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What Is Cholesterol?

To understand high blood cholesterol (ko-LES-ter-ol), it helps to learn about cholesterol. Cholesterol is a waxy, fat-like substance that's found in all cells of the body.

Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat.

Cholesterol travels through your bloodstream in small packages called lipoproteins (lip-o-PRO-teens). These packages are made of fat (lipid) on the inside and proteins on the outside.

Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important.

LDL cholesterol sometimes is called "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. (Arteries are blood vessels that carry blood from your heart to your body.)

HDL cholesterol sometimes is called "good" cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body.

What Is High Blood Cholesterol?

High blood cholesterol is a condition in which you have too much cholesterol in your blood. By itself, the condition usually has no signs or symptoms. Thus, many people don't know that their cholesterol levels are too high.

People who have high blood cholesterol have a greater chance of getting coronary heart disease, also called coronary artery disease. (In this article, the term "heart disease" refers to coronary heart disease.)

The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease.

Coronary heart disease is a condition in which plaque (plak) builds up inside the coronary (heart) arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).

Atherosclerosis

Figure A shows the location of the heart in the body. Figure B shows a normal coronary artery with normal blood flow. The inset image shows a cross-section of a normal coronary artery. Figure C shows a coronary artery narrowed by plaque. The buildup of plaque limits the flow of oxygen-rich blood through the artery. The inset image shows a cross-section of the plaque-narrowed artery.

Over time, plaque hardens and narrows your coronary arteries. This limits the flow of oxygen-rich blood to the heart.

Eventually, an area of plaque can rupture (break open). This causes a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, angina(an-JI-nuh or AN-juh-nuh) or a heart attack may occur.

Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle is cut off. If blood flow isn't restored quickly, the section of heart muscle begins to die. Without quick treatment, a heart attack can lead to serious problems or death.

Plaque also can build up in other arteries in your body, such as the arteries that bring oxygen-rich blood to your brain and limbs. This can lead to problems such ascarotid artery diseasestroke, and peripheral arterial disease (P.A.D.).

Outlook

Lowering your cholesterol may slow, reduce, or even stop the buildup of plaque in your arteries. It also may reduce the risk of plaque rupturing and causing dangerous blood clots.

The image focuses on high cholesterol in women and explains how high cholesterol increases the risk of developing heart disease. An estimated 1 in 2 women has high or borderline high cholesterol.

The image also lists the ranges of total cholesterol numbers for high, borderline high, and desirable cholesterol levels, and breaks down the percentage of women who have high cholesterol in their twenties, thirties, forties, and fifties.

Sources: National Center for Health Statistics (2007–2010). National Health and Nutrition Examination Survey; National Center for Health Statistics (2005–2008). National Health and Nutrition Examination Survey; National Heart, Lung, and Blood Institute, National Cholesterol Education Program (2002). Third report of the National Cholesterol Education Program (NCEP) exert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report.

What Causes High Blood Cholesterol?

Many factors can affect the cholesterol levels in your blood. You can control some factors, but not others.

Factors You Can Control

Diet

Cholesterol is found in foods that come from animal sources, such as egg yolks, meat, and cheese. Some foods have fats that raise your cholesterol level.

For example, saturated fat raises your low-density lipoprotein (LDL) cholesterol level more than anything else in your diet. Saturated fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Trans fatty acids (trans fats) raise your LDL cholesterol and lower your high-density lipoprotein (HDL) cholesterol. Trans fats are made when hydrogen is added to vegetable oil to harden it. Trans fats are found in some fried and processed foods.

Limiting foods with cholesterol, saturated fat, and trans fats can help you control your cholesterol levels.

Physical Activity and Weight

Lack of physical activity can lead to weight gain. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level. (Total cholesterol is a measure of the total amount of cholesterol in your blood, including LDL and HDL.)

Routine physical activity can help you lose weight and lower your LDL cholesterol. Being physically active also can help you raise your HDL cholesterol level.

Factors You Can't Control

Heredity

High blood cholesterol can run in families. An inherited condition called familial hypercholesterolemia causes very high LDL cholesterol. ("Inherited" means the condition is passed from parents to children through genes.) This condition begins at birth, and it may cause a heart attack at an early age.

Age and Sex

Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men.

What Are the Signs and Symptoms of High Blood Cholesterol?

High blood cholesterol usually has no signs or symptoms. Thus, many people don't know that their cholesterol levels are too high.

If you're 20 years old or older, have your cholesterol levels checked at least once every 5 years. Talk with your doctor about how often you should be tested.

How Is High Blood Cholesterol Diagnosed?

Your doctor will diagnose high blood cholesterol by checking the cholesterol levels in your blood. A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours.

The lipoprotein panel will give your doctor information about your:

If it's not possible to have a lipoprotein panel, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels.

Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL cholesterol is less than 40 mg/dL, your doctor will likely recommend that you have a lipoprotein panel. (Cholesterol is measured as milligrams (mg) of cholesterol per deciliter (dL) of blood.)

The tables below show total, LDL, and HDL cholesterol levels and their corresponding categories. See how your cholesterol numbers compare to the numbers in the tables below.

Total Cholesterol Level Total Cholesterol Category
Less than 200 mg/dL Desirable
200–239 mg/dL Borderline high
240 mg/dL and higher High
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 higher Very high
HDL Cholesterol Level HDL Cholesterol Category
Less than 40 mg/dL A major risk factor for heart disease
40–59 mg/dL The higher, the better
60 mg/dL and higher Considered protective against heart disease

Triglycerides also can raise your risk for heart disease. If your triglyceride level is borderline high (150–199 mg/dL) or high (200 mg/dL or higher), you may need treatment.

Factors that can raise your triglyceride level include:

How Is High Blood Cholesterol Treated?

High blood cholesterol is treated with lifestyle changes and medicines. The main goal of treatment is to lower your low-density lipoprotein (LDL) cholesterol level enough to reduce your risk for coronary heart diseaseheart attack, and other related health problems.

Your risk for heart disease and heart attack goes up as your LDL cholesterol level rises and your number of heart disease risk factors increases.

Some people are at high risk for heart attacks because they already have heart disease. Other people are at high risk for heart disease because they havediabetes or more than one heart disease risk factor.

Talk with your doctor about lowering your cholesterol and your risk for heart disease. Also, check the list to find out whether you have risk factors that affect your LDL cholesterol goal:

You can use the NHLBI 10-Year Risk Calculator to find your risk score. The score, given as a percentage, refers to your chance of having a heart attack in the next 10 years.

Based on your medical history, number of risk factors, and risk score, figure out your risk of getting heart disease or having a heart attack using the table below.

If You Have You Are in Category Your LDL Goal Is
Heart disease, diabetes, or a risk score higher than 20% I. High risk* Less than 100 mg/dL
Two or more risk factors and a risk score of10–20% II. Moderately high risk Less than 130 mg/dL
Two or more risk factors and a risk score lower than 10% III. Moderate risk Less than 130 mg/dL
One or no risk factors IV. Low to moderate risk Less than 160 mg/dL

* Some people in this category are at very high risk because they've just had a heart attack or they have diabetes and heart disease, severe risk factors, ormetabolic syndrome. If you're at very high risk, your doctor may set your LDL goal even lower, to less than 70 mg/dL. Your doctor also may set your LDL goal at this lower level if you have heart disease alone.

After following the above steps, you should have an idea about your risk for heart disease and heart attack. The two main ways to lower your cholesterol (and, thus, your heart disease risk) include:

Your doctor will set your LDL goal. The higher your risk for heart disease, the lower he or she will set your LDL goal. Using the following guide, you and your doctor can create a plan for treating your high blood cholesterol.

Category I, high risk, your LDL goal is less than 100 mg/dL.*

Your LDL Level Treatment
If your LDL level is 100 or higher You will need to begin the TLC diet and take medicines as prescribed.
Even if your LDL level is below 100 You should follow the TLC diet to keep your LDL level as low as possible.

* Your LDL goal may be set even lower, to less than 70 mg/dL, if you're at very high risk or if you have heart disease. If you have this lower goal and your LDL is 70 mg/dL or higher, you'll need to begin the TLC diet and take medicines as prescribed.

Category II, moderately high risk, your LDL goal is less than 130 mg/dL

Your LDL Level Treatment
If your LDL level is 130 mg/dL or higher You will need to begin the TLCdiet.
If your LDL level is 130 mg/dL or higher after 3 months on the TLC diet You may need medicines along with the TLC diet.
If your LDL level is less than130 mg/dL You will need to follow a heart healthy diet.

Category III, moderate risk, your LDL goal is less than 130 mg/dL.

Your LDL Level Treatment
If your LDL level is 130 mg/dL or higher You will need to begin the TLCdiet.
If your LDL level is 160 mg/dL or higher after 3 months on the TLC diet You may need medicines along with the TLC diet.
If your LDL level is less than130 mg/dL You will need to follow a heart healthy diet.

Category IV, low to moderate risk, your LDL goal is less than 160 mg/dL.

Your LDL Level Treatment
If your LDL level is 160 mg/dL or higher You will need to begin the TLCdiet.
If your LDL level is 160 mg/dL or higher after 3 months on the TLC diet You may need medicines along with the TLC diet.
If your LDL level is less than160 mg/dL You will need to follow a heart healthy diet.

Lowering Cholesterol Using Therapeutic Lifestyle Changes

TLC is a set of lifestyle changes that can help you lower your LDL cholesterol. The main parts of the TLC program are a healthy diet, weight management, and physical activity.

The TLC Diet

With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods' Nutrition Facts labels.

Foods high in soluble fiber also are part of the TLC diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

For more information about TLC, go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to Lowering Your Cholesterol With TLC."

Weight Management

If you're overweight or obese, losing weight can help lower LDL cholesterol. Maintaining a healthy weight is especially important if you have a condition calledmetabolic syndrome.

Metabolic syndrome is the name for a group of risk factors that raise your risk for heart disease and other health problems, such as diabetes and stroke.

The five metabolic risk factors are a large waistline (abdominal obesity), a high triglyceride level, a low HDL cholesterol level, high blood pressure, and high blood sugar. Metabolic syndrome is diagnosed if you have at least three of these metabolic risk factors.

Physical Activity

Routine physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol level.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Cholesterol-Lowering Medicines

In addition to lifestyle changes, your doctor may prescribe medicines to help lower your cholesterol. Even with medicines, you should continue the TLC program.

Medicines can help control high blood cholesterol, but they don't cure it. Thus, you must continue taking your medicine to keep your cholesterol level in the recommended range.

The five major types of cholesterol-lowering medicines are statins, bile acid sequestrants (seh-KWES-trants), nicotinic (nick-o-TIN-ick) acid, fibrates, and ezetimibe.

While you're being treated for high blood cholesterol, you'll need ongoing care. Your doctor will want to make sure your cholesterol levels are controlled. He or she also will want to check for other health problems.

If needed, your doctor may prescribe medicines for other health problems. Take all medicines exactly as your doctor prescribes. The combination of medicines may lower your risk for heart disease and heart attack.

While trying to manage your cholesterol, take steps to manage other heart disease risk factors too. For example, if you have high blood pressure, work with your doctor to lower it.

If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. If you're overweight or obese, try to lose weight. Your doctor can help you create a reasonable weight-loss plan.

the heart.org

It may surprise you to know that cholesterol itself isn't bad. In fact, cholesterol is just one of the many substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is produced naturally (and can be affected by your family health history), while some of it comes from the food we eat.

There are two types of cholesterol: "good" and "bad."  It's important to understand the difference, and to know the levels of "good" and "bad" cholesterol in your blood. Too much of one type — or not enough of another — can put you at risk for coronary heart disease, heart attack or stroke.

Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat. Cholesterol is only found in animal products.

cholesterol screening measures your level of HDL and LDL.  HDL is the "good" cholesterol which helps keep the LDL (bad) cholesterol from getting lodged into your artery walls.  A healthy level of HDL may also protect against heart attack and stroke, while low levels of HDL (less than 40 mg/dL for men and less than 50 mg/dL for women) have been shown to increase the risk of heart disease.  

If you need to increase your HDL to your reach your goals, studies show that regular physical activity, such as at least 150 minutes of moderate-intensity aerobic physical activity (e.g. brisk walking) every week or 75 minutes of vigorous intensity aerobic physical activity (e.g., jogging, running) or a combination of both every week can help your body produce more HDLs.  Reducing trans fats and eating a balanced, nutritious diet is another way to increase HDL.  If you smoke - stop: cigarette smoking can decrease your HDL. If these measures are not enough to increase your HDL to goal, your healthcare practitioner may prescribe a medication specifically to increase your HDLs.

LDL cholesterol is the "bad" cholesterol. When too much of it circulates in the blood, it can clog arteries, increasing your risk of heart attack and stroke.

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different, so work with your doctor to find a treatment plan that's best for you.

What Can Cholesterol Do?

High cholesterol is one of the major controllable risk factors for coronary heart diseaseheart attack andstroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressureor diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk.

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain (View an animation of cholesterol). Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. Your cholesterol level can be affected by your age, gender, family health history and diet.

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much.  Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family,lifestyle modifications may not be enough to help lower your LDL blood cholesterol. View an animation of cholesterol.  Everyone is different, so work with your doctor to find a treatment plan that's best for you.

More information:

Even though high cholesterol may lead to serious heart disease, most of the time there are no symptoms. This is why it is important to have your cholesterol levels checked by your doctor (View an animation of cholesterol).

To reduce your risk of heart disease and stroke, work with your healthcare professionals to monitor and maintain healthy cholesterol levels. Even if your cholesterol levels are good now, it's not too early to develop healthy habits that can help keep your numbers in check.

Click on each link to learn more:

Too much cholesterol in the blood can lead to cardiovascular disease. Cardiovascular disease is the No. 1cause of death in the United States.  2,200 Americans die of cardiovascular disease each day, an average of one death every 39 seconds.  The good news is, you can lower your cholesterol and reduce your risk of heart disease and stroke (View an animation of cholesterol). Take responsibility for managing your cholesterol levels. Whether you've been prescribed medication or advised to make diet and lifestyle changes to help manage your cholesterol, carefully follow your doctor's recommendations.

Lifestyle Changes Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level — and these factors may be controlled by:

Know Your Fats Knowing which fats raise LDL cholesterol and which ones don't is the first step in lowering your risk of heart disease.

Cooking for Lower Cholesterol It's not hard to whip up recipes that fit with the low-saturated-fat, low-cholesterol eating plan recommended by scientists to help you manage your blood cholesterol level and reduce your risk of heart disease and stroke.

Understand Drug Therapy Options For some people, lifestyle changes alone aren't enough to reach healthy cholesterol levels. Your doctor may prescribe medication. Learn about:

Avoid Common Misconceptions We have created a list of the common misconceptions, along with the true story, about cholesterol.

Work with Your Doctor It takes a team to develop and maintain a successful health program. You and your healthcare professionals each play an important role in maintaining and improving your heart health. Know how to talk with your doctor about your cholesterol levels and be sure you understand all instructions. Follow your plan carefully, especially when it comes to medication — it won't work if you don't take it as directed. And learn how to make diet and lifestyle changes easy and lasting.

Symptoms of high cholesterol

High cholesterol is often called "the silent killer" because for most people there are no obvious signs and symptoms to look out for. The first sign that you have high cholesterol could be:

These symptoms point to the presence of established heart and circulatory disease.

Other signs to look out for 

HEART UK believes that people should be aware of their risk from cholesterol.  There are some things that make it more likely you have unhealthy cholesterol levels. These are:

Not everyone with these signs will have high cholesterol. To help prevent cardiovascular (heart and circulatory) disease anyone over the age of 40 should have their cholesterol tested every 5 years.  Your GP should invite you to an NHS Health Check, where a cholesterol test and other checks will help determine your risk of having a heart attack or stroke in the coming years.  They will also look for sign of diabetes and kidney disease.

Other risk factors

It is important to remember that high cholesterol is only one risk factor.  Your risk of cardiovascular disease increases if you have additional risk factors such as:

- See more at: http://heartuk.org.uk/health-and-high-cholesterol/symptoms-of-high-cholesterol#sthash.LaMBgUxj.dpuf

What causes high cholesterol? People are often surprised to find out they have high cholesterol, so our Cholesterol Helpline is often asked this question.

High cholesterol can be inherited If one of your parents, a brother or a sister has high cholesterol you might too. There are over 100 genes that can affect blood fats and how these are metabolised in the body.  Sometimes just one faulty gene is enough to increase your cholesterol to dangerous levels and sometimes high cholesterol results from the small effects of many genes.

Inherited conditions that cause high cholesterol:

*Familial – this word usually indicates an inherited condition

High Cholesterol can be caused by an unhealthy lifestyle

Diet and lifestyle can affect the amount of fat in our blood and the way it circulates around the body.  All of the following can either increase your cholesterol level or affect the ratio of good to bad cholesterol.

Sometimes the way we live our life can affect how our genetic makeup is expressed.  For example a diet high in saturated fat or being overweight may help "swtich on" certain genes which increase cholesterol levels.

What else can affect my cholesterol level? Some medical conditions and prescribed medicines can affect your cholesterol levels too.  If you are worried this is the case, talk to your GP or speak to our Cholesterol Helpline.  In particular the following conditions are a common cause of unhealthy blood fats (cholesterol and triglyceride levels)

Drugs which most commonly raise cholesterol include some diuretics, steroid hormones, beta blockers and antidepressants.  If you are on any of these drugs your doctor will monitor your cholesterol and may have to adjust your treatment to help keep your cholesterol under control.

Getting older Cholesterol levels naturally increase as you get older and following the menopause women may find their cholesterol levels increase.

- See more at: http://heartuk.org.uk/health-and-high-cholesterol/what-causes-high-cholesterol#sthash.YM0Z4LLB.dpuf

 

   

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