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What Is Cholesterol?• We may associate cholesterolwith fatty foods, but most of thewaxy substance is made byour own bodies. The liverproduces 75% of thecholesterol that circulates inour blood. The other 25%comes from food. At normallevels, cholesterol actuallyplays an important role inhelping cells do their jobs. Butcholesterol levels areprecariously high in more than100 million Indians.
Symptoms of High Cholesterol• High cholesterol does notcause any symptoms. But itdoes cause damage deepwithin the body. Over time, toomuch cholesterol may lead toa buildup of plaque inside thearteries. Known asatherosclerosis, this conditionnarrows the space availablefor blood flow and can triggerheart disease. The good newsis high cholesterol is simple todetect, and there are manyways to bring it down.
Cholesterol Testing• People older than 20 shouldhave their cholesterol levelschecked at least once everyfive years. This is done with asimple blood test known as afasting lipoprotein profile. Itmeasures the different formsof cholesterol that arecirculating in your blood afteryou avoid eating for 9 to 12hours. The results show yourlevels of "bad" cholesterol,"good" cholesterol, andtriglycerides.
"Bad" Cholesterol• Most of the cholesterol in theblood is carried by proteinscalled low density lipoproteinsor LDL. This is known as thebad cholesterol because itcombines with othersubstances to clog thearteries. A diet high insaturated fats and trans fatstends to raise the level of LDLcholesterol. For most people,an LDL score below 100 ishealthy, but people with heartdisease may need to aim evenlower.
"Good" Cholesterol• Up to a third of bloodcholesterol is carried by high-density lipoproteins or HDL.This is called good cholesterolbecause it helps remove badcholesterol, preventing it frombuilding up inside the arteries.The higher the level of HDLcholesterol, the better. Peoplewith too little are more likely todevelop heart disease. Eatinghealthy fats, such as olive oil,may help boost HDLcholesterol.
Triglycerides• The body converts excesscalories, sugar, and alcoholinto triglycerides, a type of fatthat is carried in the blood andstored in fat cells throughoutthe body. People who areoverweight, inactive, smokers,or heavy drinkers tend to havehigh triglycerides, as do thosewho eat a very high-carb diet.A triglycerides score of 150 orhigher puts you at risk formetabolic syndrome, which islinked to heart disease anddiabetes.
Total Cholesterol• Total cholesterol measures thecombination of LDL, HDL, andVLDL (very low densitylipoprotein) in yourbloodstream. VLDL is aprecursor of LDL, the badcholesterol. A total cholesterolscore of under 200 isconsidered healthy in mostcases. People who score inthe "high" range have anincreased risk of developingheart disease compared tothose who score below 200.
Cholesterol Ratio• To calculate your cholesterolratio, divide your totalcholesterol by your HDLcholesterol. For example, atotal score of 200 divided byan HDL score of 50 equals acholesterol ratio of 4 to 1.Doctors recommendmaintaining a ratio of 4 to 1 orlower. The smaller the ratio,the better. While this figure isuseful in estimating heartdisease risk, its not asimportant in guiding treatment.Doctors look at totalcholesterol, HDL cholesterol,and LDL cholesterol todetermine treatment.
Cholesterol in Food• Cholesterol-rich foods, likeeggs, shrimp, and lobster areno longer completelyforbidden. Research showsthat the cholesterol we eat hasonly a small effect on bloodcholesterol levels for mostpeople. A few people are"responders," whose bloodlevels spike up after eatingeggs. But for most, saturatedfat and trans fats are biggerconcerns. Daily cholesterollimits are 300 mg for healthypeople and 200 mg for thoseat higher risk. One egg has186 mg of cholesterol.
Cholesterol and Family History• Cholesterol comes from twosources -- the body and food --and either one can contributeto high cholesterol. Somepeople inherit genes thattrigger too much cholesterolproduction. For others, diet isthe main culprit. Saturated fatand cholesterol occur inanimal-based foods, includingmeat, eggs, and dairy productsmade with milk. In manycases, high cholesterol stemsfrom a combination of diet andgenetics.
What Boosts Your Risk?Several factors can makeyou more likely todevelop high cholesterol:• A diet high in saturatedfats and cholesterol• A family history of highcholesterol• Being overweight orobese• Getting older
Cholesterol and Gender• Until menopause, womentypically have lower totalcholesterol levels than men ofthe same age. They also havehigher levels of HDLcholesterol, the good kind.One reason is estrogen: Thefemale sex hormone raises thelevel of HDL cholesterol.Estrogen production peaksduring the childbearing yearsand drops off duringmenopause. After age 55, awomans risk of developinghigh cholesterol begins toclimb.
Cholesterol and Children• Theres evidence thatcholesterol can beginclogging the arteriesduring childhood, leadingto atherosclerosis andheart disease later in life.The American HeartAssociation recommendskids and teenagers withhigh cholesterol takesteps to bring it down.Ideally, total cholesterolshould be below 170 inpeople ages 2 to 19.
Why High Cholesterol Matters• High cholesterol is one of themajor risk factors for coronaryartery disease, heart attacks,and strokes. It also appears toboost the risk of Alzheimersdisease. As we saw earlier,high cholesterol leads to abuildup of plaque that narrowsthe arteries. This is dangerousbecause it can restrict bloodflow. If the blood supply to apart of the heart or brain iscompletely cut off, the result isa heart attack or stroke.
Cholesterol Buster: Eat More Fiber• Diet changes offer apowerful way to fight highcholesterol. If youve everwondered why somecereals claim to be heart-healthy, its the fiber. Thesoluble fiber found inmany foods helps reduceLDL, the bad cholesterol.Good sources of solublefiber include whole-grainbreads and cereals,oatmeal, fruits, driedfruits, vegetables, andlegumes such as kidneybeans.
Cholesterol Buster: Know YourFats• No more than 35% of yourdaily calories should comefrom fat. But not all fats areequal. Saturated fats -- fromanimal products and tropicaloils -- raise LDL cholesterol.Trans fats carry a double-whammy, boosting badcholesterol, while lowering thegood kind. These two bad fatsare found in many bakedgoods, fried foods (doughnuts,french fries, chips), stickmargarine, and cookies.Unsaturated fats may lowerLDL when combined with otherhealthy diet changes. Theyrefound in avocados, olive oil,and peanut oil.
Cholesterol Buster: Smart Protein• Meat and full-fat milk offerplenty of protein, but they arealso major sources ofcholesterol. You may be ableto reduce LDL cholesterol byswitching to soy protein, suchas tofu, at some meals. Fish isanother great choice. Its richin omega-3 fatty acids, whichcan improve cholesterol levels.The American HeartAssociation recommendseating fish at least twice aweek.
Cholesterol Buster: Low-Carb Diet• Theres growing evidencethat low-carb diets maybe better than low-fatdiets for improvingcholesterol levels. In atwo-year study funded bythe National Institutes ofHealth, people whofollowed a low-carb planhad significantly betterHDL (good cholesterol)levels than those whofollowed a low-fat plan.
Cholesterol Buster: Lose Weight• If youre overweight, talkto your doctor aboutbeginning a weight lossprogram. Losing weightcan help you reduce yourlevels of triglycerides,LDL, and totalcholesterol. Sheddingeven a few pounds canalso boost your goodcholesterol level -- ittends to go up 1 point forevery 6 pounds you lose.
Cholesterol Buster: Quit Smoking• Giving up tobacco istough, but heres onemore reason to try. Whenyou stop smoking, yourgood cholesterol is likelyto improve by as much as10%. You may be moresuccessful if you combineseveral smokingcessation strategies. Talkto your doctor aboutwhich options are best foryou.
Cholesterol Buster: Exercise• If youre healthy but not veryactive, starting an aerobicexercise program couldincrease your good cholesterolby 5% in the first two months.Regular exercise also lowersbad cholesterol. Choose anactivity that boosts your heartrate, such as running,swimming, or walking briskly,and aim for at least 30 minuteson most days of the week. Itdoesnt have to be 30continuous minutes; two 15-minute walks works just aswell.
Treatment: Medications• If high cholesterol runs in yourfamily, diet and exercise maynot be enough to get yournumbers where you wantthem. In that case, medicationcan give your cholesterollevels an extra nudge. Statinsare usually the first choice.They block the production ofcholesterol in the liver. Otheroptions include cholesterolabsorption inhibitors, bile acidresins, and fibrates. Yourdoctor may recommend acombination of thesemedications.
Treatment: Supplements• Certain dietary supplementsmay also improve cholesterollevels. These include flaxseedoil, fish oil, and plant sterols,such as beta-sitosterol.Prescription niacin, a b-complex vitamin, has beenfound to raise good cholesterolwhile reducing bad cholesterol.Niacin found in ordinarysupplements should not beused to lower cholesterol.
Herbal RemediesSome studies suggestgarlic can knock a fewpercentage points off totalcholesterol. But garlicpills can have side effectsand may interact withmedications. Other herbsthat may reducecholesterol include:• Fenugreek seeds• Artichoke leaf extract• Yarrow• Holy basil
How Low Should You Go?• Many people are able to lowercholesterol levels through acombination of medication andlifestyle changes. But how lowis low enough? For people withdiabetes or a high risk ofdeveloping heart disease, anLDL score of less than 100 isdesirable. If you already haveheart disease or coronaryartery disease, some doctorsrecommend reducing LDL to70 or lower.
Can the Damage Be Undone?• It takes years for highcholesterol to clog the arterieswith plaque. But there isevidence that atherosclerosiscan be reversed, at least tosome degree. Dean Ornish,MD, has published severalstudies showing that a low-fatvegetarian diet, stressmanagement, and moderateexercise can chip away at thebuild-up inside the coronaryarteries. Other researchsupports the idea that bigdrops in cholesterol cansomewhat help open cloggedarteries.
Interpreting the numbersCholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) ofblood in the United States and some other countries. Canada and most Europeancountries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider thesegeneral guidelines when you get your lipid panel (cholesterol test) results back to see ifyour cholesterol falls in ideal levels.• Total cholesterol(U.S. and some other countries)• Below 200 mg/dL Best• 200-239 mg/dL Borderline high• 240 mg/dL and above High• Total cholesterol*(Canada and most of Europe)• Below 5.2 mmol/L Best• 5.2-6.2 mmol/L Borderline high• Above 6.2 mmol/L HighInformation on this slide and the following slides are taken from Mayo Clinichttp://www.mayoclinic.com/health/high-blood-cholesterol/DS00178/DSECTION=tests-and-diagnosis
• LDL cholesterol(U.S. and some other countries)• Below 70 Best for people athigh risk of heart disease• Below 100 mg/dL Best for peopleat risk for heart disease• 100-129 mg/dL Near ideal• 130-159 mg/dL3.4-4.1 mmol/LBorderline high• 160-189 mg/dL High• 190 mg/dL and above Very high• LDL cholesterol(Canada and most of Europe)• Below 1.8 mmol/L Best for peopleat high risk of heart disease• Below 2.6 mmol/L Best for peopleat risk for heart disease• 2.6-3.3 mmol/L Near ideal• 3.4-4.1 mmol/L Borderline high• 4.1-4.9 mmol/L High• Above 4.9 mmol/L Very high
• HDL cholesterol(U.S. and some other countries)• Below 40 mg/dL (men)Below 50 mg/dL (women) Poor• 50-59 mg/dL Better• 60 mg/dL and above Best• HDL cholesterol(Canada and most of Europe)• Below 1 mmol/L (men)Below 1.3 mmol/L (women) Poor• 1.3-1.5 mmol/L Better• Above 1.5 mmol/L Best
• Triglycerides(U.S. and some other countries)• Below 150 mg/dL Best• 150-199 mg/dL Borderline high• 200-499 mg/dL High• 500 mg/dL and above Very high• Triglycerides(Canada and most of Europe)• Below 1.7 mmol/L Best• 1.7-2.2 mmol/L Borderline high• 2.3-5.6 mmol/L High• Above 5.6 mmol/L Very highThe American Heart Association (AHA) recommends that a triglyceride level of 100mg/dL (1.3 mmol/L) or lower is considered "optimal." The AHA says this optimal levelwould improve your heart health. However, the AHA doesnt recommend drug treatmentto reach this level. Instead, for those trying to lower their triglycerides to this level,lifestyle changes such as diet, weight loss and physical activity are encouraged. Thatsbecause triglycerides usually respond well to dietary and lifestyle changes.*Canadian and European guidelines differ slightly from U.S. guidelines. Theseconversions are based on U.S. guidelines
This information is from Quality Healthcare MedicalCenter’s physical examination report reference section• the table of risk• Risk Male Female• 1/2 avg 3.4 3.3• avg risk 5.0 4.4• 2 x avg 9.6 7.1• 3 x avg 23.4 11.0• How to get the riskratio :• Total cholesteroldivided by HDL