FAQ

Many people don’t know that they have high levels of cholesterol in their blood (hypercholesterolemia) because there are usually no signs or symptoms associated with an early buildup of cholesterol in the arteries. For some people, the first sign of elevated cholesterol may be a heart attack or stroke. You should also know that people with high total cholesterol are twice as likely to develop heart disease; about 1 in 3 American adults has high blood levels of low-density lipoprotein-cholesterol (LDL-C, or “bad cholesterol”).1 Women need to be aware that their cholesterol level becomes even more important after they reach menopause because levels often change at this time.1

Eating excess amounts of dietary fats will cause the fat to be absorbed by the body and raise levels of LDL-C in the blood. Saturated and trans fats raise LDL-C levels in the blood, thereby increasing the risk of heart disease. Foods that are high in animal fat (full-fat milk, cheese, meat) and/or are prepared with butter, shortening, or partially hydrogenated oils (cookies and cakes), are often the main culprits.1

The following common conditions, comorbidities, and behaviors are associated with hypercholesterolemia.2

  • Type 2 diabetes lowers high-density lipoprotein-cholesterol (HDL-C, or “good” cholesterol) levels and raises low-density lipoprotein-cholesterol (LDL-C, or “bad” cholesterol) levels; this combination raises the risk of heart disease and stroke.
  • Obesity, which is linked to higher triglyceride levels, higher LDL-C levels, and lower HDL-C levels, can also lead to heart disease, high blood pressure, and diabetes.
  • Other conditions such as familial hypercholesterolemia (FH) can cause very high LDL-C levels.
  • Eating a diet high in saturated fat and trans fat may contribute to high cholesterol and related conditions, such as heart disease.
  • Not getting enough physical activity can cause weight gain and can lead to high cholesterol.
  • Smoking damages blood vessels, making them more likely to collect fatty deposits, and may also lower HDL-C levels.

 References

  1. American College of Cardiology (ACC) CardioSmart. High cholesterol. www.cardiosmart.org/Heart-Conditions/High-Cholesterol/Content/Understanding-High-Cholesterol. Accessed November 20, 2019.
  2. Centers for Disease Control and Prevention (CDC). Knowing your risk for high cholesterol. www.cdc.gov/cholesterol/risk_factors.htm. Accessed November 5, 2019.

High cholesterol in the blood (hypercholesterolemia) usually has no signs or symptoms. The only way to know whether or not you have high cholesterol is to have a healthcare professional conduct a blood test to check the cholesterol level.

Desirable Cholesterol Levels1-3

Total cholesterol

Less than 200 mg/dL

Low-density lipoprotein-cholesterol (LDL-C, or “bad” cholesterol)

Less than 100 mg/dL

High-density lipoprotein-cholesterol (HDL, or “good” cholesterol)

Equal to or greater than 60 mg/dL

Triglycerides

Less than 150 mg/dL

Cholesterol numbers are important, but they are just one part of the overall health picture. It is important to consider family history, age, gender, and other lifestyle or health factors, such as smoking, that could raise your risk for high cholesterol.

  • Most healthy adults should have their cholesterol checked every 4 to 6 years.1
  • Some people, such as those who have heart disease, diabetes, or a family history of high cholesterol, need to get their cholesterol checked more often.4
  • Children and adolescents should have their cholesterol checked at least once between the ages 9 and 11 and again between the ages 17 and 21.2

The following common conditions, comorbidities, and behaviors are associated with hypercholesterolemia.5

  • Type 2 diabetes lowers high-density lipoprotein-cholesterol (HDL-C, or “good” cholesterol) levels and raises low-density lipoprotein-cholesterol (LDL-C, or “bad” cholesterol) levels; this combination raises the risk of heart disease and stroke.
  • Obesity, which is linked to higher triglyceride levels, higher LDL-C levels, and lower HDL-C levels, can also lead to heart disease, high blood pressure, and diabetes.
  • Other conditions such as familial hypercholesterolemia (FH) can cause very high LDL-C levels.
  • Eating a diet high in saturated fat and trans fat may contribute to high cholesterol and related conditions, such as heart disease.
  • Not getting enough physical activity can cause weight gain and can lead to high cholesterol.
  • Smoking damages blood vessels, making them more likely to collect fatty deposits, and may also lower HDL-C levels.

References

  1. Centers for Disease Control and Prevention (CDC). Getting your cholesterol checked. www.cdc.gov/cholesterol/cholesterol_screening.htm. Accessed November 20, 2019.
  2. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J  Am Coll Cardiol. 2019;73:e285-e350.
  3. National Cholesterol Education Program. 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) final report. Circulation. 2002;106:3143-3421.
  4. HealthFinder.gov. Get your cholesterol checked. https://healthfinder.gov/healthtopics/category/doctor-visits/screening-tests/get-your-cholesterol-checked. Accessed November 20, 2019.
  5. CDC. Knowing your risk for high cholesterol. www.cdc.gov/cholesterol/risk_factors.htm. Accessed November 20, 2019.

Your treatment plan to lower your cholesterol numbers and help optimize your heart health will be based on your overall risk for cardiovascular disease. Recommended treatments will also depend on:

  • Your cholesterol levels;
  • Other health conditions you may have;
  • Previous treatments tried (if applicable); and
  • Personal choice.

Your efforts to lower your elevated levels of low-density lipoprotein-cholesterol (LDL-C, or “bad cholesterol”) can often be helped by making healthier lifestyle choices. Choices made every day can affect cholesterol levels.

Four (4) things that can make a difference include:

  1. Revamping the way you eat by following a heart-healthy plan, such as the Mediterranean or DASH diets, which are less “diets” and more ways of adopting healthier eating habits;
  2. Exercising regularly; 
  3. Staying at a healthy weight and losing any extra pounds; and
  4. Not smoking and staying away from secondhand smoke.

Many people with elevated LDL-C also need to take medication, which can include the following.

  • Statins—in combination with lifestyle changes—are a treatment of choice, with at least seven statins available. As with any medication, it is important to tell your doctor about any side effects or problems you may experience with statins.
  • Other medications (non-statins) that may be prescribed include: 
    • Ezetimibe (e-zet-ah-mibe), a cholesterol absorption inhibitor;
    • PCSK9 inhibitors alirocumab (a-leer-rock-u-mab) and evolocumab (e-voh-lock-u-mab), which help increase LDL-C clearance from the blood;
    • Bile-acid-binding sequestrants or resins and high-dose omega-3 fatty acids for treating severely high triglyceride levels; and
    • Fibrates (mostly used to treat high levels of triglycerides).

No matter which medication(s) your clinician prescribes, take your medications exactly as directed, which is the only way to make sure they work as intended. If you have side effects or concerns, talk with your healthcare provider before making any changes. Your pharmacist is also a good resource if you have questions.

Reference

American College of Cardiology (ACC) CardioSmart. High cholesterol. www.cardiosmart.org/Heart-Conditions/High-Cholesterol/Content/Understanding-High-Cholesterol. Accessed November 20, 2019.

Cholesterol numbers are important, but they are just one part of the overall health picture. It is important to consider family history, age, gender, and other lifestyle or health factors, such as smoking, that could raise the risk for high blood cholesterol (hypercholesterolemia).

  • Most healthy adults should have their cholesterol checked every 4 to 6 years.1
  • Some people, such as those who have heart disease, diabetes, or a family history of high cholesterol, need to get their cholesterol checked more often.2
  • Children and adolescents should have their cholesterol checked at least once between the ages 9 and 11 and again between the ages 17 and 21.3

Adopting a heart-healthy diet and getting regular exercise are the most important steps you can take to prevent or control cholesterol problems and heart disease. Here are some general tips.4 

  • Get physical. Aim to get a minimum of 30 minutes of moderate-intensity activity at least five times a week. If you don’t have a 30-minute block of free time, even 10-minute bursts of activity three times throughout the day are helpful.
  • Take time to read and understand food labels, and pay special attention to the amount of saturated fats, trans fats (hydrogenated or partially hydrogenated oils), and sugar in your food choices.
  • Try to avoid full-fat dairy products, processed foods, and foods high in salt (sodium) and preservatives.
  • Swap out butter or margarine for healthier fats, such as olive oil, avocados, and/or a handful of almonds. Remember, fat that becomes solid at room temperature should probably be avoided. Nuts, fish, certain oils (olive, canola, and peanut oils), and other foods rich in omega-3 fatty acids are good choices.
  • Consider keeping a food diary so you can see what you are eating and what dietary habits you might need to change.
  • Ask about seeing a dietitian or nutritionist who can help you plan meals and can provide dietary strategies for lowering low-density lipoprotein-cholesterol (LDL-C, or “bad cholesterol”) or triglycerides, improving your blood sugar levels, and boosting your energy.
  • As with any goal, start small. Make sure you are setting yourself up for success.
  • Limit alcohol. Too much alcohol can raise triglyceride levels and blood pressure.

Many people who have excess LDL-C also need to take medicine to lower their cholesterol levels at some point. This is especially true for people with atherosclerotic cardiovascular disease or those who are at high risk for developing it.4

 References

  1. Centers for Disease Control and Prevention (CDC). Getting your cholesterol checked. cdc.gov/cholesterol/cholesterol_screening.htm. Accessed November 5, 2019.
  2. gov. Get your cholesterol checked. https://healthfinder.gov/healthtopics/category/doctor-visits/screening-tests/get-your-cholesterol-checked. Accessed November 5, 2019.
  3. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73:e285-e350.
  4. American College of Cardiology (ACC) CardioSmart. High cholesterol. www.cardiosmart.org/Heart-Conditions/High-Cholesterol/Content/Understanding-High-Cholesterol. Accessed November 20, 2019.

Some sample questions are listed below to help you begin a conversation with your clinician about your condition.

  • What is “good” cholesterol? What does it do?
  • How can I increase my level of “good” cholesterol?
  • What is “bad” cholesterol? What does it do?
  • How can I decrease my level of “bad” cholesterol?
  • What medications are available for high cholesterol? Do they have side effects?
  • When should I take medication for cholesterol?
  • Is high cholesterol hereditary?
  • What is cholesterol? Why is it important?
  • How often should I have my cholesterol checked?
  • Does high cholesterol cause symptoms?

Reference

American College of Cardiology (ACC) CardioSmart. High cholesterol. www.cardiosmart.org/Heart-Conditions/High-Cholesterol/Questions-to-Ask-Your-Doctor. Accessed November 20, 2019.

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