Your blood cholesterol level has a lot to do with your chances of getting heart disease. High cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.
When there is too much cholesterol (a fat-like substance) in your blood, it builds up in the walls of your arteries. Over time, this buildup causes "hardening of the arteries" so that arteries become narrowed and blood flow to the heart is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.
High blood cholesterol itself does not cause symptoms; so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it. Cholesterol lowering is important for everyone--younger, middle age, and older adults; women and men; and people with or without heart disease.
The main goal of cholesterol-lowering treatment is to lower your LDL level enough to reduce your risk of developing heart disease or having a heart attack. The higher your risk, the lower your LDL goal will be. To find your LDL goal, there are two main ways to lower your cholesterol:
Therapeutic Lifestyle Changes (TLC): Includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
The TLC Diet: This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories from saturated fat and less than 200 mg of dietary cholesterol per day. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If your LDL is not lowered enough by reducing your saturated fat and cholesterol intakes, the amount of soluble fiber in your diet can be increased. Certain food products that contain plant stanols or plant sterols (for example, cholesterol-lowering margarines) can also be added to the TLC diet to boost its LDL-lowering power.
Weight Management: Losing weight if you are overweight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
Physical Activity: Regular physical activity (30 minutes on most, if not all, days) is recommended for everyone. It can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement.
Drug Treatment: If cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.
Even if you begin drug treatment to lower your cholesterol, you will need to continue your treatment with lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of drugs available for cholesterol lowering including Statins, bile acid sequestrants, nicotinic acid, fibric acids, and cholesterol absorption inhibitors. Your doctor can help decide which type of drug is best for you. The statin drugs are very effective in lowering LDL levels and are safe for most people. Bile acid sequestrants also lower LDL and can be used alone or in combination with statin drugs. Nicotinic acid lowers LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but are used mainly to treat high triglyceride and low HDL levels. Cholesterol absorption inhibitors lower LDL and can be used alone or in combination with statin drugs.
Once your LDL goal has been reached, your doctor may prescribe treatment for high triglycerides and/or a low HDL level, if present. The treatment includes losing weight if needed, increasing physical activity, quitting smoking, and possibly taking a drug.
Causes and Risk factors:Uncontrollable risk factors include:
1. Gender: After menopause, a woman's LDL-cholesterol level ("bad" cholesterol) goes up, as does her risk for heart disease.
2. Age: Your risk increases as you get older. Men aged 45 years or older and women aged 55 years or older are at increased risk of high cholesterol.
3. Family history: Your risk increases if a father or brother was affected by early heart disease (before age 55) or a mother or sister was affected by early heart disease (before age 65).
Controllable risk factors include:
1. Diet: The saturated fat and cholesterol in the food you eat raise total and LDL-cholesterol levels.
2. Weight: Being overweight can make your LDL-cholesterol level go up and your HDL level go down.
3. Physical activity/exercise: Increased physical activity helps to lower LDL- cholesterol and raise HDL-cholesterol (the "good" cholesterol) levels. It also helps you lose weight.
High blood cholesterol is diagnosed by checking levels of cholesterol in your blood. It is best to have a blood test called a lipid profile to measure your cholesterol levels. Most people will need to "fast" (not eat or drink anything) for 9 to 12 hours before taking the test.
The lipoprotein profile will give information about your:
1. Total cholesterol
2. LDL (bad) cholesterol: the main source of cholesterol buildup and blockage in the arteries.
3. HDL (good) cholesterol: the good cholesterol that helps keep cholesterol from building up in arteries.
4. Triglycerides: another form of fat in your blood.
If it is not possible to get a lipid profile done, 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 is less than 40 mg/dL, you will need to have a lipoprotein profile done. Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
Medicine and medications:
Types of cholesterol medications:
Niacin: This vitamin, when taken in high doses, reduces bad cholesterol and triglyceride levels while also increasing good cholesterol levels. Niacin, the generic name, is prescribed by your doctor as Nicolar or Niaspan. It can have minor side effects such as skin flushing, itching or tingling, and also headaches. You must tell your doctor if you experience these side effects.
Bile-acid Sequestrants or Resins: These work by binding bile, which is made from cholesterol, in the intestines to stop it being reabsorbed into the bloodstream. Common brand names are Questran (generic name cholestyramine), Questran Light, Colestid (generic name Colestipol) and Welchol. Common side effects of resins are gas, constipation and an upset stomach.
Statins or HMG-CoA reductase inhibitors: This type of cholestrol medication works by blocking the production of cholestrol in the liver. They have been shown to be very effective in lowering cholestrol and reducing the risk of heart disease. Statins include Atorvastatin (prescribed as Lipitor), Simvastatin (prescribed as Zocor), Fluvastatin (Lescol), Pravastatin (Pravachol), Lovastatin (Mevacor) and rosuvastatin (Crestor). Minor side effects of statins are upset stomach, gas, constipation, abdominal pain and headaches. They have also been known to cause joint and muscle pain in some cases. In very rare cases they have caused damage to the liver.
Fibrates: Fibrates (ciprofibrate, bezafibrate, fenofibrate and gemfibrozil) work by reducing the triglyceride level in the body while increasing the level of HDL or good cholestrol. Fibrates are normally prescribed for people who cannot tolerate statin medications or in patients with type II diabetes. Minor side effects can be an upset stomach, anemia, possible gallstone production, temporary blurred vision or dizziness and muscle aching. If the patient is on Warfarin the blood thinning effect may be increased.
Zetia (generic name ezetimibe): This cholestrol medication reduces the amount of cholestrol which is absorbed from food. It is often prescribed along with statin medications to maximize the results. It has been shown to lower total cholestrol and bad LDL cholestrol while increasing the level of good HDL cholestrol. Its side effects include nausea, fever, muscle pain, upset stomach, joint pain, headaches and possible liver damage.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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