Overview, Causes, & Risk Factors
High cholesterol is an excessive level of cholesterol in the blood. Cholesterol is a waxy substance that is used for many body processes. Low-density lipoprotein, or LDL, is known as the "bad cholesterol". High-density lipoprotein, or HDL, is known as the "good cholesterol".
What is going on in the body?
The body produces all the cholesterol it needs. When too much cholesterol and other fats are consumed, the body cannot get rid of the excess. The fats build up in various cells and tissues of the body.
Cholesterol can build up on the insides of blood vessel walls. This results in atherosclerosis, or hardening of the arteries. LDL cholesterol is the main source of build-up on the blood vessel walls. HDL cholesterol carries cholesterol back to the liver and prevents build-up on the blood vessel walls.
What are the causes and risks of the disease?
Common causes of high cholesterol include the following:
heredity
diet high in cholesterol and saturated fat
excess weight
lack of physical activity and exercise
smoking
Until age 45, men tend to have higher total cholesterol levels than women do, and women tend to have higher HDL levels. Men in their 40s are four times more likely to die from heart disease than are women the same age. However, as time goes on, the statistics for women change. After menopause, a woman's LDL level tends to go up, and her HDL level goes down. Also, her risk of heart disease continues to rise with age. After menopause, women tend to have higher LDL levels than do men of the same age.
These health conditions may increase a person's risk for high cholesterol:
alcohol abuse
diabetes
kidney disease
liver disease
underactive thyroid gland, called hypothyroidism
These medicines may raise total cholesterol level:
anabolic steroids
certain types of medicine to lower blood pressure, such as clonidine and methyldopa
some diuretics, also called water pills
progestins
These medicines may reduce HDL, or good, cholesterol:
anabolic steroids
some beta-blockers
some progestins
Symptoms & Signs
What are the signs and symptoms of the disease?
High total and LDL cholesterol levels cause no symptoms. When the cholesterol builds up in the body, the person may start having symptoms. For example, atherosclerosis of the arteries that supply the heart causes coronary artery disease. The individual may have chest pain and shortness of breath.
Diagnosis & Tests
How is the disease diagnosed?
A blood cholesterol test is used to diagnose high cholesterol. This test measures total cholesterol, LDL, HDL, and the triglycerides. Total cholesterol results are evaluated as follows:
desirable range is less than 200 milligrams per deciliter or mg/dL
borderline-high is 200 to 239 mg/dL
high cholesterol is 240 mg/dL or greater
LDL results are evaluated differently in people with certain risk factors. People with CAD and CAD risk equivalents have the strictest LDL guidelines. CAD risk equivalents include the following factors:
diabetes
multiple risk factors that give the person a greater than 20% chance of developing CAD within 10 years
other clinical signs of atherosclerosis, such as peripheral arterial disease, abdominal aortic aneurysm, or certain types of carotid artery disease
The person's risk of developing CAD within 10 years is based on data from the Framingham heart study. This 10-year risk is calculated from a formula that takes the following into account:
age
cigarette smoking
HDL cholesterol
systolic blood pressure, which is the top number on a blood pressure reading
total cholesterol
treatment for high blood pressure
LDL results in healthy adults are evaluated as follows:
optimal is less than 100 milligrams per deciliter, or mg/dL
near optimal/above optimal is 100 to 129 mg/dL
borderline high is 130 to 159 mg/dL
high is 160 to 189 mg/dL
very high is 190 mg/dL or greater
If an individual has certain other risk factors, LDL guidelines are more strict. LDL goals for these groups are as follows:
less than 100 mg/dL for people with CAD and CAD risk equivalents
less than 130 mg/dL for individuals with two or more risk factors
less than 160 mg/dL for people with 0 to 1 risk factor
A low HDL level is less than 40 milligrams per deciliter, or mg/dL. Low HDL increases a person's risk for coronary artery disease. A high HDL is 60 mg/dL or above. High HDL lowers the risk of coronary artery disease, or CAD.
Prevention & Expectations
What can be done to prevent the disease?
Adults 20 years or over should be tested every five years for cholesterol, LDL, HDL, and triglycerides.
Some factors that affect cholesterol cannot be controlled. High cholesterol can run in families, for example, due to genetic factors. Many cases of high cholesterol can be prevented by choosing a healthy lifestyle. Recommendations include the following:
eating a heart-healthy diet low in cholesterol and saturated fat
exercising regularly
maintaining a healthy body weight
limiting alcohol intake
not smoking
seeking effective treatment for diabetes, hypothyroidism, and other health conditions
What are the long-term effects of the disease?
High levels of total and LDL cholesterol greatly increase the risk of atherosclerosis, coronary artery disease, and stroke. High cholesterol levels following a heart attack increase the chance of a second heart attack.
What are the risks to others?
High cholesterol is not contagious. However, some forms of high cholesterol run in families.
Treatment & Monitoring
What are the treatments for the disease?
Recently, treatment of high cholesterol has shifted from total cholesterol to LDL cholesterol. Treatment focuses on reduction of LDL cholesterol to the optimal level, whenever possible. LDL can be lowered with therapeutic lifestyle changes, or TLC. It can also be reduced with medications.
Therapeutic lifestyle changes include regular physical activity and weight reduction. TLC also includes the following dietary guidelines:
20-30 grams of total fiber per day
10-25 grams of soluble fiber per day
saturated fat less than 7% of daily calories
polyunsaturated fat less than 10% of daily calories
monosaturated fat up to 20% of daily calories
total fat 25-35% of daily calories
carbohydrates 50-60% of daily calories
protein at 15% of daily calories
cholesterol less than 200 mg per dayTLC guidelines also recommend 2 grams of plant stanols/esters per day. Plant sterols are naturally found in fruits, vegetables, nuts, seeds, cereals, legumes, and other plant-based foods. Plant sterol esters are being found in food products, such as certain salad dressings and food spreads.
Cholesterol-lowering medications are recommended for people whose short or long-term risk of CAD is high. These medications include:
bile acid resins, such as cholestyramine and colestipol
nicotinic acid, also known as niacin or vitamin B3
fibric acids, such as gemfibrozil, fenofibrate, and clofibrate
statins, such as atorvastatin, fluvastatin, cerivastatin, pravastatin, and simvastatin
The choice of medications is based on the cholesterol level, the person's age, and any other health conditions.
What are the side effects of the treatments?
The side effects depend on the particular medication chosen. Most cholesterol-lowering medicines can have bad effects on the liver. Blood tests are often done to measure the levels of enzymes produced by the liver. Niacin can cause flushing of the skin and itching. It may also cause nausea, vomiting, diarrhea, and high blood glucose.
What happens after treatment for the disease?
Treatment of high total and LDL cholesterol is lifelong. Diet, exercise, and a healthy lifestyle are key to quality of life.
How is the disease monitored?
The individual will have regular cholesterol tests and visits with the healthcare provider. Any new or worsening symptoms should be reported to the provider.
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