Disease In Focus: Cholesterol

 

Cholesterol is a waxy substance that's found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having

high cholesterol can increase your risk of heart disease.

 

When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

 

High cholesterol (hypercholesterolemia) can be inherited, but it's often the result of unhealthy lifestyle choices, and thus preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.

 

SYMPTOMS

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.

 

When to see a doctor

Ask your doctor for a baseline cholesterol test at age 20 and then have your cholesterol retested at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements. Your doctor may also suggest you have more frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, such as smoking, diabetes or high blood pressure.

 

CAUSES

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:

 

Low-density lipoprotein (LDL). LDL, or "bad," cholesterol transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.

Very-low-density lipoprotein (VLDL). This type of lipoprotein contains the most triglycerides, a type of fat, attached to the proteins in your blood. VLDL cholesterol makes LDL cholesterol larger in size, causing your blood vessels to narrow. If you're taking cholesterol-lowering medication but have a high VLDL level, you may need additional medication to lower your triglycerides.

High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.

Factors within your control — such as inactivity, obesity and an unhealthy diet — contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.

 

RISK FACTORS

You're more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

 

Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or "good," cholesterol.

Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.

Large waist circumference. Your risk increases if you are a man with a waist circumference of at least 40 inches (102 centimeters) or a woman with a waist circumference of at least 35 inches (89 centimeters).

Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your cholesterol level.

Lack of exercise. Exercise helps boost your body's HDL "good" cholesterol while lowering your LDL "bad" cholesterol. Not getting enough exercise puts you at risk of high cholesterol.

Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.

COMPLICATIONS

High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits (plaques) can reduce blood flow through your arteries, which can cause complications, such as:

 

Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.

Heart attack. If plaques tear or rupture, a blood clot may form at the plaque-rupture site — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you'll have a heart attack.

Stroke. Similar to a heart attack, if blood flow to part of your brain is blocked by a blood clot, a stroke occurs.

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high cholesterol and its complications, including heart attack and stroke.

You're considered to be at a high risk of heart disease if you: 

Have had a previous heart attack or strokeHave artery blockages in your neck (carotid artery disease)

Have artery blockages in your arms or legs (peripheral artery disease)

Have known diabetes that requires treatment

In addition, two or more of the following risk factors might also place you in the high-risk group:

Smoking

High blood pressure

Low HDL cholesterol

Family history of early heart disease

Age older than 45 if you're a man, or older than 55 if you're a woman

Elevated lipoprotein (a), another type of fat (lipid) in your blood

 

 

LIFESTYLE AND HOME REMEDIES

The same heart-healthy lifestyle changes that can lower your cholesterol can help prevent you from having high cholesterol in the first place. To help prevent high cholesterol, you can:

 

Lose extra pounds and maintain a healthy weight

Quit smoking

Eat a low-fat, low-salt diet that includes many fruits, vegetables and whole grains

Exercise on most days of the week for at least 30 minutes

Drink alcohol in moderation, if at all

 

ALTERNATIVE MEDICINE

Few natural products have been proven to reduce cholesterol, but some might be helpful. With your doctor's OK, consider these cholesterol-lowering supplements and products:

 

Artichoke

Barley

Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ)

Blond psyllium (found in seed husk and products such as Metamucil)

Garlic

Oat bran (found in oatmeal and whole oats)

Sitostanol (found in oral supplements and some margarines, such as Benecol)

You may have also heard of another supplement to reduce cholesterol, red yeast. Some brands of red yeast contain lovastatin, the active ingredient in the drug Mevacor. This can be unsafe, since there's no way to determine the quantity or quality of the lovastatin in the supplement.

 

If you choose to take cholesterol-lowering supplements, remember the importance of a healthy lifestyle. If your doctor prescribes medication to reduce your cholesterol, take it as directed. Make sure your doctor knows which supplements you're taking as well.