Cholesterol

Cholesterol is a fat-like substance found in your blood and in all your body's cells. The American Heart Association (AHA) says you need a certain amount of cholesterol for good health. But too much cholesterol in your blood can lead to clogged arteries and contribute to atherosclerosis. (Read about "Arteriosclerosis & Atherosclerosis") Atherosclerosis is a major risk factor for heart disease. (Read about "Coronary Heart Disease")

Your total blood cholesterol level can help determine your relative risk of developing heart disease. (Read about "Heart Risks") The National Heart, Lung, and Blood Institute (NHLBI) says that, in general, the following overall cholesterol levels are considered acceptable for the average adult with no other known heart disease risk factors:

Normal - less than 200mg/100dL

Borderline - 200-239 mg/100dL

High - over 240 mg/dL

But those numbers don't tell the whole story, because not all cholesterol is bad. AHA says that a high level of high-density lipoprotein (HDL) cholesterol is believed to be beneficial. High-density lipoproteins (the so-called "good" cholesterol) remove cholesterol from the bloodstream. Under the latest guidelines from the National Cholesterol Education Program (NCEP), an HDL of less than 40 mg/dL is considered low for most adults, and indicates a potentially higher risk of heart disease. According to NCEP, HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Low-density lipoprotein (LDL) cholesterol is the so-called "bad" cholesterol. This is the kind of cholesterol that can build up and block arteries. NCEP says that an LDL reading of less than 130 mg/dL is considered desirable.

For high-risk patients, the overall goal is an LDL level of less than 100 mg/dL. But for people at very high risk, a group that is considered a "sub-set" of the high-risk category, it is suggested that a level of under 70 mg/dL should be the goal.

NCEP defines high-risk patients as those who have coronary heart disease or disease of the blood vessels to the brain or extremities, or diabetes (Read about "Diabetes"), or multiple (2 or more) risk factors such as smoking and hypertension (Read about "Quit Smoking" and "Hypertension: High Blood Pressure") that give them a greater than 20 percent chance of having a heart attack (Read about "Heart Attack") within 10 years. Very high-risk patients are those who have cardiovascular disease together with either multiple risk factors (especially diabetes), or severe and poorly controlled risk factors (e.g., continued smoking), or metabolic syndrome. (Read about "Metabolic Syndrome") Patients hospitalized for acute coronary syndromes such as heart attack are also at very high risk.

Triglycerides are another form of fat in the blood. Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people, according to NHLBI.

Depending on your age and other heart disease risk factors, your doctor can help you determine how often you should be screened for total cholesterol, triglycerides, as well as LDL and HDL levels. Remember too that several screening tests are usually needed before your doctor can make a final determination of your condition.

Where does cholesterol come from?

The body produces its own cholesterol (about a thousand milligrams a day for most people.) Cholesterol also comes from the food we eat. The American Medical Association says two kinds of food can raise the level of cholesterol in your blood:

• Foods that contain cholesterol - Meat, chicken, fish, eggs and dairy products - all foods that come from animal sources - contain cholesterol. NCEP recommends that healthy adults and children over the age of two limit their average daily cholesterol intake to 200 milligrams a day or less.
• Foods containing fats, especially saturated fats - Saturated fats are also found primarily in animal foods as well as in palm and coconut oil. According to the AMA, the hydrogenated trans fats or trans-fatty acids found in shortening and margarine can also raise total cholesterol levels. NCEP says for most healthy adults, no more than 35 percent of their daily calories should come from fat, and no more than 7 percent of their total daily calories should come from saturated or solid fat. (NCEP says some individuals, such as patients with high triglycerides, may need a higher fat intake; consult with your doctor.)

The AMA says cholesterol levels can also be affected by weight, physical inactivity, inherited health traits, age and gender.

What kinds of foods are the best choices?

According to the American Dietetic Association (ADA), in general, cholesterol is NOT found in plant foods. Therefore, vegetables, fruits, grains and cereals are usually healthy choices - provided of course you don't load them up with high-fat sauces and dressings. When choosing animal protein foods, look for the ones that are lower in saturated fat and cholesterol such as the leanest cuts of meat, poultry without the skin, most fish, skim milk, and low- and non-fat dairy products. (Read about "Dietary Guidelines")

The way you cook your food can affect how much cholesterol you get too. (Read about "Low Fat Food Tips") When cooking meats, ADA suggests you always trim all visible fat before cooking. Since egg yolks contain cholesterol, try substituting two egg whites for one whole egg when cooking. Use vegetable broth to stir-fry foods instead of butter or other fats.

Many processed foods advertise that they contain little or no cholesterol. Remember that if these foods came from plant sources (potato chips for example) they never had cholesterol in their natural form in the first place. With processed foods, the U.S. Food and Drug Administration says the important thing to watch out for is fat and saturated fat. Read the nutrition label carefully when choosing processed foods to ensure that no more than a third of your daily calories are coming from fat.

Talk with your doctor about cholesterol and your diet. Particularly if you have a severe problem with cholesterol, you may need to restrict your cholesterol intake even more.

Cholesterol drugs

If you have a high level of cholesterol that can't be brought down by diet or exercise your doctor might prescribe drugs. It's estimated by the NCEP that some 13 million people in the United States are taking drugs to lower their cholesterol, with the number expected to rise. There are different types of cholesterol lowering drugs:

• Statins are the most prominent. They keep the liver from producing as much cholesterol and help the liver take more out of the blood stream. NHLBI says statins are very effective at lowering LDL cholesterol. Statins can lower LDL cholesterol by as much as 60 percent, according to the Food and Drug Administration.
• Nicotinic Acid is better known as niacin, and has been shown to lower total LDL and raise HDL cholesterol. But the dosage needed for treatment is much higher than the Daily Recommended Allowance, so its use must be carefully supervised by a physician. (Read about "Vitamins & Minerals")
• Resins remove bile acids in the intestine before they get back into the blood stream. The liver, now forced to make more bile, removes cholesterol from the bloodstream as a raw material.
• Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels.
• A newer drug, ezetimibe, prevents the intestines from absorbing cholesterol.

As with all treatments, it is important that you talk with your doctor. Trying to treat yourself or self-medicate could have disastrous side effects. (Read about Medicine Safety)

Related Information:

    Peripheral Arterial Disease

    Vascular System

    Aneurysms

    Metabolic Syndrome

    Glossary of Stroke Terms

    Glossary of Heart Terms