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DESCRIPTION
Understanding Cholesterol
Pick up just about any newspaper or magazine these days and you will probably find mention of cholesterol. Everyone seems to be concerned with lowering his or her cholesterol level, and most people would like to know how they can do this. It is first helpful to know how cholesterol is produced and used by the body.
Cholesterol is a crystalline substance that is technically classified as a steroid. However, because it is soluble in fats rather than in water, it is also classified as a lipid, as fats are. It is found naturally in the brain, nerves, liver, blood, and bile of both humans and vertebrate animals. This is why persons who wish to decrease their cholesterol levels are told to stay away from meat and other foods containing animal products or derived from animals.
Despite its current unsavory reputation, cholesterol is actually necessary for the proper functioning of the body. About 80 percent of total body cholesterol is manufactured in the liver, while 20 percent comes from dietary sources. It is used by cells to build membranes, and it is also used in sex hormones and in the digestive process. Cholesterol travels from the liver through the blood stream to the various tissues of the body by means of a special class of protein molecules called lipoproteins. The cells take what they need, and any excess remains in the bloodstream until other lipoproteins pick it up for transport back to the liver.
There are two main types of lipoproteins: low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs). LDLs are often referred to as "bad cholesterol"; HDLs as "good cholesterol." An analysis of the function of each will explain why. Low-density lipoproteins are heavily laden with cholesterol, because they are the molecules that transport cholesterol from the liver to all the cells of the body. High-density lipoproteins, on the other hand, carry relatively little cholesterol, and circulate in the bloodstream removing excess cholesterol from the blood and tissues. After HDLs travel through the bloodstream and collect the excess cholesterol, they return it to the liver, where it may once again be incorporated into LDLs for delivery to the cells. If everything is functioning as it should, this system remains in balance. However, if there is too much cholesterol for the HDLs to pick up promptly, or if there are not enough HDLs to do the job, cholesterol can form plaque that sticks to artery walls and may eventually cause heart disease.
The precise ways in which lipoproteins perform their functions are not known, nor is it known whether or how they work with other elements in the body. It is known that persons with high HDL levels and relatively low LDL levels have a lower risk of heart disease. In those who already have clogged arteries or have had a heart attack, an increase in HDL levels and a decrease in LDL levels can result in improvement of arterial obstruction.
The National Cholesterol Education Program has set the "safe" level of total serum cholesterol (including both LDL and HDL) at 200 milligrams per deciliter of blood (mg/dl). A reading above 200 indicates an increased potential for developing heart disease. A level of 200 to 239 is borderline, and those with levels over 240 are considered at high risk.
The normal HDL level for adult men in the United States is 45 to 50 mg/dl, and that for women is 50 to 60 mg/dl. It is suggested that higher levels, such as 70 to 80 mg/dl, may protect against heart disease. An HDL level under 35 mg/dl is considered risky. So if you have a cholesterol reading of 200, with HDL at 80 and LDL at 120, you are considered as low risk for heart disease. On the other hand, even if you have a total cholesterol level well under 200, if your HDL level is under 35, you would still be considered at increased risk of developing cardiovascular disease. In other words, as your HDL decreases, your potential for heart problems intensifies, even if your total is on the low side.
Because LDLs are so undesirable, it is imperative to realize the effect of diet on cholesterol levels. It is only logical that we should decrease our overall cholesterol levels. However, dietary cholesterol is only a part of the story. There are other substances that affect cholesterol levels. Saturated fats, for example, have been shown to increase cholesterol levels even more than dietary cholesterol does - so even if a food product label proclaims "No Cholesterol" the product may still have a negative effect on your cholesterol level. There are other substances that raise cholesterol, too. Sugar and alcohol both raise the level of natural cholesterol (that which the body produces). Although we do need this substance, we do not need to overproduce it, which is what happens when we consume sugar and alcohol. Stress also results in an overproduction of natural cholesterol. Therefore, preventing (or fighting) heart disease requires a comprehensive approach that includes avoiding the consumption of animal products, saturated fats, sugar, and alcohol, and eliminating stress. Elevated blood cholesterol and triglyceride levels lead to plaque-filled arteries, with impeded blood flow to the brain, kidneys, genitals, extremities, and heart. High cholesterol levels are among the primary causes of heart disease, because cholesterol produces fatty deposits in arteries. High cholesterol levels are also implicated in gallstones, impotence, mental impairment, and high blood pressure. Colon polyps and cancer (especially prostate and breast cancer) have also been linked to high serum cholesterol levels.
Cholesterol levels are greatly influenced by diet. The consumption of foods high in cholesterol and/or saturated fats increases cholesterol levels, while a vegetarian diet, regular exercise, and the nutrients niacin and vitamin C can lower cholesterol.
Cholesterol Level Self-Testing
A test called the Advanced Care Cholesterol Kit, produced by Johnson & Johnson, can be used to check your cholesterol level at home. It is available in drugstores without a prescription, and it gives a cholesterol level in 15 minutes. The test contains pads that are the size of a credit card and have a chemical reagent zone. When a drop of blood is placed on the surface of the pad, the reagents read with enzymes in the blood and the treated zone changes color. The color of the zone is then matched against a color-coded chart to find the serum cholesterol level. The major drawback with this system is it only gives total cholesterol levels, not HDL or LDL levels.
Other Self-Testing Kits
Other Cholesterol Self Testing Kits can be found at Drugstore.com. They have a selection of several types and a selection of prices for these home tests.CAUSES
The following factors may contribute to high cholesterol:
- A high-fat, high-cholesterol diet.
- Being overweight, which may increase triglycerides and lower HDL.
- Lack of physical activity, which may increase LDL and lower HDL.
- Your age and sex.
- Health conditions, such as diabetes, high blood pressure, or hypothyroidism.
- Your family history.
- Rarely, high cholesterol is caused by an inherited problem called a lipid disorder that changes the way the body handles cholesterol. People with lipid disorders may have total cholesterol levels well over 250 mg/dL (6.46 mmol/L). A total cholesterol level below 200 mg/dL (5.17 mmol/L) is desirable. Certain types of inherited lipid disorders may be more difficult to treat.
SIGNS & SYMPTOMS
High cholesterol rarely causes symptoms. It is usually detected during a routine blood test that measures cholesterol levels. You may first discover it when you are diagnosed with a condition that is caused in part by high cholesterol, such as coronary artery disease, stroke, or peripheral vascular disease.
Some people with lipid disorders, such as familial hypercholesterolemia, may have other distinct symptoms such as deposits of excess cholesterol that collect in the skin or eye tissue. These cholesterol deposits can also cause nodules in tendons in the hands or feet or, rarely, yellow streaks in the hands.RISK FACTORS
Some risk factors for high cholesterol are within your control; some are not.
Risk factors you can control:
- A high-fat, high-cholesterol diet, which may raise LDL cholesterol and lower HDL cholesterol.
- Being overweight, which lowers HDL cholesterol and may raise LDL cholesterol.
- Lack of regular exercise, which may increase LDL and lower HDL cholesterol.
- Smoking, which may lower HDL cholesterol by as much as 15%.
- Metabolic syndrome (abnormal physical findings related to the body's metabolism).
You may be able to control some other conditions that can raise cholesterol, including diabetes.
Risk factors that you cannot control:
- Family history.
- Age and sex.
It is important to remember that high cholesterol is just one of many risk factors for coronary artery disease (CAD) and stroke. Modifying or reducing all of your risk factors for CAD is important to decrease your risk of heart attack or other diseases.
PREVENTION
Following the tips in the "Living With High Cholesterol" section can help prevent high cholesterol. Since cholesterol levels tend to increase with age, paying attention to diet and exercise is particularly important as you get older.
Remember that high cholesterol is just one of many risk factors for coronary artery disease (CAD). Controlling other risk factors, such as smoking, high blood pressure, and diabetes, is also important to reduce your overall risk.
TREATMENT DIAGNOSIS & TESTS
Exams and Tests
A history and physical exam are done to screen for high cholesterol. Your health care provider will also look for other medical conditions that may increase your risk of developing high cholesterol, such as thyroid or kidney disease and diabetes. A blood test is used to measure total cholesterol, LDL, HDL, and triglyceride levels.
Cholesterol and Triglycerides Tests - Test Overview:
Cholesterol is a type of fat (called a lipid) that the body uses to help build cells and produce certain hormones. However, too much cholesterol in the blood may increase the risk of heart disease, stroke, and coronary artery disease (see an illustration of coronary artery disease).
When there is too much cholesterol in the blood, it and other substances may begin to build up along the inside of the artery walls, forming what is known as plaque. A large deposit of plaque may obstruct the flow of blood through the artery, affecting blood flow to the heart, brain, or other vital organs. If unstable plaque tears open, it may trigger the formation of a blood clot in the artery, which can result in a heart attack or stroke.
Cholesterol travels through the blood attached to a protein. This cholesterol-protein package is called a lipoprotein. Lipoproteins are either high density or low density, depending on how much protein they have in relation to fat. Lipoproteins with more protein than fat are called high-density lipoproteins (HDL). Lipoproteins with more fat than protein are called low-density lipoproteins (LDL). Triglycerides are another type of fat that is usually measured along with cholesterol.
High-density lipoprotein cholesterol is sometimes called "good" cholesterol. HDL cholesterol helps remove LDL cholesterol from the body by binding with it in the bloodstream and carrying it back to the liver for disposal. A high level of HDL cholesterol appears to lower a person's risk of developing heart disease and stroke. Low-density lipoprotein cholesterol is sometimes called "bad" cholesterol. LDL cholesterol collects inside the walls of the arteries and often contributes to the formation of plaque. LDL cholesterol is calculated from the total cholesterol, HDL, and triglyceride levels.
Triglycerides are a type of fat the body uses to store energy. Only a small amount of triglycerides are found in the blood. A high triglyceride level along with high LDL cholesterol may be more of a risk for heart disease than having only a high LDL cholesterol level.
A total cholesterol test measures the total amount of cholesterol in the blood. Lipoprotein analysis (lipoprotein profile or lipid profile) measures blood levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Some medical experts recommend routine lipoprotein analysis to screen for lipid disorders, while others may routinely choose to measure only total cholesterol and HDL levels.
The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, or ATP III) recommends a fasting lipoprotein analysis every 5 years for all adults age 20 and older. Total cholesterol and HDL testing is acceptable if the screening sample is non-fasting. However, if the total cholesterol level from a non-fasting sample exceeds 200 mg/dL, or HDL cholesterol is less than 40 mg/dL, the ATP III recommends repeat testing with a fasting blood sample.
The U.S. Preventive Services Task Force (USPSTF) recommends total cholesterol and HDL testing for all men age 35 and older and for all women age 45 and older. The USPSTF also recommends routine total cholesterol and HDL testing for men between the ages of 20 and 35 and for women between the ages of 20 and 45 who have risk factors for heart disease.
All of these tests are done on a sample of blood taken from a vein.
Cholesterol & Triglycerides Test:
- Total and HDL cholesterol levels can be measured from a blood sample any time of the day, without fasting.
- To accurately measure the total cholesterol and triglycerides, and to calculate the LDL and HDL cholesterol levels, a fasting blood sample is needed. This test is also called a lipoprotein analysis.
If results of the cholesterol and triglycerides test indicate further evaluation is needed, additional tests may be done.
Evaluating Cholesterol Test Results: Treatment for high cholesterol should not be based on a single LDL cholesterol measurement. Two LDL measurements within a 1- to 8-week period are recommended. If they differ by more than 30 mg/dL, a third measurement is recommended. Treatment is based on the average of the 2 or 3 measurements.
Two or three measurements of HDL cholesterol are recommended to obtain accurate results. A separate test is not required for HDL cholesterol. It can be measured at the same time as LDL with a blood test.
LDL cholesterol:LDL cholesterol below 100 mg/dL is optimal.
LDL cholesterol of 100 mg/dL to 129 mg/dL is near optimal/above optimal.
LDL cholesterol of 130 mg/dL to 159 mg/dL is borderline high.
LDL cholesterol of 160 to 189 mg/dL is high.
LDL cholesterol of 190 mg/dL and above is very high.
Total cholesterol:A total cholesterol of less than 200 mg/dL is desirable.
A total cholesterol of 200 mg/dL to 239 mg/dL is borderline high.
A total cholesterol of 240 mg/dL and above is high.
HDL cholesterol:HDL cholesterol of less than 40 mg/dL is low.
HDL cholesterol of 60 mg/dL and above is high. HDL levels of 60 and above can help lower your risk for heart disease.
Triglycerides:Triglycerides that are 150 mg/dL to 199 mg/dL are borderline high.
Triglycerides that are 200 mg/dL or more are high.
If your test results show you have high cholesterol, a clinical exam is recommended, including medical history, physical exam, and lab tests as needed. An evaluation for secondary causes of high cholesterol, such as an underlying disease, diet, or medication, or for inherited lipid disorders may be done if needed.
These findings will help a health care provider determine whether follow-up testing should be done or treatment with diet or medication is needed.
Home Cholesterol Tests: Disposable cholesterol kits are available without a prescription for about $10 to $20. They usually include an alcohol pad, finger stick, and a thermometer-like test strip. Follow package instructions carefully for the most accurate results.
Results are not given as exact numbers. They are stated as desirable (under 200 mg/dL or 5.17 mmol/L); borderline-high (200 mg/dL to 239 mg/dL or 5.17 mmol/L to 6.18 mmol/L); or high risk for heart disease (over 240 mg/dL or 6.21 mmol/L). When used correctly, results from a home test kit can be as accurate as screening tests used in a health care provider's office. Most health care providers will want to verify home screening results before deciding what to do next.
Main benefits of home screening: Home screening can alert you to a previously unknown high cholesterol level, which can increase your risk for atherosclerosis. If you know you are at risk, you may be more motivated to see a health care provider for follow-up education and testing. Home screening can help you monitor the success of changes you have made in your diet and exercise routine. You should report persistently high cholesterol levels to your health care provider.
Main drawbacks of home screening: Interpreting cholesterol results can be difficult. Home tests do not give you a precise reading or indication of risk because these tests don't measure HDL and LDL cholesterol levels. This can lead you to be falsely reassured by normal results or needlessly alarmed by abnormal results.
Cholesterol Testing Questions:
No matter which testing system is used, you may want to ask:
- What is being measured: total cholesterol, HDL cholesterol, LDL cholesterol, or triglycerides?
- Do I need to fast before the test?
- How long will it take to get the test results?
- Will someone be available to explain the results and whether I need further testing?
- Will I receive educational materials with my test results?
- How reliable are the results? Is the lab certified? The accuracy and reliability of cholesterol tests vary from lab to lab. Labs participating in the U.S. Centers for Diseases Control and Prevention standardization testing should be used.
CONVENTIONAL MEDICAL TREATMENT
There are two basic ways of lowering your high cholesterol. The first is to modify your lifestyle by changing your diet, managing your weight, increasing exercise, and quitting smoking. The other is to use one or more cholesterol-lowering medications while modifying your lifestyle. Both treatment methods are aimed at lowering LDL ("bad") cholesterol, raising HDL ("good") cholesterol, lowering triglycerides, and reducing other risk factors for heart disease.
The goal of lowering your cholesterol is to reduce your risk of developing coronary artery disease (CAD), heart attack, stroke, and other disorders caused by atherosclerosis. Treatment is even more critical for those who already have coronary artery disease or diabetes or who have had a heart attack or stroke.
Treatment will depend on whether you need primary or secondary prevention. Primary prevention means reducing your risk of developing CAD. Secondary prevention is reducing your risk for further complications of CAD when you already have it or if you have another condition equally as serious.
People who have more than a 20% chance of developing CAD over the next 10 years or who already have CAD need to seriously consider aggressive treatment for all of their risk factors for heart disease and stroke.1 These people are considered to be in the highest risk category and usually need to reduce their cholesterol to a level lower than those at a lesser risk.
Those at high risk for CAD or who already have CAD are likely to have a greater benefit from medications to lower their cholesterol than those who have a lesser risk. Evidence shows that medications called statins are the most effective type of treatment for reducing cholesterol and the risk for heart attack, stroke, and death in people at high risk for coronary artery disease. 5 For those at a lower risk for CAD, lifestyle changes are more appropriate and cost-effective.
High cholesterol is an important risk factor for coronary artery disease and stroke; however, it is only one of several risk factors that can contribute to these health problems. Treating other risk factors may be just as important as lowering your cholesterol. Everyone can benefit from exercise, a balanced diet, and efforts to reduce or eliminate their risk factors for heart disease. It is important to work with your health professional to determine your individual risk for heart disease based on all your risk factors, not just your cholesterol level.
If you need treatment to lower your cholesterol, the first steps usually involve making lifestyle changes. The National Cholesterol Education Panel guidelines recommend Therapeutic Lifestyle Changes, which include:
- Diet.
- Exercise.
- Weight loss.
Also, it is important to treat other conditions, such as high blood pressure and diabetes, and to eliminate smoking and other factors that increase the risk of atherosclerosis.
For people with known heart disease, diabetes, previous heart attack, or stroke, treatment with medication is strongly recommended, especially if diet and exercise are unlikely to lower cholesterol levels to an acceptable range. In these people, cholesterol-lowering medications may help prevent atherosclerosis from getting worse and may lower the risk of having another heart attack, stroke, or death.
TREATMENT DECISIONS:
Diet therapy is most effective for lowering cholesterol in people who have higher-than-average fat intake in their diets.
A diet and exercise program is the preferred initial treatment for lowering cholesterol in children, young men, and women before menopause. This depends, however, on their risk for coronary artery disease (CAD).
High cholesterol caused by inherited (genetic) lipid disorders usually is treated aggressively at any age, often by using medications. A recent study showed that a large dose of a statin medication started during hospitalization for heart attack, angina, or unstable angina reduced the chance of developing further episodes of angina requiring hospitalization.
MEDICATION CHOICES:
Evidence shows that medications, particularly statins, can reduce the risk for heart attack, stroke, and death in some people who have known coronary artery disease (CAD) or diabetes along with high, and even average, cholesterol levels.
Some people can try diet and exercise for at least 3 months before medications are started. However, those with CAD should start medications immediately. Other people who may need to start treatment with medication as soon as possible include those with a strong family history of early CAD, those with inherited forms of high cholesterol, and those who have peripheral vascular disease or have had a previous heart attack or stroke. Many people at low risk (children or people who have no other CAD risk factors) do not need to take medication to lower their cholesterol.
Many experts use guidelines established by the National Cholesterol Education Program (NCEP) to determine when to begin treatment with medication to lower cholesterol, based on your LDL cholesterol level and risk factors for coronary artery disease. However, each person is different, and so your health professional also may take into account other factors, such as your age, when discussing your treatment options.
Cholesterol treatment guidelines will continue to evolve as more is learned about who is at highest risk for heart disease and who is most likely to benefit from treatment with medication to lower cholesterol. However, everyone can benefit from a balanced, low-fat diet, regular exercise, and reducing other risk factors, such as smoking.
NCEP (2001) & American Heart Association
Medication Guidelines for High Cholesterol:
The National Cholesterol Education Program's (NCEP) recommendations for medication therapy are based on cholesterol levels and the number of risk factors for heart disease. While these guidelines provide a good starting point for treatment, individual risk assessment is important to determine whether starting medication to lower your cholesterol is appropriate for you.
For people without known coronary artery disease (CAD) and with one or no risk factors for heart disease, medication may be started when:
- LDL is 190 mg/dL (4.91 mmol/L) or higher.
- The goal of medication is to lower LDL below 160 mg/dL (4.14 mmol/L).
- When LDL cholesterol is between 160 mg/dL and 189 mg/dL (4.14 mmol/L and 4.91 mmol/L), medication may be considered. The goal is still to lower LDL cholesterol to below 160 mg/dL (4.14 mmol/L).
For people without known coronary artery disease, medication is considered when two or more cardiac risk factors are present, there is a 20% or less risk of developing symptomatic CAD within 10 years, and:
- LDL is 160 mg/dL (4.14 mmol/L) or higher and the 10-year risk is less than 10%.
- LDL is 130 mg/dL (3.36 mmol/L) or higher and the 10-year risk is between 10% and 20%.
- The goal of treatment with medication is to lower LDL below 130 mg/dL (3.36 mmol/L).
- When LDL cholesterol is between 130 mg/dL and 160 mg/dL (3.36 mmol/L and 4.14 mmol/L), diet and exercise are usually emphasized. The goal is still to lower LDL cholesterol below 130 mg/dL (3.36 mmol/L).
For people with known coronary artery disease, diabetes, or more than a 20% risk of developing symptomatic CAD during the next 10 years, medication is considered when:
- LDL is 130 mg/dL (3.36 mmol/L) or higher.
- The goal of treatment with medication is to lower LDL to less than 100 mg/dL (2.58 mmol/L).
- If the LDL cholesterol is between 100 mg/dL and 129 mg/dL (2.58 mmol/L and 3.36 mmol/L), diet and exercise may be tried, but medication may be started sooner if the person has coronary artery disease.
MEDICATION CONSIDERATIONS
This information will help you understand your health care choices and what the results may be, whether you choose to share in the decision-making process or to rely on your health care provider's recommendation.
Key points in making your decision...
Lowering your high cholesterol can help you prevent a heart attack or stroke. Consider the following when making your decision:
- High cholesterol is only one of several risk factors for heart disease. To reduce your risk of coronary artery disease (CAD) and heart attack, you need to reduce all of your risk factors, not just high cholesterol.
- People who probably should take statins include those with CAD or who are at high risk for CAD and heart attack. The choice is less clear for those with moderately high cholesterol and few risk factors for CAD and heart attack. This group may find this decision point most helpful.
- Therapeutic lifestyle changes are as important as medication in reducing your risk for CAD and heart attack. For some people, quitting smoking, reducing blood pressure, losing weight, or getting more exercise can have the same or greater impact on lowering cholesterol than taking medication.
HIGH CHOLESTEROL AND CORONARY HEART DISEASE (CAD)What is cholesterol, and why is high cholesterol dangerous?
Cholesterol is a type of fat and is an essential nutrient your body needs for many important functions, such as producing new cells. However, if your cholesterol levels are too high, you may develop atherosclerosis, a buildup of fat and calcium inside your arteries that can cause coronary artery disease (CAD) and lead to heart attack or stroke.
Your cholesterol levels, especially your LDL cholesterol levels, are a good indication of risk for CAD. However, they need to be assessed with other risk factors, such as high blood pressure or diabetes, when making a decision about whether to use medication.
What are the risk factors for coronary artery disease (CAD)?
High cholesterol is not the only risk factor for developing CAD. You are at increased risk for CAD if you:
- Are a man age 45 or older or a woman 55 or older.
- Have a family history of CAD: CAD in your father or a brother younger than 55 or in your mother or a sister younger than 65.
- Have smoked any cigarettes within the last 30 days.
- Have high blood pressure (140/90 or above) or are taking medication for high blood pressure.
- Have a low HDL cholesterol level (below 40 mg/dL or 0.91 mmol/L).
What are CAD equivalents?
CAD equivalents are diseases that put you at the same risk for heart attack as having coronary artery disease. They include diabetes, peripheral vascular disease, a diseased carotid artery that causes symptoms, or an abdominal aortic aneurysm.
If you have any of these conditions, you are at highest risk (in risk category 1) for heart attack.
What are other risk factors?
Other factors that put you at risk for coronary artery disease and heart attack include high homocysteine levels, obesity and lack of regular exercise, menopause and the drop in estrogen that follows it, and metabolic syndrome.
CALCULATING RISK & MAKING MEDICATION DECISIONS
An important part of your decision on whether to take statins is determining your risk for coronary artery disease and heart attack. Use one of the following risk calculators from the National Cholesterol Education Program (NCEP) to calculate your risk. NOTE: You will have to know your blood pressure, total cholesterol, and HDL cholesterol to use the calculator.
Click here to use the WebMD Risk Category Calculator for Men.
Click here to use the WebMD Risk Category Calculator for Women.
Along with medical guidelines for taking medications, your decision to take statins to lower your cholesterol level includes your personal feelings.
Reasons to use medication
Reasons not to use medication
- Your LDL cholesterol is over 190.
- Your total cholesterol is over 240.
- You have two or more risk factors for CAD or have a CAD equivalent.
- You are worried about high cholesterol levels and/or coronary artery disease.
- Medication is easy and convenient to use.
- You feel that your current diet and activity level are appropriate.
List other reasons why you might use medications to lower cholesterol:
- Your LDL cholesterol is below 100.
- Your total cholesterol is below 200.
- You may have to take medication for the rest of your life.
- You may need periodic blood tests to check liver function
- You may be able to reduce cholesterol levels through diet and exercise
- If you are over 82, the long-term benefit for cholesterol-lowering medication has not been proven in medical studies.
- Medications are expensive if insurance does not pay for them.
- You may have side effects from taking medication.
List other reasons why you might not use medications to lower cholesterol:
Medication choices
Statins are the most effective and widely prescribed cholesterol-lowering medication. They include lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), fluvastatin (Lescol), and Atorvastatin (Lipitor).
Other medications also lower cholesterol, and some may be used to lower triglycerides or raise HDL. They include:
- Nicotinic acid (Niac, Niacor, and Slo-Niacin).
- Fibric acid derivatives: gemfibrozil (Lopid), or fenofibrate (Tricor).
- Bile acid sequestrants: cholestyramine (Questran) and colestipol (Colestid).
These medications are sometimes used in combination with a statin.
Medication
Reasons to take
Reasons not to take
Statins
Research shows:
- Statins reduce LDL by 18% to 55%.
- Statins increase HDL by 5% to 15%.
- Statins reduce triglycerides by 7% to 30%.
- Statins reduce CAD, deaths from CAD, and deaths from heart attack in people who have had previous heart attacks. Those who benefit most from cholesterol-lowering medication are those at the greatest risk for another heart attack.
- Statins are beneficial for a wide range of LDL levels. They lower risk significantly among those at highest risk for CAD, even if LDL levels are moderate.
- You may have side effects, such as fatigue, upset stomach, gas, constipation, and abdominal pain or cramps.
- Regular blood tests are recommended to check liver function while taking statins.
- Muscle pain (rhabdomyolysis) may occur (rare).
- There is no proven benefit in those over age 82.
Use this worksheet to help you make your decision. After completing it, you will have a better idea of how you feel about taking medication to lower cholesterol levels. Discuss the worksheet with your health care provider.
Circle the answer that best applies to you.
My health care provider has told me that my risk for CAD is high. Yes No Unsure My LDL cholesterol level is above 190. Yes No Unsure The NCEP guidelines recommend that I take medication. Yes No Unsure I have the finances and/or insurance to pay for medication. Yes No Unsure I worry about my cholesterol levels. Yes No Unsure I worry about getting CAD or having a heart attack. Yes No Unsure I believe that medication can help me. Yes No Unsure I am comfortable with taking medications long-term or for the rest of my life. Yes No Unsure I feel I can cope with the side effects of cholesterol-lowering medication Yes No Unsure Having to take regular blood tests for liver function doesn't bother me. Yes No Unsure Medication that I'm currently taking does not interfere with medication to lower cholesterol. Yes No NA* Diet and exercise have not helped me lower my cholesterol. Yes No NA I have difficulty staying on a diet. Yes No NA I have difficulty staying with an exercise regimen. Yes No NA
*NA = not applicable
Use the following spaces to list any other important concerns you have about this decision.
Worksheet Results
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medications.
Check the box below that represents your overall impression about your decision.
Leaning toward taking medication
Leaning toward NOT taking medication
References
Grundy S, et al. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 285(19): 2486–2497.
Pignone M (2002). Secondary prevention of ischaemic cardiac events. Clinical Evidence (7): 137–140.
LaRosa JC, et al (1999). Effect of statins on risk of coronary disease: A meta-analysis of randomized controlled trials. JAMA, 282(24): 2340–2346.
Canner PL, et al. (1986). Fifteen-year mortality in coronary drug project patients: Long-term benefit with niacin. Journal of the American College of Cardiology, 8(6): 1245–1255.
Frick MH, et al. (1987). Helsinki heart study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. New England Journal of Medicine, 317(20): 1237–1245.
Rubins H, et al. (1999). Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. New England Journal of Medicine, 341(6): 410–418.
Heart Protection Study Collaborative Group (2002). MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial. Lancet, 360: 7–22.
Shepherd J, et al. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomized controlled trial. Lancet, 360: 1623–1630.
SURGERY
Most people who have high cholesterol can be successfully treated with medication and lifestyle changes. In rare cases, however, when medication cannot lower your cholesterol to an acceptable level, your health care provider may recommend a partial ileal bypass. This surgery bypasses the last section of the small intestine, which prevents bile acids from being absorbed and lowers LDL ("bad") cholesterol.
THERAPEUTIC LIFESTYLE CHANGES (TLC)
Eating a sensible diet low in saturated fat and cholesterol and getting moderate exercise are important ways you can lower your high cholesterol level. For many people, these lifestyle changes may be all that is needed to decrease LDL cholesterol and raise HDL cholesterol.
However, because of genetic reasons, you may not be able to reduce your cholesterol level, even when following a strict diet and a proper exercise routine. In this case, you may need medication to reduce your lifetime risk of coronary artery disease.
As part of the treatment for high cholesterol, your health professional may recommend using the Therapeutic Lifestyle Changes (TLC) recommended by the National Cholesterol Education Program of the National Institutes of Health. These lifestyle changes include:
- The TLC cholesterol-lowering diet.
- Exercise.
- Weight loss, if needed.
The TLC diet is low in saturated fat and cholesterol, recommending that less than 7% of your daily calories come from saturated fat and that you eat no more than 200 milligrams of dietary cholesterol per day. Also, the TLC plan recommends increasing soluble fiber and, if needed, adding plant stanols and sterols to your diet. Plant sterols are found in small quantities in many fruits, vegetables, nuts, seeds, cereals, legumes, and other plant sources. Plant stanols come from some of the same sources. Vegetable oils, for example, contain plant sterols and stanols. Plant stanols and sterols are available in salad dressings and margarines, such as Benecol and Take Control. They are safe for children with genetic high cholesterol, but pregnant women need to avoid them.
Generally, saturated fats and cholesterol are found in animal products, such as meat, poultry, fish, milk and milk products, and eggs. Other examples include butter, margarine, sour cream, salad dressings, marinades, mayonnaise, shortening, and many snack foods and desserts. Snack foods often contain a lot of saturated fat, unless a special effort has been made to use unsaturated vegetable oil.
Plant foods, such as grains, fruits, and vegetables, usually contain very little fat and no cholesterol. Plant fats, such as vegetable oils, are usually low in saturated fats unless they have been hydrogenated. Hydrogenation is a process to make the fats solid or semisolid.
Some foods, especially saturated fats, tend to increase total cholesterol levels. Many foods contain both saturated fats and cholesterol.
See the following for more information about the TLC diet:
- Meat and the low-fat diet
- Soy protein
- Fiber
- Fish and fish oil
- Antioxidants, flavonoids, and red wine
- Cholesterol-lowering margarines
Be careful of Very-low-fat diets. Although very-low-fat diets may indeed lower cholesterol levels, they are not recommended. Very-low-fat diets usually allow less than 15% of total calories from fat. A cholesterol-reducing diet allows 25% to 35% of calories to come from fat. A diet with less than 25% of its calories from fat can increase triglycerides and decrease HDL (good) cholesterol. Such a diet may deplete your body of other important nutrients and vitamins.
HOME TREATMENT
Change your diet. See the TLC diet and holistic and nutritional supplemental recommendations below.
Avoid stress and sustained tension as much as possible. Learn stress management techniques. See Stress for more information.
Get regular moderate exercise. Always consult with your health care provider before beginning any new exercise program.
There are a number of cholesterol-lowering drugs on the market. Available by prescription only, these tend to be costly and they can have serious side effects. These drugs should only be used as last resort. The sensible way to keep the serum fats within a safe range is to follow a diet that excludes animal fats (including meat, milk, and all dairy products) and includes ample amounts of fiber and bulk (whole grains, fruits, and vegetables).
Certain drugs can elevate cholesterol levels. These include steroids, oral contraceptives, furosemide (Lasix) and other diuretics, and levodopa (L-dopa, sold under the brand names Dopar, Larodopa, and Sinemet), which is used to treat Parkinson's disease. Beta-blockers often prescribed to control high blood pressure, can cause unfavorable changes in the ratio of LDL to HDL in the blood.
Studies have shown that so-called Third World diets, which consists of grains, fruits, and vegetables, result in lower blood cholesterol levels. In the United States and Northern Europe, where people consume large amounts of meat and dairy products, extremely high rates of heart and circulatory disease are present. Even children in these nations show signs of progressive vascular disease due to hypercholesterolemia (an excess of cholesterol in the blood).
Some people claim that taking charcoal tablets lowers blood cholesterol. However, charcoal also absorbs good nutrients along with the cholesterol. Activated charcoal should not be consumed daily, and it should not be taken at the same time as other supplements or medications. Other "experts" recommend taking fish oil capsules to lower cholesterol, but fish oil is 100 percent fat, and the evidence is lacking that the ingestion of fish oil reduces serum fats.
Therapeutic Lifestyle Changes (TLC) Diet for High Cholesterol
People have varying degrees of success in lowering their cholesterol by changing their diets. People who have high cholesterol because they eat too many fatty foods may be able to lower their cholesterol 10% to 20% with diet changes alone, while others may only achieve a 5% to 8% reduction. Those who are most successful using diet changes to lower their cholesterol are those who lose excess weight. Diet changes are usually the first step in lowering cholesterol before medications are added.
The TLC diet is recommended by the National Cholesterol Education Program of the National Institutes of Health. The diet's main focus is to reduce the amount of saturated fats you eat because they elevate your cholesterol. You can reduce the saturated fats in your diet by limiting the amount of meat and milk products you consume. Choose low-fat products from those food groups instead. Replace most of the animal fats in your diet with unsaturated fats, especially monounsaturated oils, such as olive, canola, or peanut. Monounsaturated fat lowers LDL ("bad") cholesterol if substituted for saturated fat and keeps HDL ("good") cholesterol up.
The TLC diet calls for less than 7% of your daily calories to come from saturated fat and that you eat no more than 200 mg of dietary cholesterol per day. However, the diet allows 25% to 35% of daily calories from fat, mainly from unsaturated fats. Your diet should include only enough calories to maintain a desired weight and avoid weight gain.
Food group Number of servings Serving size Lean meat, poultry, fish, dry beans, and dry peas Limit to 5 ounces total per day 5 ounces maximum per day of lean meat, poultry, or fish Substitute ½ cup dry beans or peas for one ounce of meat.
Eggs Limit to 2 yolks per week 1 whole egg. Egg whites or substitutes are not limited. Low-fat milk and milk products 2 to 3 per day 1 cup nonfat or 1% milk
1 cup nonfat or low-fat yogurt
1 ounce fat-free or low-fat cheese (3 grams of fat or less per ounce)Fruits 2 to 4 per day 1 piece fruit, such as apple, orange, or banana
½ cup canned fruit
1 cup berries or melon
¾ cup fruit juiceVegetables 3 to 5 per day 1 cup raw leafy greens
½ cup cooked or raw vegetables
¾ cup vegetable juiceBread, cereals, pasta, rice, and other grains 6 to 11 per day 1 slice of bread
½ hot dog or hamburger bun, bagel, or English muffin
1 ounce cold cereal
½ cup cooked pasta, rice, noodles, or other grainsFats and oils 6 or 8 per day 1 teaspoon oil, such as canola, olive, peanut, corn, or safflower oil
1 teaspoon soft margarine
1 tablespoon salad dressing
1 tablespoon mayonnaise
2 tablespoons nuts or seedsSweets and snacks Within calorie limit Choose snacks that are low in fat or are made with unsaturated fats.
Adapted from the food guide pyramid to help you plan a diet that is low in saturated fat and cholesterol.
Nutrient Composition of the TLC Diet for High Cholesterol
The therapeutic lifestyle changes (TLC) cholesterol-reducing diet is based on reducing saturated fat and cholesterol in your diet. Here are the recommended amounts of nutrients.
- Saturated fat: Less than 7% of total calories
- Polyunsaturated fat: Up to 10% of total calories
- Monounsaturated fat: Up to 20% of total calories
- Carbohydrate: 50% to 60% of total calories
- Fiber: 20 to 30 g per day
- Protein: Approximately 15% of total calories
- Cholesterol: Less than 200 mg per day
- Total calories: Balance calorie intake and expenditure to maintain desirable body weight and prevent weight gain.
Tips for Success with the Therapeutic Lifestyle Changes (TLC) Diet
Use the following tips for success with the cholesterol-lowering therapeutic lifestyle changes (TLC) diet.
- Work with your health care provider on a plan for lowering cholesterol through diet.
- Gather detailed, easy-to-understand educational materials about the diet.
- Gather information about menus, cooking classes, support groups, books, and videos.
- Get support from your family in making changes in your diet.
- Think ahead and make realistic and customized meal plans.
- Get the help of a registered dietitian if you have questions about the TLC diet.
- Change the way you plan, prepare, and eat every meal.
- Learn how to read and interpret food labels. Look for the amount of saturated fat per serving, and determine its percentage of your total saturated fat intake for the day. "Low-fat" doesn't always mean what it seems. Some labels measure fat content by weight rather than as a percentage of the calories in a serving.
- Limit fast foods. It can be difficult to choose a low-fat alternative.
- Exercise. Always consult your health care provider before beginning an exercise program.
Sample Menu for the TLC Diet for High Cholesterol
Here is a sample one-day menu for the therapeutic lifestyle changes (TLC) diet. The menu contains approximately 2,200 calories, with 25% of calories from total fat (5% from saturated fat, 13% from monounsaturated fat, and 7% from polyunsaturated fat).
Breakfast ½ cup oatmeal with 1 cup nonfat milk
1 teaspoon of brown sugar
1 sliced banana
Caffè lattè made with 1 cup nonfat milkLunch Sandwich made from 2 slices whole wheat bread
2 ounces lean turkey
1 tablespoon mayonnaise
lettuceSnack 1 cup low-fat or nonfat vanilla yogurt
½ cup mixed raisins and peanutsDinner 3 ounces baked or broiled salmon
1 cup cooked brown rice
1 cup cooked broccoli
1 tablespoon olive oil (used in cooking)
Salad made with 1½ cups romaine lettuce, ½ cup tomatoes, ¼ cucumber, 1 tablespoon vinegar and oil dressing
1 slice Italian bread with 1 teaspoon soft margarineSnack 1 sliced peach with 1 cup nonfat milk
EXERCISE, HIGH CHOLESTEROL & HEART DISEASE
All people, and especially those with high cholesterol, should exercise at least 30 minutes on most if not all days. Exercise is a very effective way of reducing risk factors for coronary artery disease (CAD) and high cholesterol. Regular exercise:
- Raises HDL cholesterol levels.
- May lower LDL cholesterol levels.
- Can help overweight people lose weight.
- Lowers blood pressure in some people.
There is growing evidence that regular physical activity protects against coronary artery disease. Added benefits of regular exercise include:
- Mental well-being and stress relief.
- Increased flexibility, if stretching is done afterwards.
- Increased bone strength, if the exercise includes weight-bearing exercises, such as jogging or lifting weights.
Customize your exercise program according to your fitness level, the health of your heart, and your personal preferences. Aerobic exercise (brisk walking, jogging, swimming, bicycling, racquetball) is best.
Some people, especially those with a history of CAD, should discuss their exercise plans with their health care providers before starting a vigorous fitness program.
Exercise is especially important for those with high triglyceride levels, low HDL levels, and a large waist (metabolic syndrome). A large waist is more than 40 inches for men and more than 35 inches for women.
WEIGHT LOSS, HIGH CHOLESTEROL & HEART DISEASE
If you are overweight, you can lower the risk of developing coronary artery disease by losing weight. Benefits of weight loss include:
- Reducing LDL cholesterol.
- Increasing HDL cholesterol.
- Lowering blood pressure.
- Improving your body's use of blood sugar (glucose) and helping to prevent or control diabetes.
- Lowering triglycerides.
Even small amounts of weight loss enhance the LDL cholesterol reduction that results from a low-fat diet. A weight loss of 5 lb (2.27 kg) to 10 lb (4.54 kg) can double the LDL cholesterol reduction of a low-fat diet.
Increasing physical activity and reducing calorie intake are the keys to long-term weight reduction. The goals for a weight-loss program need to be practical and individualized.
Losing weight is especially important if you have high triglyceride levels and low HDL levels and are overweight with a large waist measurement (metabolic syndrome). This means more than a 40-inch waist for men and more than 35 inches for women.
If you are trying to lose weight, it is recommended that you lose no more than 1 lb (0.45 kg) per week. This can be done by reducing the daily calorie intake by 250 calories and increasing exercise to burn 250 calories a day (for a net reduction of 500 calories per day).
Very low-calorie diets (500 to 800 calories a day) and rapid weight-loss programs usually don't work in the long run and can be harmful.
NUTRITION, HOLISTIC RECOMMENDATIONS, HERBS & SUPPLEMENTS
Include in the diet the following foods, which aid in lowering cholesterol: Apples, bananas, carrots, cold-water fish, dried beans, garlic, grapefruit, and olive oil.
Make sure to take in plenty of fiber in the form of fruits, vegetables, and whole grains. Water-soluble dietary fiber is very important in reducing serum cholesterol. It is found in barley, beans, brown rice, fruits, glucomannan, guar gum, and oats. Oat bran and brown rice bran are the best foods for lowering cholesterol. Whole-grain cereals (in moderation) and brown rice are good as well. Since fiber absorbs the minerals from the food it is in, take extra minerals separately from the fiber.
Drink fresh juices, especially carrot, celery, and beet juices. Carrot juice helps to flush out fat from the bile in the liver and this helps lower cholesterol. See Juicing for more information.
Go on a monthly spirulina fast, with carrot and celery juice or lemon and steam-distilled water. See Fasting for more information.
Use only unrefined cold-pressed or expeller-pressed oils. Cold-pressed oil are those that have never been heated above 110°F during processing - at this temperature, enzyme destruction begins. Use vegetable oils that are liquid at room temperature, such as olive, soybean, flaxseed, primrose, and black currant seed oil. Olive oil is recommended.
Pure virgin olive oil appears to help reduce serum cholesterol. A monounsaturated-fatty-acid-rich diet that includes olive oil may be the reason for the low serum cholesterol levels found in people living in Italy and Greece.
Do not eat any nuts except for walnuts, which can be eaten in moderation. Eat walnuts only if they are raw and have been kept tightly sealed or refrigerated; do not eat them if they have been roasted (or otherwise subjected to heat) or exposed to air (such as those found in open bins in shopping mall kiosks and candy stores).
Reduce the amount of saturated fat and cholesterol in your diet. Saturated fats include all fats of animal origin as well as coconut and palm kernel oils. Eliminate from the diet all hydrogenated fats and hardened fats and oils such as margarine, lard, and butter. Consume no heated fats or processed oils, and avoid animal products (especially pork and pork products) and fried fatty foods. Always read food product labels carefully. You may consume nonfat milk, low-fat cottage cheese, and skinless white poultry meat (preferably turkey), but only in moderation.
Meat and dairy products are primary sources of dietary cholesterol. Vegetables and fruits are free of cholesterol.
The body does need some fats, but they must be the right kind. Good fats supply essential fatty acids, which are a very important link in our health chain. Fats supply energy, and they stay in the digestive tract for longer periods than proteins or carbohydrates, giving a feeling of fullness. They act as an intestinal lubricant, generate body heat, and carry the fat-soluble vitamins A, D, E, and K in the body. The protective myelin sheaths that protect nerve fibers are composed of fats. All cell membranes are composed of fats as well. Unfortunately, most Americans consume much too much of the wrong fats - that is, saturated, hydrogenated, and heated fats - which are linked to obesity, cardiovascular disease, and certain types of cancer.
Many fast-food restaurants use beef tallow (fat) to make their hamburgers, fish, chicken, and French-fried potatoes. Not only do these fried foods contain high amounts of cholesterol, but this fat is subjected to high temperatures in the deep-frying process, resulting in oxidation and the formation of free radicals. Heating fat, especially frying food in fat, also produces toxic trans-fatty acids, which seem to behave much like saturated fats in clogging the arteries and raising blood cholesterol levels.
Many people use margarine or vegetable shortening as substitutes for butter because they contain no cholesterol. However, these products contain compounds called cis- and trans-fatty acids that become oxidized when exposed to heat and can clog the arteries. They have been linked to the formation of damaging free radicals.
Do not consume alcohol, cakes, candy, carbonated drinks, coffee, gravies, nondairy creamers, pies, processed or refined foods, refined carbohydrates, tea, tobacco, or white bread.
In large amounts, coffee can elevate blood cholesterol levels, more than doubling the risk of heart disease. According to a report published in The New England Journal of Medicine, observation of 15,000 coffee drinkers revealed that as the intake of coffee rises, the amount of cholesterol in the blood goes up.
Cream substitutes (non-dairy creamers) are actually poor alternatives to cholesterol-heavy dairy products. Many contain coconut oil, which is a highly saturated fat. Soymilk or almond milk is preferable.
Avoid gas-forming foods such as Brussels sprouts, cabbage, cauliflower, and sweet pickles.
Kombucha tea, which has energizing, detoxifying, and immune-boosting properties, may help to lower cholesterol levels. See Kombucha Tea for more information.
ALTERNATIVE OR COMPLEMENTARY MEDICINE THERAPIES
Human growth hormone therapy has been found to decrease cholesterol levels. See Growth Hormone Therapy for more information.
Some people have hereditary disorders that prevent even the healthiest diet from lowering LDL levels. For these people, researchers are working on a device that uses an enzyme to break down LDL and accelerate its removal before it can fasten onto artery walls to form plaque. The device would be implanted under the skin to control the LDL levels in the blood. There currently is a system called Liposorber that uses a filtration system for removing LDL cholesterol in those individuals that do not respond to other treatments.
See Chelation Therapy for more information.
HERBS
Cayenne (capsicum), goldenseal, and hawthorn berries help to lower cholesterol. Caution: Do not take goldenseal internally on a daily basis for more than one week at a time, do not use it during pregnancy, and use with caution if you are allergic to ragweed.
NUTRITIONAL SUPPLEMENTS
NUTRIENTS Supplement Suggested Dosage Comments Very Important Apple Pectin As directed on label. Lowers cholesterol levels by binding fats and heavy metals. Calcium As directed on label. To prevent hypocalcemia, or low calcium levels. Use calcium aspartate form. Chromium picolinate 400-600 mcg daily. Lowers total cholesterol levels and improves HDL-to-LDL ratio. Coenzyme 10 60 mg daily. Improves circulation. Fiber (oat bran and guar gum are good sources) As directed on label, 1/2 hour before the first meal of the day. Take separately from other supplements and medications. Helps lower cholesterol. Garlic (Kyolic) 2 capsules 3 times daily. Effective in lowering cholesterol levels and blood pressure. Lecithin granules
Or
Capsules1 tbsp 3 times daily, before meals
1,200 mg 3 times daily, before meals.Lowers cholesterol. A fat emulsifier. Lipotropic factors As directed on meals. Substances that prevent fat deposits (as in atherosclerosis). Vitamin B complex
plus extra
Vitamin B1 (Thiamine)
Plus
Choline
And
InositolAs directed on label.
As directed on label.
100-300 mg 5 times daily.B vitamins work best when taken together.
Important in controlling cholesterol levels
Important in fat metabolism. Protects the liver from fat deposits.Vitamin B3 (niacin) 300 mg daily. Do not exceed this amount. Lowers cholesterol. Do not use a sustained-release formula, and do not substitute niacinamide for niacin. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure. Vitamin C with bioflavonoids 3,000-8,000 mg daily, in divided doses. Lowers cholesterol. Vitamin E emulsion Begin with 200 IU daily and slowly increase dosage to 1,000 IU daily. Improves circulation. The emulsion form offers rapid assimilation. Helpful Essential Fatty Acids (Black currant seed oil, borage oil, and primrose oil are good sources) As directed on label. Take with vitamin E as recommended above. Reduces LDL level and thins the blood. Heart Science from Source Naturals As directed on label. Contains antioxidants to lower cholesterol, plus herbs, vitamins, and other nutrients that protect the heart and promote healthy cardiovascular function. Proteolytic enzymes As directed on label. Take with meals and between meals. Aids digestion. Caution: Do not give the supplement to a child. Selenium 200 mcg daily. Deficiency has been linked to heart disease. Shiitake
Or
ReishiAs directed on label.
As directed on label.Helps to control and lower cholesterol levels.
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FOR FURTHER INFORMATION
BOOKS
American Heart Association Low-Fat Low-Cholesterol Cookbook
-- By American Heart Association
Eater's Choice: A Food Lover's Guide to Lower Cholesterol
-- By Nancy Goor, Ronald Goor
ORGANIZATIONS
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: http://www.americanheart.org
Call the American Heart Association (AHA) to find your nearest local or state AHA group. The AHA can provide brochures and information on support groups and community programs, including Mended Hearts, a nationwide organization whose members visit heart patients and provide information and support.
National Cholesterol Education Program (NCEP)
of the National Heart, Lung, and Blood Institute
of the National Institutes of Health
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
E-mail: NHLBIinfo@rover.nhlbi.nih.gov
Web Address: http://www.nhlbi.nih.gov
Contact the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) for information on the National Cholesterol Education Program (NCEP). The NCEP can provide information on high cholesterol as a risk factor for heart disease and stroke. You will also find information on cholesterol-lowering diets, recipes, exercise, weight loss, and lifestyle changes.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
High cholesterol usually has no symptoms. Sometimes, the first sign that you have high cholesterol or other risk factors for heart disease is a heart attack, a stroke, or a transient ischemic attack. If you have any symptoms of these, call 911 or other emergency services.
Call your health professional for an appointment if:
- You think you may have diabetes.
- You have family members who have high cholesterol, coronary artery disease, or diabetes.
- You are concerned about your cholesterol.
If a screening test shows that your cholesterol is high or borderline high, talk with your health professional about ways to reduce your LDL cholesterol or triglyceride levels. Doing this, along with reducing other risk factors for coronary artery disease, can reduce your risk of having a heart attack or stroke.
A regular cholesterol test is important for people who have been diagnosed with heart disease and those at high risk for heart disease. For people who have no other signs or risk factors for heart disease, testing may not be needed as often.
Almost any health professional can order a cholesterol test. Most commonly, a cholesterol test is ordered as part of a routine physical exam. These health professionals can also evaluate risk factors, provide counseling and education, or provide a more complete evaluation if needed. In some cases, a nurse specialist, registered dietitian, or pharmacist can help set up a treatment plan for your high cholesterol.
People who have rare lipid disorders, which can be more difficult to treat, may need to see a lipid specialist, often an endocrinologist.
If you have already been diagnosed with coronary artery disease or other heart disease, you may have your cholesterol levels tested and treated by a cardiologist, who specializes in heart diseases.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
Helpful Links
The Cholesterol Myths (An interesting perception to Cholesterol & Treatment)
