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High
Blood Cholesterol: What You Need to Know
Table of
Contents
Your blood
cholesterol level has a lot to do with your chances of getting
heart disease. High blood cholesterol is one of the major risk
factors for heart disease. A risk factor is a condition that
increases your chance of getting a disease. In fact, the higher
your blood cholesterol level, the greater your risk for developing
heart disease or having a heart attack. Heart disease is the
number one killer of women and men in the United States. Each
year, more than a million Americans have heart attacks, and about
a half million people die from heart disease.
When there
is too much cholesterol (a fat-like substance) in your blood, it
builds up in the walls of your arteries. Over time, this buildup
causes "hardening of the arteries" so that arteries become
narrowed and blood flow to the heart is slowed down or blocked.
The blood carries oxygen to the heart, and if enough blood and
oxygen cannot reach your heart, you may suffer chest pain. If the
blood supply to a portion of the heart is completely cut off by a
blockage, the result is a heart attack.
High blood
cholesterol itself does not cause symptoms, so many people are
unaware that their cholesterol level is too high. It is important
to find out what your cholesterol numbers are because lowering
cholesterol levels that are too high lessens the risk for
developing heart disease and reduces the chance of a heart attack
or dying of heart disease, even if you already have it.
Cholesterol lowering is important for everyone--younger, middle
age, and older adults; women and men; and people with or without
heart disease.
Everyone age
20 and older should have their cholesterol measured at least once
every 5 years. It is best to have a blood test called a
"lipoprotein profile" to find out your cholesterol numbers. This
blood test is done after a 9- to 12-hour fast and gives
information about your:
- Total
cholesterol
- LDL (bad)
cholesterol--the main source of cholesterol buildup and blockage
in the arteries
- HDL
(good) cholesterol--helps keep cholesterol from building up in
the arteries
-
Triglycerides--another form of fat in your blood
If it is not
possible to get a lipoprotein profile done, knowing your total
cholesterol and HDL cholesterol can give you a general idea about
your cholesterol levels. If your total cholesterol is 200 mg/dL*
or more or if your HDL is less than 40 mg/dL, you will need to
have a lipoprotein profile done. See how your cholesterol numbers
compare to the tables below.
|
Total
Cholesterol Level |
Category |
|
Less than
200 mg/dL |
Desirable |
|
200-239 mg/dL |
Borderline
High |
|
240 mg/dL
and above |
High |
*
Cholesterol levels are measured in milligrams (mg) of cholesterol
per deciliter (dL) of blood.
|
LDL
Cholesterol Level |
LDL-Cholesterol
Category |
|
Less than
100 mg/dL |
Optimal |
|
100-129 mg/dL |
Near
optimal/above optimal |
|
130-159 mg/dL |
Borderline
high |
|
160-189 mg/dL |
High |
|
190 mg/dL
and above |
Very high |
HDL (good)
cholesterol protects against heart disease, so for HDL, higher
numbers are better. A level less than 40 mg/dL is low and is
considered a major risk factor because it increases your risk for
developing heart disease. HDL levels of 60 mg/dL or more help to
lower your risk for heart disease.
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.
A variety of
things can affect cholesterol levels. These are things you can do
something about:
Diet.
Saturated fat and cholesterol in the food you eat make your
blood cholesterol level go up. Saturated fat is the main
culprit, but cholesterol in foods also matters. Reducing the
amount of saturated fat and cholesterol in your diet helps lower
your blood cholesterol level.
Weight.
Being overweight is a risk factor for heart disease. It also
tends to increase your cholesterol. Losing weight can help lower
your LDL and total cholesterol levels, as well as raise your HDL
and lower your triglyceride levels.
Physical Activity. Not being physically active is a risk
factor for heart disease. Regular physical activity can help
lower LDL (bad) cholesterol and raise HDL (good) cholesterol
levels. It also helps you lose weight. You should try to be
physically active for 30 minutes on most, if not all, days.
Things you
cannot do anything about also can affect cholesterol levels. These
include:
Age and
Gender. As women and men get older, their cholesterol levels
rise. Before the age of menopause, women have lower total
cholesterol levels than men of the same age. After the age of
menopause, women's LDL levels tend to rise.
Heredity. Your genes partly determine how much cholesterol
your body makes. High blood cholesterol can run in families.
In general,
the higher your LDL level and the more risk factors you have
(other than LDL), the greater your chances of developing heart
disease or having a heart attack. Some people are at high risk for
a heart attack because they already have heart disease. Other
people are at high risk for developing heart disease because they
have diabetes (which is a strong risk factor) or a combination of
risk factors for heart disease. Follow these steps to find out
your risk for developing heart disease.
Step 1:
Check the table below to see how many of the listed risk factors
you have; these are the risk factors that affect your LDL goal.
Major Risk
Factors That Affect Your LDL Goal
- Cigarette
smoking
- High
Blood Pressure (140/90 mmHg or higher or on blood pressure
medication)
- Low HDL
cholesterol (less than 40 mg/dL)*
- Family
history of early heart disease (heart disease in father or
brother before age 55; heart disease in mother or sister before
age 65)
- Age (men
45 years or older; women 55 years or older)
* If your
HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total
count.
Even though
obesity and physical inactivity are not counted in this list, they
are conditions that need to be corrected.
Step 2:
How many major risk factors do you have? If you have 2 or more
risk factors in the table above,
use the NIH risk scoring tables* (which include your
cholesterol levels) to find your risk score. Risk score refers to
the chance of having a heart attack in the next 10 years, given as
a percentage. My risk score is ________%.
Step 3:
Use your medical history, number of risk factors, and risk
score to find your risk of developing heart disease or having a
heart attack in the table below.
| If
You Have |
You
Are in Category |
| Heart
disease, diabetes, or risk score more than 20%* |
I.
Highest Risk |
| 2 or
more risk factors and risk score 10-20% |
II.
Next Highest Risk |
| 2 or
more risk factors and risk score less than 10% |
III.
Moderate Risk |
| 0 or 1
risk factor |
IV.
Low-to-Moderate Risk |
* Means that
more than 20 out of 100 people in this category will have a heart
attack within 10 years.
My risk
category is ______________________.
The main
goal of cholesterol-lowering treatment is to lower your LDL level
enough to reduce your risk of developing heart disease or having a
heart attack. The higher your risk, the lower your LDL goal will
be. To find your LDL goal, see the boxes below for your risk
category. There are two main ways to lower your cholesterol:
Therapeutic
Lifestyle Changes (TLC)--includes a cholesterol-lowering diet
(called the TLC diet), physical activity, and weight management.
TLC is for anyone whose LDL is above goal.
Drug
Treatment--if cholesterol-lowering drugs are needed, they are used
together with TLC treatment to help lower your LDL.
If you are
in...
-
Category I, Highest Risk, your LDL goal is less than 100 mg/dL.
If your LDL is 100 or above, you will need to begin the TLC
diet. If your LDL is 130 or higher, you will need to start drug
treatment at the same time as the TLC diet. If your LDL is 100
to 129, you may also need to start drug treatment together with
the TLC diet. Even if your LDL is below 100, you should follow
the TLC diet on your own to keep your LDL as low as possible.
-
Category II, Next Highest Risk, your LDL goal is less than
130 mg/dL. If your LDL is 130 mg/dL or above, you will need to
begin treatment with the TLC diet. If your LDL is 130 mg/dL or
more after 3 months on the TLC diet, you may need drug treatment
along with the TLC diet. If your LDL is less than 130 mg/dL, you
will need to follow the heart-healthy diet for all Americans,
which allows a little more saturated fat and cholesterol than
the TLC diet.
-
Category III, Moderate Risk, your LDL goal is less than 130
mg/dL. If your LDL is 130 mg/dL or above, you will need to begin
the TLC diet. If your LDL is 160 mg/dL or more after you have
tried the TLC diet for 3 months, you may need drug treatment
along with the TLC diet. If your LDL is less than 130 mg/dL, you
will need to follow the heart-healthy diet for all Americans.
-
Category IV, Low-to-Moderate Risk, your LDL goal is less
than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need
to begin the TLC diet. If your LDL is still 160 mg/dL or more
after 3 months on the TLC diet, you may need drug treatment
along with the TLC diet to lower your LDL, especially if your
LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL,
you will need to follow the heart-healthy diet for all
Americans.
To reduce
your risk for heart disease or keep it low, it is very important
to control any other risk factors you may have such as high blood
pressure and smoking.
TLC is a set
of things you can do to help lower your LDL cholesterol. The main
parts of TLC are:
- The
TLC Diet. This is a low-saturated-fat, low-cholesterol
eating plan that calls for less than 7% of calories from
saturated fat and less than 200 mg of dietary cholesterol per
day. The TLC diet recommends only enough calories to maintain a
desirable weight and avoid weight gain. If your LDL is not
lowered enough by reducing your saturated fat and cholesterol
intakes, the amount of soluble fiber in your diet can be
increased. Certain food products that contain plant stanols or
plant sterols (for example, cholesterol-lowering margarines) can
also be added to the TLC diet to boost its LDL-lowering power.
-
Weight Management. Losing weight if you are overweight
can help lower LDL and is especially important for those with a
cluster of risk factors that includes high triglyceride and/or
low HDL levels and being overweight with a large waist
measurement (more than 40 inches for men and more than 35 inches
for women).
-
Physical Activity. Regular physical activity (30 minutes
on most, if not all, days) is recommended for everyone. It can
help raise HDL and lower LDL and is especially important for
those with high triglyceride and/or low HDL levels who are
overweight with a large waist measurement.
| Foods
low in saturated fat include fat free or 1% dairy products,
lean meats, fish, skinless poultry, whole grain foods, and
fruits and vegetables. Look for soft margarines (liquid or
tub varieties) that are low in saturated fat and contain
little or no trans fat (another type of dietary fat that can
raise your cholesterol level). Limit foods high in
cholesterol such as liver and other organ meats, egg yolks,
and full-fat dairy products.
Good
sources of soluble fiber include oats, certain fruits (such
as oranges and pears) and vegetables (such as brussels
sprouts and carrots), and dried peas and beans. |
Even if you
begin drug treatment to lower your cholesterol, you will need to
continue your treatment with lifestyle changes. This will keep the
dose of medicine as low as possible, and lower your risk in other
ways as well. There are several types of drugs available for
cholesterol lowering including statins, bile acid sequestrants,
nicotinic acid, and fibric acids. Your doctor can help decide
which type of drug is best for you. The statin drugs are very
effective in lowering LDL levels and are safe for most people.
Bile acid sequestrants also lower LDL and can be used alone or in
combination with statin drugs. Nicotinic acid lowers LDL and
triglycerides and raises HDL. Fibric acids lower LDL somewhat but
are used mainly to treat high triglyceride and low HDL levels.
Once your
LDL goal has been reached, your doctor may prescribe treatment for
high triglycerides and/or a low HDL level, if present. The
treatment includes losing weight if needed, increasing physical
activity, quitting smoking, and possibly taking a drug.
For more
information about lowering cholesterol and lowering your risk for
heart disease, write to the NHLBI Health Information Center, P.O.
Box 30105, Bethesda, MD, 20824-0105 or call 301-592-8573, or visit
the Web sites listed below:
The links below take you away from the NHLBI Website. The
privacy policy on these Websites may differ from that of the
NHLBI.
This
information is from:
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Heart, Lung, and Blood Institute
NIH Publication No. 01-3290
http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm *
May 2001
*a new
browser window will open with this link. The inclusion of links to
other web sites does not imply any endorsement of the material on
the web sites or any association with their operators
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Cholesterol
is a waxy substance produced by the body and found in
foods that come from animals. Cholesterol is needed by
your body to make hormones, skin oils digestive juices
and vitamin D. You could not live without some
cholesterol in your body.
