For Good Health, Know Your Cholesterol Level

The amount of cholesterol in your blood has a lot to do with your chances of getting cardiovascular disease (CVD). High blood cholesterol is one of the major risk factors this illness. In fact, the higher your blood cholesterol level, the greater your risk for developing CVD or having a heart attack.

Cholesterol is a fat-like substance produced by your liver; it is necessary for building cell walls and in the production of hormones. Cholesterol is also found in some foods.

When you have too much cholesterol in your blood, it builds up in the walls of your arteries. Over time, this buildup causes "hardening of the arteries," meaning that the inside of the arteries becomes narrow, affecting blood flow to the heart. Blood carries oxygen to your heart and other vital organs. If enough blood and oxygen cannot reach your heart, you may feel chest pain. If the blood supply to an area of the heart is completely blocked, the result is a heart attack.

No symptoms

High blood cholesterol does not cause symptoms, so many people are unaware that their cholesterol level is too high until it has caused symptoms of cardiovascular disease. That's why it's important to find out what your cholesterol level is. If your level is high, you can take steps to reduce it, and thus reduce your risk of developing CVD, or of dying of a heart attack if you already have heart disease.

Keeping your cholesterol within healthy limits is important for you no matter what your age or gender, whether you have CVD or not. Everyone age 20 and older should have a blood cholesterol test at least once every five years. The most accurate test is the "lipoprotein profile," which is done after fasting.

A lipoprotein profile measures:

• Total cholesterol

• LDL ("bad") cholesterol, which is the main source of cholesterol buildup and blockage in the arteries

• HDL ("good") cholesterol, which helps keep LDL cholesterol from building up in the arteries

• Triglycerides, which are another form of fat in your blood

• VLDL (very low-density lipoproteins) and a cholesterol/HDL ratio may also be included in the profile

If it's not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol level.

Understanding treatment guidelines

Current guidelines for treatment of high cholesterol come from the National Cholesterol Education Program III, overseen by the National Heart, Lung, and Blood Institute. The guidelines are used to determine a person's risk of experiencing a heart attack within 10 years by considering factors such as age, gender, and whether he or she smokes and has hypertension or diabetes.

A person's cholesterol level is one part of the equation for determining risk for CVD. Other risks for CVD include smoking, obesity, high blood pressure, family history of heart disease, and age (older than 45 for men and older than 55 for women).

Treatment for high cholesterol depends on how many other risk factors are present.

Treatment

If you have high cholesterol, your goal is to reduce your LDL level enough to cut your risk of developing heart disease or having a heart attack. The higher your risk of these illnesses, the lower your LDL should be.

You can lower your LDL level through lifestyle changes such as a cholesterol-lower diet, exercise, and weight management. A low-saturated-fat, low-cholesterol diet has less than 7 percent of calories from saturated fat and less than 200 mg of cholesterol. If this diet doesn't lower your LDL enough, you can add soluble fiber to your diet. It's important to control your weight in order to control your LDL, especially if your HDL level is low, your triglycerides are high, or your waist circumference is too great (more than 40 inches if you're a man or more than 35 inches if you're a woman). To get enough exercise, aim for 30 to 60 minutes of moderate physical activity most, if not all, days. (In some people, there are genetic reasons that the LDL level can't be lowered by these methods. In others, these methods just don't work well. In both of these cases, medications may have to be added.)

To reduce your risk for CVD, it's also important to control your blood pressure and to stop smoking.

Your doctor may prescribe cholesterol-lowering medication along with lifestyle changes. Maintaining your lifestyle changes will keep your medication dose as low as possible and lower your risk of CVD disease in other ways. Several types of drugs are available for lowering cholesterol, including statins, bile acid sequestrants, nicotinic acid, fibric acids, and cholesterol absorption inhibitors. This last class of drugs blocks cholesterol absorption in the intestine and lowers LDL and triglyceride levels.

How statins work

Statins lower LDL cholesterol by blocking a liver enzyme that helps to make cholesterol. They may also protect against CVD by decreasing the formation of plaque in artery walls, preventing plaque from breaking open, and reducing clot formation.

"If you take one of these drugs, there's a good chance it will lower your cholesterol by 20 to 30 percent within a few weeks," says Michael Lauer, M.D., a cardiovascular medicine specialist in Cleveland. "They're taken once a day and they're long-term, meaning once you're prescribed a statin, there's a good chance you'll stay on it for the rest of your life."

Initially, your doctor may monitor you for liver and muscle toxicity, the most serious side effects of statins. But such side effects are uncommon, says Dr. Lauer, occurring in only 1 to 3 percent of patients.

The other potential side effects, which any medication can cause, include constipation, headache, and nausea. But most people don't experience them.

Bile acid resins

This class of medication binds to bile from the liver when it enters the small intestine. It prevents bile from being reabsorbed. Because bile is made largely from cholesterol, these drugs work by forcing the body to make more bile, which depletes the body's supply of cholesterol. Side effects can be constipation, gas, and stomach upset.

Nicotinic acid (niacin)

Another cholesterol-lowering medication is nicotinic acid (niacin), a B vitamin that works in the liver to affect the production of blood fats, lower triglyceride and LDL cholesterol levels, and raise HDL cholesterol. Unfortunately, however, many people don't tolerate niacin well because of the common side effects of flushing, itching, stomach upset, dizziness, and headache.

Fibrates

A class of drugs called fibrates is another option. They primarily act by reducing triglyceride levels. They might be the better drug to use if someone has more of a triglyceride disorder than high LDL cholesterol.

Cholesterol absorption inhibitors

Yet another option is the newest drug category called cholesterol absorption inhibitors, which block cholesterol absorption in the intestine. They are useful for people who can’t take statins or can be taken with statins to help lower LDL levels even more.

Maintain a heart-healthy lifestyle

No matter which cholesterol-lowering medication you take, it's important to remember that diet and exercise also lower cholesterol and are a valuable part of your treatment strategy. Don't think you can just take a pill.