High Cholesterol (Hypercholesterolemia)

What is hypercholesterolemia?

Hypercholesterolemia is a high level of cholesterol in your blood. When you have too much cholesterol, fat builds up in the blood vessel walls. This fat is sometimes called plaque. The blood vessel walls thicken and become stiff and narrow. This is a condition called hardening of the arteries, or atherosclerosis. It makes it harder for blood to flow through your blood vessels and bring oxygen to cells throughout the body. These changes increase your risk of heart disease, heart attack, and stroke.

Cholesterol is a fatty substance, also called a lipid. Your body needs small amounts of cholesterol to make hormones and to build and maintain cells. Your body makes some cholesterol and gets the rest from foods such as meats, dairy products, and eggs.

Blood tests can measure the cholesterol in your blood. The 2 most important measurements are LDL (low-density lipoprotein) and HDL (high-density lipoprotein). LDL and HDL carry cholesterol through your blood.

• LDL carries a lot of cholesterol, leaves behind fatty deposits on artery walls, and contributes to heart disease. LDL is called bad cholesterol. (You can think of "L" for "lousy" cholesterol.)
• HDL does the opposite: HDL cleans the artery walls, remove extra cholesterol from the body, and lower the risk of heart disease. HDL is called good cholesterol. (Think of "H" for "healthy" cholesterol.)

It is good to have low levels of LDL and high levels of HDL.

How does high cholesterol occur?

Causes of high cholesterol include:

• eating foods that are high in saturated fat or cholesterol (the main cause)
• being overweight or obese
• not being physically active
• having an inherited problem with the way your body processes cholesterol
• having a disease that raises your cholesterol level (for example, diabetes, kidney disease, liver disease, or hypothyroidism).

What are the symptoms?

High cholesterol is a silent disease. It does not cause any symptoms until problems have already developed--for example, pain in your calf when you walk or the chest pain of a heart attack.

How is it diagnosed?

Your healthcare provider may give you a physical exam. Your provider may ask about your diet, exercise, smoking habits, and your family history of diseases and health problems.

You will have blood tests to check your cholesterol level. These lab tests usually measure your total cholesterol level as well as the levels of HDL, LDL, and triglycerides. (Triglycerides are another type of fat in the blood.)

When you get your cholesterol checked, your provider will give you a number for your total cholesterol level.

• A total cholesterol less than 200 is good.
• 200 to 239 is borderline high.
• 240 or above is high.

HDL levels of 60 milligrams per deciliter (mg/dL) or more help to lower your risk for heart disease. An HDL less than 40 mg/dL is a major risk factor for heart disease.

Your provider will evaluate your risk factors for heart disease to determine if your overall risk is low, moderate, or high. This will help you know what your LDL goal should be.

• If you have a low risk of heart disease, the recommended level of LDL is less than 160.
• If you have a moderate risk for heart disease, your goal is less than 130.
• If you have heart disease, diabetes, or a high risk of heart disease, your LDL should be below 100. For many people with heart disease, especially if they also have diabetes, the goal is below 70 mg/dL.

Your triglyceride level should be 150 mg/dL or less.

How is it treated?

The goal of most cholesterol treatments is to:

• Lower the LDL in your blood and
• Raise the HDL.

The lower your total cholesterol and your LDL are, the lower your risk for heart attack and stroke.

A diet high in fiber and low in saturated fat and cholesterol can help to lower cholesterol levels. Being more physically active also helps lower your cholesterol and LDL.

If you are overweight, losing weight will help. You should also exercise as recommended by your healthcare provider.

If diet and exercise are not enough to lower your cholesterol level, your healthcare provider may prescribe medicine.

• Statins are a class of drugs that lower blood cholesterol. Commonly used statins are lovastatin and simvastatin.
• Ezetimibe (Zetia) is another drug that can lower cholesterol. It decreases absorption of cholesterol from the digestive system. It may be used with a statin to lower cholesterol.
• Some of the other drugs used to lower blood cholesterol are cholestyramine, nicotinic acid (niacin), and gemfibrozil.

Each medicine has slightly different effects on the different types of cholesterol. Your provider will choose the best medicine for you. In some cases it may take some time to find the right one. You may need more than 1 medicine to control your cholesterol.

To raise your HDL you need to start an exercise program according to your healthcare provider's recommendation. And if you smoke, stop smoking. If neither of these is sufficient, then you may need medicine. Niacin is often prescribed if HDL is your only cholesterol test result that is abnormal. If you have other cholesterol problems besides your HDL, you may be started on a statin.

How can I take care of myself and prevent high cholesterol?

• Watch your diet. Eat a diet low in cholesterol and saturated fat.
• Get more exercise, especially aerobic exercise. Exercise lowers total and LDL cholesterol. It also raises your "good" HDL cholesterol. Ask your healthcare provider for an exercise prescription. Start slowly to avoid injury.
• Do not smoke. Smoking lowers your HDL and increases your risk for heart disease in other ways as well.
• Keep a healthy weight.
• Get your cholesterol levels and weight checked regularly. At first your cholesterol level may need to be checked every 3 to 6 months until it is staying in the normal range. Then you may need to check it just once a year.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File card3632.htm Release 13/2010