may increase the frequency of screenings anytime your total cholesterol measurement is 200 mg/dL or your HDL level is less than 40 mg/dL. You will also be screened if you develop diabetes, high blood pressure or heart disease.
Just how much LDL and HDL you have in your blood depends on your gender, your age, your family history, your lifestyle and your health. If high cholesterol or heart disease was an issue for a parent or grandparent, it’s a good idea to tell your Wellstar physician so he or she can watch your cholesterol levels more closely. Being honest about your diet, exposure to cigarette smoke, alcohol consumption and exercise habits is also critical. Some people can make changes in their lifestyle to lower bad cholesterol, raise good cholesterol and lower triglycerides. Others require medication, in combination with dietary or other changes. Your Wellstar physician can tailor a plan specifically for you.
Symptoms
People with high cholesterol typically show no symptoms at all. However, your Wellstar physician typically will screen for cholesterol readings if you show symptoms of atherosclerosis, once these more serious conditions are stabilized:
- Angina (chest pains)
- Shortness of breath
- Heart attack
- Stroke
- Embolism
Risk Factors
Are you at risk for high cholesterol? Risk factors include:
- Family history of high cholesterol
- Heart disease
- History of heart disease before age 55 in father or brother, or before age 65 in mother or sister
- High blood pressure
- Family history of high blood pressure
- Too much dietary cholesterol, especially saturated fats and trans fats
- Not maintaining a healthy weight
- Little or no physical activity
- Exposure to cigarette smoke
- Drinking excessive alcohol
- Being a woman over the age of 55 (or postmenopausal)
- Being a man over the age of 45
High Cholesterol Prevention
Except where genetics plays a role, many types of high cholesterol can be prevented and controlled with healthy lifestyle choices.
Reduce Your Risk of High Cholesterol
You can lower your levels of good cholesterol (HDL), lower your levels of bad cholesterol (LDL) and lower your triglycerides with these lifestyle changes:
- Take part in some kind of physical activity for 30 minutes each day
- Eat a diet low in saturated fats, trans fats, cholesterol and sodium
- Eat a diet rich in fruits, vegetables, whole grains, high-fiber foods, fat-free foods and low-fat dairy
- Limit carbohydrates to less than 60% of total calories
- Stop smoking and limit exposure to second-hand smoke
- Treat high blood pressure, if needed
- Limit alcohol consumption
Tests and Screenings
Your Wellstar physician can run a lipoprotein profile using a small blood sample from your arm. If your physician is screening for your total cholesterol, HDL, LDL and triglyceride levels, you will need to fast—no food, liquid or pills—for nine to 12 hours before the test. Otherwise, the test will only indicate total cholesterol and your HDL (good cholesterol) level. (If results indicate total cholesterol of more than 200 mg/dL or HDL before 40 mg/dL, your physician will ask you to fast and take blood test again, yielding the full lipoprotein profile). Optimum results include:
- Total cholesterol: Optimum is less than 200 mg/dL
- HDL (good cholesterol): Optimum is 40 mg/dL and above
- LDL (bad cholesterol): Optimum is less than 130 mg/dL, unless you are diabetic or have coronary artery disease
- Triglycerides: Preferred is less than 150 mg/dL
These numbers do not take into account your age, gender, risk factors, diet or other health concerns. If you take a home test or participate in a health screening that includes a cholesterol panel, be sure to have your Wellstar physician interpret your results. Your physician will determine the frequency of follow-up screenings, prescribe any necessary medications and recommend changes you can make to improve your cholesterol counts.
High Cholesterol Diagnosis
If screening tests or check-ups reveal high cholesterol, your Wellstar physician may perform further evaluations regarding atherosclerosis and related diseases.
Procedures
To determine whether you have high cholesterol (LDL, or bad cholesterol), your Wellstar physician will take a sample of your blood and test it for levels of your total cholesterol, LDL, HDL (good cholesterol) and triglycerides. Your physician can create a plan for you to achieve the levels listed below:
- Total cholesterol: Optimum is less than 200 mg/dL
- HDL (good cholesterol): Optimum is 40 mg/dL and above
- LDL (bad cholesterol): Optimum is less than 130 mg/dL, unless you are diabetic or have coronary artery disease
- Triglycerides: Preferred is less than 150 mg/dL
If you have high cholesterol and your Wellstar physician suspects you may have atherosclerosis, he or she may order tests to determine the extent of any plaque buildup and any effect it may have on heart function. Among the tests:
- Electrocardiogram (ECG) to record the electrical activity of your heart and to reveal if there are rhythmic issues or areas of the heart that are not getting sufficient oxygen
- Holter monitoring, using a portable ECG device worn for about 24 hours, to detail your heart’s activity during your usual activities
- Echocardiogram, an ultrasound test, designed to show the pumping performance of your heart
- Cardiac stress test to measure your heart’s performance during exertion
- Cardiac computerized tomography (CT) technologies, such as electron beam computerized tomography (EBCT) or a CT coronary angiogram, to help your doctor to “see” your arteries. EBCT can reveal calcium within fatty deposits.
- Magnetic resonance angiogram (MRA), which uses MRI technology and contrast dye to identify blockages
- Cardiac catheterization, in which a thin, flexible tube (catheter) is inserted into your groin or arm and guided through the aorta into your heart. A dye is injected through the tube so that parts of your heart appear in scans.
High Cholesterol Treatment
Your Wellstar physician may prescribe lifestyle changes, medication or a combination of both to get your cholesterol levels within the optimum ranges.
Your physician may ask you to adjust your lifestyle to include the following, if they are not already part of your daily habits:
- Take part in some kind of physical activity for 30 minutes each day
- Eat a diet low in saturated fats, trans fats, cholesterol and sodium
- Eat a diet rich in fruits, vegetables, whole grains, high-fiber foods, fat-free foods and low-fat dairy.
- Limit carbohydrates to less than 60% of total calories
- Stop smoking and limit exposure to second-hand smoke
- Treat high blood pressure, if needed
- Limit alcohol consumption
Your physician may prescribe one or more of the following medications to increase your HDL (good cholesterol), lower your LDL (bad cholesterol) or lower your triglycerides:
- Statins: They prevent cholesterol from forming in the liver. These medications can lower LDL, may sometimes raise HDL and may sometimes lower triglycerides. Your physician can discuss side effects with you. Among the statins available in the United States: Atorvastatin (Lipitor®); Fluvastatin (Lescol®); Lovastatin (Mevacor®, Altoprev); Pravastatin (Pravachol®); Rosuvastatin Calcium (Crestor®) and Simvastatin (Zocor®). Some combination medications include statins: Advicor® (lovastatin + niacin); Caduet® (atorvastatin + amlodipine); and Vytorin™ (simvastatin + ezetimibe).
- Selective Cholesterol Absorption Inhibitors: These medications prevent the absorption of cholesterol in the intestines. They can lower LDL, may slightly raise HDL and may slightly lower triglycerides. Your physician may prescribe ezetimibe (Zetia®) for this purpose. Your physician can discuss side effects with you. Resins: Also known as bile acid-binding drugs, resins lower LDL by helping the intestines to get rid of more of the bad cholesterol. These drugs bind to bile, preventing it from being used in the digestive process so that the body will make more bile. Because the body needs cholesterol to make bile, the added production causes the body to use additional LDL. Among the medications your physician may prescribe: Cholestyramine (Questran®, Questran® Light, Prevalite®, Locholest, Locholest® Light); Colestipol (Colestid®); Colesevelam Hcl (WelChol®)
- Fibrates: Fibric acid derivatives are prescribed to lower triglycerides. They also sometimes raise HDL (good cholesterol). Your physician may prescribe these in combination with statins. Medications include Gemfibrozil (Lopid®); Fenofibrate (Antara®, Lofibra®, Tricor®, and Triglide™);Clofibrate (Atromid-S).
- Niacin: Nicotinic acid alters production of blood fats in the liver, which typically means higher HDL levels. Note that nonprescription immediate-release forms are not recommended, because their side effects may be more pronounced. You should also avoid dietary supplements of niacin as a way to control cholesterol. Your physician may monitor your liver function if you are taking niacin.
In every case, your Wellstar physician will help you weigh the benefits of each treatment approach and make an experienced recommendation for the best outcome. You can feel confident your decision will be based on both your input and the expertise and recommendations of your experienced physician.
Ongoing Care for High Cholesterol
Wellstar offers world-class, community-based physicians based in state-of-the-art medical centers and hospitals with access to the latest technologies and other medical resources. They are dedicated to:
- Help you create and maintain healthy lifestyles
- Offer advice to prevent illness and injuries
- Provide early and appropriate care of acute illness to prevent its progression
Heart Care at Wellstar
Wellstar’s Cardiovascular Network provides top-flight Cardiac Care throughout its physicians’ offices, urgent care centers and emergency rooms. Emergency departments at Wellstar Cobb, Wellstar Douglas, Wellstar Kennestone, and Wellstar Paulding hospitals provide comprehensive cardiac services. Wellstar Cobb and Wellstar Kennestone hospital’s cardiac diagnostic and treatment services provide the next level of defense against heart disease. The technologically advanced Cardiac Center at Wellstar Kennestone Hospital raises the bar on world-class cardiac care. Wellstar’s Cardiac Rehabilitation Services’ medically supervised programs focus on helping heart disease patients maintain a healthier heart through education and support groups.
Ongoing Care at Home
Though genetics may not be on your side, there are a number of ways to lower LDL (bad cholesterol) and triglycerides, while increasing your HDL (good cholesterol). Among them:
- Take part in some kind of physical activity for 30 minutes each day
- Eat a diet low in saturated fats, trans fats, cholesterol and sodium
- Eat a diet rich in fruits, vegetables, whole grains, high-fiber foods, fat-free foods and low-fat dairy
- Limit carbohydrates to less than 60% of total calories
- Stop smoking and limit exposure to second-hand smoke
- Treat high blood pressure, if needed
- Limit alcohol consumption
Additionally, maintain any regimen recommended by your Wellstar physician.