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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.
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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.
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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 nhlbi Framingham Point Score table (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 and salad dressings) 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.
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