High blood cholesterol levels

Also known as: Lipid disorders, Hyperlipoproteinemia, Hyperlipidemia, Dyslipidemia or Hypercholesterolemia

Definition

Cholesterol is a fat (also called a lipid) that your body needs to work properly. But too much bad cholesterol can increase your chance of getting heart disease, stroke, and other problems.

The medical term for high blood cholesterol is lipid disorder, or hyperlipidemia.

What does a lipid profile (also called a lipid panel) measure?The correct answer is all of the above. The test measures the level of these fats, or lipids, in your blood. Cholesterol is found in all parts of the body. Your body needs a little bit of cholesterol. But too much cholesterol can clog your arteries and lead to heart disease and stroke. Some cholesterol is considered "good" (HDL) and some is considered "bad." (LDL) Having high LDL cholesterol is healthy.The correct answer is false. When you have too much LDL, or "bad," cholesterol in your blood, it can build up on artery walls, causing them to become hard and narrow. The lower your LDL, the lower your risk for heart disease. Ask your doctor what your LDL level should be.Which type of cholesterol is called "good" cholesterol?The correct answer is HDL. HDL helps remove LDL cholesterol from artery walls. HDL levels of 60 mg/dL or above helps protect you from heart disease. HDL below 40 mg/dL for men and below 50 mg/dL for women can increase your risk for heart disease.Having high cholesterol and triglyceride levels increases your risk for:The correct answer is all of the above. When plaque builds up on your artery walls, blood clots can form that block blood flow to the heart or brain, causing a heart attack or stroke. Talk with your doctor about how you can lower your risk for heart disease.Medicine is the only treatment for high cholesterol and triglycerides.The correct answer is false. Improving your health habits can lower cholesterol and triglyceride levels. Sometimes, lifestyle changes alone aren't enough, so your doctor may prescribe medicine.Which habits can lead to high cholesterol levels?The correct answer is all of the above. Family history, diabetes, and other medical problems also increase your risk. Ask your doctor about healthy changes you can make to help lower high cholesterol. If you are overweight, losing 5 to 10 pounds can help lower cholesterol levels.The correct answer is true. To lose about one pound a week, eat about 500 fewer calories a day. You can lose weight by eating smaller portions. Also replace low-fiber, high-fat foods with lean meats and other proteins, whole grains, low-fat dairy products, and plenty of fruits and vegetables. Getting regular exercise can improve your cholesterol numbers.The correct answer is true. Exercising 30 minutes a day at least 5 days a week can increase HDL levels by about 5 percent. If you haven't been active, check with your doctor before starting to exercise. Start by walking just a few minutes several times a week. Build up to 30 minutes of brisk exercise 5 days a week. Heart-healthy fats include:The correct answer is monounsaturated and polyunsaturated fats. They are found in fish, nuts, seeds, avocados, and olive, canola, corn, soy, and sunflower oils. Replacing saturated and trans fats with these healthy fats helps lower LDL and increase HDL. Omega-3s from fish help lower high triglycerides. Quitting smoking can help you:The correct answer is all of the above. Quitting isn't easy, but keep in mind that the more times you attempt to quit, the more likely you are to be successful.

Causes, incidence, and risk factors

There are many types of cholesterol. The ones talked about most are:

  • Total cholesterol - all the cholesterols combined
  • High density lipoprotein (HDL) cholesterol - often called "good" cholesterol
  • Low density lipoprotein (LDL) cholesterol - often called "bad" cholesterol

For many people, abnormal cholesterol levels are partly due to an unhealthy lifestyle -- most commonly, eating a diet that is high in fat. Other lifestyle factors are:

  • Being overweight
  • Heavy alcohol use
  • Lack of exercise and leading an inactive lifestyle

Certain health conditions can also lead to high cholesterole, including:

Medicines such as certain birth control pills, diuretics (water pills), beta-blockers, and some medicines used to treat depression may also raise cholesterol levels.

Several disorders that are passed down through families lead to abnormal cholesterol and triglyceride levels. They include:

Smoking does not cause higher cholesterol levels, but it can reduce your HDL ("good") cholesterol.

Signs and tests

A cholesterol test is done to diagnose a lipid disorder. Some guidelines recommend having your first screening cholesterol test at age 20. Everyone should have their first screening test by age 35 in men, and age 45 in women.

It is important to work with your health care provider to set your cholesterol goals. General targets are:

  • LDL: 70-130 mg/dL (lower numbers are better)
  • HDL: more than 40-60 mg/dL (high numbers are better)
  • Total cholesterol: less than 200 mg/dL (lower numbers are better)
  • Triglycerides: 10-150 mg/dL (lower numbers are better)

If your cholesterol results are abnormal, your doctor may also do:

Treatment

There are steps everyone can take to improve their cholesterol levels, and help prevent heart disease and a heart attack.

Quit smoking. This is the single most important change you can make to reduce your risk of heart disease and stroke.

Other important lifestyle changes:

  • Eat foods that are naturally low in fat. These include whole grains, fruits, and vegetables. Use low-fat toppings, sauces, and dressings.
  • Look at food labels. Avoid foods that are high in saturated fat.
  • Exercise regularly
  • Lose weight if you are overweight

See also: Cholesterol and lifestyle

Your doctor may want you to take medicine for your cholesterol if lifestyle changes do not work. This will depend on:

  • Your age
  • Whether or not you have heart disease, diabetes, or other blood flow problems
  • Whether you smoke or are overweight
  • Whether you have high blood pressure or diabetes

You are more likely to need medicine to lower your cholesterol:

  • If you have heart disease or diabetes, your LDL cholesterol should stay below 100
  • If you are at risk for heart disease (even if you do not yet have any heart problems), your LDL cholesterol should be below 130
  • Almost everyone else may get health benefits from LDL cholesterol that is lower than 160 to 190

There are several types of drugs to help lower blood cholesterol levels, and they work in different ways. Statins are one kind of drug that lower cholesterol.

Expectations (prognosis)

High cholesterol levels can lead to hardening of the arteries, also called atherosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body.

Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control.

References

Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122198-208.

Genest J, Libby P. Lipoprotein disorders and cardiovascular disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 47.

Semenkovich, CF. Disorders of lipid metabolism. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 213.

U.S. Preventive Services Task Force. Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ);2008 Jun.

U.S. Preventive Services Task Force. Screening for lipid disorders in children. U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ);2007 Jul.

Review date:
March 6, 2012
Reviewed by:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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