What Is High Cholesterol?
There are two major forms of cholesterol: Low-density lipoprotein or LDL, also known as "bad" cholesterol, and high-density lipoprotein or HDL, also called "good" cholesterol. LDL is the main source of artery-clogging plaque. HDL, on the other hand, clears cholesterol from your blood.
Ordinarily, your liver makes all the cholesterol your body needs. But you also get cholesterol from food. You'll find these in many processed foods like doughnuts, frozen pizza, cookies, and crackers. You can also get it from milk, eggs, meat, and other animal products. Over time, without your even being aware, this extra cholesterol collects inside your body and begins to do damage.
Symptoms of High Cholesterol
High cholesterol doesn’t have symptoms. So you can be unaware that your levels are getting too high. That’s why it’s important to find out what your cholesterol numbers are. If they're too high, lowering them will lessen your risk for getting heart disease. And if you already have heart disease, lowering cholesterol can reduce your odds of a heart attack or of dying from heart disease.
High Cholesterol Diagnosis
If you’re older than 20, your doctor should measure your cholesterol levels at least once every 5 years. All that’s needed for this is a simple blood test called a lipid profile. The test will show you your:
Children between ages 9 and 11 should be checked once for high cholesterol, too. Kids should have their cholesterol checked earlier -- after age 2 but by age 10 -- if they have any of these risk factors:
- A mother or grandmother who had a stroke, heart attack, or blocked arteries before age 65
- A father or grandfather who had a stroke, heart attack, or blocked arteries before age 55
- Any parent or grandparent who has or had a total cholesterol level over 240
- Unknown family health history because of adoption
- High blood pressure, diabetes, obesity, and any other conditions linked to heart disease
Children should have a total cholesterol level below 170 and an LDL below 110. High cholesterol in kids is defined as a total cholesterol level of about 200.
Your numbers will help you and your doctor know not only your risk for heart disease but also the best options for lowering it. For instance, an LDL level of 190 or above in adults is considered very high. The doctor will likely talk to you about taking medicine to lower it. And if your HDL level is 60 or above, your risk of heart disease goes down. The goal is a lower LDL and a higher HDL to prevent and manage heart disease.
But cholesterol numbers are only one part of a larger equation. The doctor will also look at in your age, blood pressure, smoking history, and use of blood pressure medicines. All of these things plus whether you already have heart disease will give a picture of your chance of a major heart problem over the next 10 years. You and your doctor will use that information to create a plan to lower your risk. This could involve lowering your cholesterol level with diet and medicine.
High Cholesterol Causes and Risk Factors
Lots of things can affect your cholesterol levels. They include:
- Diet. Reducing the amount of saturated fat, trans fats, simple sugars, and cholesterol in your diet can help lower your blood cholesterol. Eating too much sugar and too many simple carbohydrates will also boost your cholesterol levels.
- Weight. Being overweight is a risk factor for heart disease. It also can increase your cholesterol. Losing weight will help lower your LDL, total cholesterol levels, and triglyceride levels. At the same time, it can help you raise your HDL.
- Exercise. Regular exercise can lower LDL cholesterol and raise HDL cholesterol. You should try to be physically active for 30 minutes on most days.
- Age and gender. As you get older, your cholesterol rises. Before menopause, women tend to have lower total cholesterol than men. After menopause, though, women's LDL levels tend to rise.
- Heredity. High blood cholesterol can run in families.
- Medical conditions. Sometimes a medical condition may cause higher cholesterol levels. Examples include hypothyroidism (an underactive thyroid gland), liver disease, and kidney disease.
- Medications. Some drugs, such as steroids and progestins, can increase the "bad" cholesterol and decrease the "good" cholesterol.
- Smoking. Tobacco smoke can raise levels of blood fats (triglycerides) and make your “good” HDL cholesterol go down.
High Cholesterol Treatment
Cholesterol-lowering drugs include:
- Bile-acid sequestrants
- Cholesterol absorption inhibitors
- PCSK9 inhibitors
Cholesterol-lowering drugs work best when combined with a low-cholesterol diet and an exercise program.
Statins block the production of cholesterol in the liver. They lower LDL and triglycerides and can slightly raise HDL. These drugs are the first treatment for most people with high cholesterol. If you already have heart disease, statins reduce the chances of heart attacks. Side effects can include diabetes, liver damage, and, in a few people, muscle tenderness or weakness. If your doctor prescribes statins, you should ask them the percentage by which you should lower your cholesterol. Generally, it will be between 30% and 50%. Commonly used statins include:
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol, Lescol XL)
- Lovastatin (Altocor, Altoprev, Mevacor)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
Niacin is a B vitamin. It's found in food, but you can get high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling, and headache. Aspirin can reduce many of these symptoms. Speak with your doctor first, though, before taking aspirin. Research suggests that even though niacin may improve your cholesterol numbers, it doesn’t appear to lower your risk of heart disease, especially if you’re already taking a statin.
Bile acid sequestrants
These drugs work inside the intestine, where they bind to bile and prevent your circulatory system from reabsorbing it. Bile is made largely from cholesterol, so these drugs work by reducing the body's supply of cholesterol. That then lowers both total and LDL cholesterol. The most common side effects are constipation, gas, and upset stomach. Commonly used bile acid sequestrants include:
- Cholestyramine resin (Prevalite, Questran, and Questran Light Questran Light)
- Colesevelam (WelChol)
- Colestipol (Colestid)
Fibrates lower triglyceride levels and can increase HDL and lower LDL. Scientists think fibrates help your body break down triglyceride-rich particles and stop it from putting out certain blood fats. Commonly used fibrates include:
Cholesterol absorption inhibitors
Ezetimibe (Zetia) lowers LDL by inhibiting the absorption of cholesterol in the intestines. Vytorin is a drug that combines ezetimibe and a statin. It can decrease total and LDL cholesterol and raise HDL levels.
You get this newer type of cholesterol-lowering drug as a shot. Doctors use it to treat people with a genetic form of high cholesterol called familial hypercholesterolemia.
Some people with high cholesterol get the best results with combination drugs. These are pills that contain more than one medication. Commonly used combination drugs include:
Side Effects of Cholesterol-Lowering Drugs
The side effect you need to be most concerned about is muscle aches. They could be a sign of a life-threatening condition. If you have muscle aches, call your doctor immediately.
Other side effects of cholesterol-lowering drugs include:
- Abnormal liver function
- Allergic reaction (skin rashes)
- Abdominal pain
- Decreased sexual desire
- Memory loss
Foods or Other Drugs to Avoid
Ask your doctor about the other drugs you’re taking, including herbals and vitamins, and their impact on cholesterol-lowering medications. You shouldn’t drink grapefruit juice while taking cholesterol-lowering drugs. It can make it harder for your liver to process these medications.
Complications of High Cholesterol
When you have too much cholesterol, it builds up in the walls of your arteries, causing them to harden -- a process called atherosclerosis. It also narrows your arteries, which slows and even blocks the flow of blood. That’s where the problem starts. Your blood is supposed to carry oxygen to all parts of your body, including your heart muscle. Without enough oxygen, your body’s parts won’t work the way they’re supposed to.
Complications of high cholesterol include:
- High blood pressure. If clogged arteries make it hard for blood to move to and from your heart, the heart has to pump harder, and your blood pressure will go up.
- Chest pain. If your heart muscle doesn’t get enough blood and oxygen, you'll have chest pain.
- Heart attack or stroke. If a piece of plaque breaks off or forms a clot, it can cut off the blood supply to a portion of your heart, causing a heart attack or stroke. If you have heart disease risk factors (like smoking, diabetes, or high blood pressure), you’re especially at risk of this complication.
- Peripheral artery disease (PAD). A cholesterol buildup can block blood flow to the arteries in your legs and feet. PAD may also affect arteries in your kidneys.