High Cholesterol
(Cholesterol, High; Hypercholesterolemia)
Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Understanding Cholesterol Levels
Definition
You have this condition if there are high levels of cholesterol in the blood. There are three parts of cholesterol:
- Low density lipoproteins (LDL)—known as bad cholesterol. It causes build up of cholesterol and other fats in the blood vessels. High LDL levels can cause artery and heart disease.
- High density lipoproteins (HDL)—known as good cholesterol. It can remove cholesterol and other fats from the blood vessels. High levels of HDL can protect against heart disease.
- Triglycerides—a common form of fat in the body. Often elevated in people with diabetes or certain genetic conditions.
- Particles—proteins associated with certain types of cholesterols in the body. These may be a better signal about your risk of developing disease in the blood vessels.
Causes
Causes of high cholesterol include:
- Genetics
- High-fat diet
- Overweight
- Sedentary lifestyle
- Excess alcohol intake
- Liver or kidney disease
- Anorexia nervosa
- Underactive thyroid disease
Risk Factors
These factors increase your chance of high cholesterol:
- Age: cholesterol levels tend to rise with age
-
Sex:
- Males
- Females after menopause
- Family members with high cholesterol
- High-fat diet
- Obesity, overweight
- Sedentary lifestyle
Symptoms
The condition itself will rarely cause any symptoms. If not treated, it often leads to atherosclerosis. This is a dangerous hardening of the arteries. It can end up blocking blood flow through arteries. In severe cases, this may result in:
- Angina
- Heart attack
- Stroke
- Other serious complications
If you have an inherited form of high cholesterol, cholesterol deposits in the:
- Tendons
- Under the eyes
- Around the cornea
Atherosclerosis
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Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. These tests are used to measure the cholesterol levels in your blood:
- Total cholesterol
- HDL cholesterol
- LDL cholesterol
- Triglycerides
Treatment
Treatment may include:
Lifestyle Changes
- Eat a low-fat, low-cholesterol diet. Eat high-fiber food. A vegetarian or vegan diet may be helpful in lowering your LDL cholesterol. Talk to your doctor about the best meal plan for you.
- Begin a safe exercise program with the advice of your doctor.
- If you smoke, quit.
- If you are overweight, lose weight.
- Avoid processed and refined sugars and starches (white bread, white potatoes, white rice and simple sugars)
- Drink alcohol in moderation. This means two drinks per day for men, and one drink per day for women.
Cholesterol-Lowering Medication
If diet and exercise do not work, you may need medication. Examples include:
- Cholestyramine (Questran)
- Colestipol (Colestid)
- Niacin (Niacor)
-
Statins
- Lovastatin (Mevacor)
- Pravastatin (Pravachol)
- Atorvastatin (Lipitor)
- Simvastatin (Zocor)
- Rosuvastatin (Crestor)
- Ezetimibe (Zetia)
Statins are often prescribed for high cholesterol. They have been shown to reduce mortality (death), heart attacks, and stroke. Ezetimibe has reduced plaque in arteries. However, it has not been shown to reduce mortality.
Some may have a high risk for coronary artery disease. In this case, combination therapy may be needed to lower LDL.
Prevention
To help reduce your chance of getting high cholesterol, follow the lifestyle changes above. Work with your doctor to monitor and control your cholesterol levels.
RESOURCES:American Heart Association
http://www.americanheart.org/
National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/
Canadian Cardiovascular Society
http://www.ccs.ca/
Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/
REFERENCES:
Goroll AH, Mulley AG. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Heart disease and stroke statistics update. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1928 . Updated 2008. Accessed July 7, 2008.
How can I lower high cholesterol? American Heart Association website. Available at: http://www.americanheart.org . Published October 2007. Accessed July 7, 2008.
Lipid-lowering pharmacotherapy overview. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 23, 2008.
Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). National Cholesterol Education Program website. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm . Accessed December 17, 2007.
What is cholesterol? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbc/HBC_WhatIs.html . Updated February 2006. Accessed July 7, 2008.
12/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Ferdowsian HR, Barnard ND. Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009;104(7):947-956.
Last reviewed November 2009 by David N. Smith, MD
Last Updated: 12/14/2009