Tuesday, July 7, 2009

High Cholesterol Level Risk

A lot of people don’t take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. Could something so common really be a serious health risk? Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.

“Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society”, says Laurence S Sperling MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, USA.

The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol. But if you’ve been diagnosed with high cholesterol, don’t despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.

All About High Cholesterol Rick Numbers

When it comes to high cholesterol risks, it’s tough to keep the details straight. We might have a vague idea of whether our cholesterol is good or bad., but we forget the actual numbers by the time we get to the parking lot outside our doctor’s office. So it may be worth reviewing the basics.

Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It helps produce new cells and some hormones. But an excess of it in the bloodstream can lead to trouble.

There are two types of cholesterol: LDL and HDL

LDL is also called ‘bad cholesterol’. LDL can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 3.5 mmol/L. However, people who already have heart disease may need to aim for under 3 mmol/L.

HDL is ‘good cholesterol’. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it’s filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 3 mmol/L or higher.

Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 2 mmol/L.

So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of LDL and triglycerides and a low level of HDL.

What about total cholesterol, which is the sum of your LDL and HDL? While anything under 5.2 mmol/L is still considered the target, most expert don’t focus on the number. It doesn’t mean all that much.

How Harmful Is High Cholesterol?

Everyone has cholesterol in their blood. But if your levels of LDL is too high, the excess can accumulate on the walls of your arteries. This buildup of cholesterol and other substances - called plaque - can narrow the artery like a clogged drain. It can also lead to arteriosclerosis, or hardening of the arteries, which turns the normally flexible tissue into more brittle.

Plaques can form anywhere. If they form in the carotid artery in the neck, it’s carotid artery disease. When they form in the coronary arteries - which supply the heart muscle with blood - it’s called coronary artery disease. Like any organ, the heart needs a good supply of blood to work. If it doesn’t get that blood, you could get angina, which causes a squeezing pain in the chest and other symptoms.

There are other high cholesterol risks. If these plaques break open, they can form a clot. If a clot lodges in an artery and completely chokes off the blood supply, the cells don’t get the nutrients and oxygen they need and die. If clot gets to the brain and blocks blood flow, it can cause a stroke. If a clot lodges in the coronary arteries, it can cause a heart attack.

Are We Aware Of High Cholesterol Levels?

Experts say that people don’t take high cholesterol risks seriously enough. According to the CDC, in 2005 almost a quarter of American adults said they hadn’t had their cholesterol checked in the last five years.

One problem is that high cholesterol doesn’t cause symptoms that make people pay attention.

“People naturally respond more to medical conditions that cause symptoms”, says Nathan D Wong, PhD, fellow of the American College of Cardiology and director of the Heart Disease Prevention Program at the University of California, Irvine. SInce you won’t feel your rising cholesterol levels, you won’t go to the doctor about it.

By the same token, people may be less likely to stick to treatment for high cholesterol than they would be for a painful condition.

“People on cholesterol-lowering medicine don’t feel any better”, says Sperling. “It’s not like taking a painkiller for an aching knee, where you know it’s working”. As a result, people may be less likely to follow their treatment plan over the long term, Sperling says.

Also, high cholesterol risks are usually not immediate. The damage accumulates over years and decades - high cholesterol in your 20s and 30s can take its toll in your 50s and 60s. Because the effects take time, many people don’t feel real urgency in treating it. They feel they can just deal with it later.

“Unfortunately, I think that many people are too casual about their high cholesterol”, says Adolph Hutter MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. “They ignore it for years and it only gets their attention when they actually develop vascular disease”.

How To Lower High Cholesterol Risks

There are many good treatments for heart disease, arteriosclerosis and other serious conditions caused by high cholesterol. But it’s terrible shame to let things get that far when making changes now could prevent these life threatening illnesses. Reducing your high cholesterol risks is a crucial step.

So what should you do? First, go to the doctor. “It’s very important for all adults to get their cholesterol tested”, says Wong. Every adult over 20 should have a cholesterol test at least once every five years.

Also keep track of your cholesterol levels yourself. Write down your current numbers and, if they’re high, what numbers you should be striving for.

If you do have high cholesterol, get serious. Talk with your doctor about what your goals should be and how you should achieve them. Make sure you understand what lifestyle changes you need to make. If you already have heart disease or other risk factors like diabetes, you need to be even more careful.

There are products available in the market to help reduce high cholesterol. One of the most effective and clinically proven is Proactol. It is 100% natural, 100% green (suitable for vegetarian) and certified organic. Proactol is clinically proven to lower blood cholesterol by binding 28% of dietary fat intake, and used as a treatment for obesity. It is backed by many medical experts including Dr. Joerg Gruenwald, a leading scientific director of Phytopharm Consulting, and the author of the international reference work for botanical medicines Physican Desk Reference for Herbal Medicines.

“Coronary heart disease and diabetes are all too often found in people with high cholesterol, excess weight, unhealthy eating habits and lack of exercise. However, it is especially this high risk group that finds it difficult to take charge of their weight and eating habits. It is therefore encouraging to see that a product like P

Cholesterol Questions To Ask Your Doctor

Many people have questions for their doctors about tests, drug treatments, risk factors and lifestyle changes. Below are examples of common questions.For a printable version to take to your doctor's office, click the link in the right column of this page.

About Blood Cholesterol

  • What do my cholesterol numbers mean?
  • What is my cholesterol goal?
  • How long will it take to reach my cholesterol goals?
  • How often should I have my levels checked?
  • How does exercise affect my cholesterol levels?
  • How does smoking affect my cholesterol levels?
  • What type of foods should I eat?
  • Do I need to lose weight, and if so, how much?
  • Will I need cholesterol-lowering medicine?

About Drug Treatment

  • What kind of medicine should I take?
  • Can I take the generic form of the medicine?
  • What should I know about the medicine?
  • What are the side effects?
  • How do I know if it’s working?
  • How can I remember when to take the medicine?
  • What if I forget to take a medicine?
  • Should I avoid any foods or other medicines?
  • Can I drink alcohol?
  • How long will I need to take my medicine?

Why Is Cholesterol Important?

Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood 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.

How Does Cholesterol Cause 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.

What Do Your Cholesterol Numbers Mean?

Everyone age 20 and older should have their cholesterol measured at least once every 5 years. It is best to have a blood test called a "lipoprotein profile" to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about your:

  • Total cholesterol
  • LDL (bad) cholesterol--the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol--helps keep cholesterol from building up in the arteries
  • Triglycerides--another form of fat in your blood

If it is not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. 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. See how your cholesterol numbers compare to the tables below.

Total Cholesterol Level Category
Less than 200 mg/dL Desirable
200-239 mg/dL Borderline High
240 mg/dL and above High

* Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.



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 above Very high

HDL (good) cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40 mg/dL is low and is considered a major risk factor because it increases your risk for developing heart disease. HDL levels of 60 mg/dL or more help to lower your risk for heart disease.

Triglycerides can also raise heart disease risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more) may need treatment in some people.

What Affects Cholesterol Levels?

A variety of things can affect cholesterol levels. These are things you can do something about:

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level go up. Saturated fat is the main culprit, but cholesterol in foods also matters. Reducing the amount of saturated fat and cholesterol in your diet helps lower your blood cholesterol level.

  • Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.

  • Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.

Things you cannot do anything about also can affect cholesterol levels. These include:

  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.

  • Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

What Is Your Risk of Developing Heart Disease or Having a Heart Attack?

In general, the higher your LDL level and the more risk factors you have (other than LDL), the greater your chances of developing heart disease or having a heart attack. Some people are at high risk for a heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes (which is a strong risk factor) or a combination of risk factors for heart disease. Follow these steps to find out your risk for developing heart disease.

Step 1: Check the table below to see how many of the listed risk factors you have; these are the risk factors that affect your LDL goal.

Major Risk Factors That Affect Your LDL Goal

  • Cigarette smoking
  • High blood pressure (140/90 mmHg or higher or on blood pressure medication)
  • Low HDL cholesterol (less than 40 mg/dL)*
  • Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
  • Age (men 45 years or older; women 55 years or older)

* If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total count.

Even though obesity and physical inactivity are not counted in this list, they are conditions that need to be corrected.

Step 2: How many major risk factors do you have? If you have 2 or more risk factors in the table above, use the attached risk scoring tables (which include your cholesterol levels) to find your risk score. Risk score refers to the chance of having a heart attack in the next 10 years, given as a percentage. My risk score is ________%.

Step 3: Use your medical history, number of risk factors, and risk score to find your risk of developing heart disease or having a heart attack in the table below.

If You Have You Are in Category
Heart disease, diabetes, or risk score more than 20%* I. High Risk
2 or more risk factors and risk score 10-20% II. Next Highest Risk
2 or more risk factors and risk score less than 10% III. Moderate Risk
0 or 1 risk factor IV. Low-to-Moderate Risk

* Means that more than 20 of 100 people in this category will have a heart attack within 10 years.

My risk category is ______________________.

Treating High Cholesterol

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, see the boxes below for your risk category. 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.

  • Drug Treatment--if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

If you are in...

  • Category I, Highest Risk, your LDL goal is less than 100 mg/dL. you will need to begin the TLC diet to reduce your high risk even if your LDL is below 100 mg/dL. If your LDL is 100 or above, you will need to start drug treatment at the same time as the TLC diet. If your LDL is below 100 mg/dL, you may also need to start drug treatment together with the TLC diet if your doctor finds our risk is very high, for example if you had a recent heart attack or have both heart disease and diabetes.

  • Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin treatment with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.

  • Category III, Moderate Risk, your LDL goal is less than 130 mg/dL. If your LDL is 130 mg/dL or above, you will need to begin the TLC diet. If your LDL is 160 mg/dL or more after you have tried the TLC diet for 3 months, you may need drug treatment along with the TLC diet. If your LDL is less than 130 mg/dL, you will need to follow the heart healthy diet for all Americans.

  • Category IV, Low-to-Moderate Risk, your LDL goal is less than 160 mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the TLC diet, you may need drug treatment along with the TLC diet to lower your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is less than 160 mg/dL, you will need to follow the heart healthy diet for all Americans.

To reduce your risk for heart disease or keep it low, it is very important to control any other risk factors you may have such as high blood pressure and smoking.

Lowering Cholesterol With Therapeutic Lifestyle Changes (TLC)

TLC is a set of things you can do to help lower your LDL cholesterol. The main parts of TLC are:

  • The TLC Diet. This is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7percent 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.

Foods low in saturated fat include fat-free or 1percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Look for soft margarines (liquid or tub varieties) that are low in saturated fat and contain little or no trans fat (another type of dietary fat that can raise your cholesterol level). Limit foods high in cholesterol such as liver and other organ meats, egg yolks, and full-fat dairy products.

Good sources of soluble fiber include oats, certain fruits (such as oranges and pears) and vegetables (such as brussels sprouts and carrots), and dried peas and beans.


Drug Treatment

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 inhibitorrs 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.

High Blood CholesterolHigh Blood Cholesterol: What You Need To Know

What Is Cholesterol?

To understand high blood cholesterol (ko-LES-ter-ol), it is important to know more about cholesterol.

  • Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body needs some cholesterol to work the right way. Your body makes all the cholesterol it needs.
  • Cholesterol is also found in some of the foods you eat.
  • Your body uses cholesterol to make hormones, vitamin D, and substances that help you digest foods.

Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both:

  • Low-density lipoprotein (LDL) cholesterol is sometimes called bad cholesterol.
    • High LDL cholesterol leads to a buildup of cholesterol in arteries. The higher the LDL level in your blood, the greater chance you have of getting heart disease.
  • High-density lipoprotein (HDL) cholesterol is sometimes called good cholesterol.
    • HDL carries cholesterol from other parts of your body back to your liver. The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease.

What Is High Blood Cholesterol?

Too much cholesterol in the blood, or high blood cholesterol, can be serious. People with high blood cholesterol have a greater chance of getting heart disease. High blood cholesterol on its own does not cause symptoms, so many people are unaware that their cholesterol level is too high.

Cholesterol can build up in the walls of your arteries (blood vessels that carry blood from the heart to other parts of the body). This buildup of cholesterol is called plaque (plak). Over time, plaque can cause narrowing of the arteries. This is called atherosclerosis (ath-er-o-skler-O-sis), or hardening of the arteries.

Illustration of an artery showing normal blood flow through the artery and also showing narrowing of the artery with abnormal blood flow.

The illustration shows a normal artery with normal blood flow (figure A) and an artery containing plaque buildup (figure B).

Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary heart disease (CHD). Large plaque areas can lead to chest pain called angina (an-JI-nuh or AN-juh-nuh). Angina happens when the heart does not receive enough oxygen-rich blood. Angina is a common symptom of CHD.

Some plaques have a thin covering and can burst (rupture), releasing cholesterol and fat into the bloodstream. The release of cholesterol and fat may cause your blood to clot. A clot can block the flow of blood. This blockage can cause angina or a heart attack.

Lowering your cholesterol level decreases your chance for having a plaque burst and cause a heart attack. Lowering cholesterol may also slow down, reduce, or even stop plaque from building up.

Plaque and resulting health problems can also occur in arteries elsewhere in the body.