CONDITIONS

High Cholesterol

What Is High Cholesterol

There is a lot of conversation around the topic of high cholesterol, but what is cholesterol? Cholesterol is a fat, also called a lipid, that your body needs to work properly. It’s crucial in the manufacture of hormones and vitamin D. However, too much cholesterol, especially when it comes from unhealthy food choices, can clog blood vessels and lead to heart attack or stroke.  The two types of lipoproteins that carry cholesterol to and from cells are low-density lipoprotein, or LDL, and high-density lipoprotein, or HDL. According to the American Heart Association (AHA), LDL cholesterol is considered the “bad” cholesterol because it contributes to plaque. HDL cholesterol is considered “good” cholesterol because it helps remove LDL cholesterol from the arteries. The Center for Disease Control and Prevention (CDC) estimates that 71 million American adults (33.5%) have high “bad” (LDL) cholesterol, and only half seek treatment.

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What Causes High Cholesterol

There are a number of factors that affect cholesterol levels in your blood—so while no single factor causes high cholesterol, there are a number of things that do contribute to high cholesterol. There are some factors that you can control, and some that you cannot. Among the things that you can control are:

  • Diet. “Bad” LDL cholesterol is found in foods that come from animals sources, like meat, egg yolks, cheese—consuming a lot of these foods can lead to high cholesterol. Other foods that can be bad for cholesterol include deep-fried and processed foods. In general, foods that are high in saturated fat, or high in trans fat need to be limited to help control high cholesterol levels.
  • Exercise and Weight. Being overweight tends to raise “bad” LDL cholesterol levels—and lack of physical activity can contribute to weight gain. Regular exercise can both help you lose weight and lower LDL cholesterol, it also has the added benefit of raising HDL or “good” cholesterol levels.

Among the factors that you cannot control are:

  • Heredity. High cholesterol often runs in families.
  • Age and Sex. Men tend to have more high cholesterol than women, though this evens out as men and women age. Before age 55, women tend to have both lower LDL “bad” cholesterol, and higher HDL “good” cholesterol.
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Risk Factors For High Cholesterol

The following factors increase your risk of high cholesterol:

  • Smoking.
  • Obesity.
  • Eating foods that are high in cholesterol, such as red meat, full-fat dairy products, saturated and trans fats
  • Lack of exercise.
  • High blood pressure.
  • Diabetes.
  • Family history of heart disease.
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Diagnosing High Cholesterol

Cholesterol levels are determined through a blood test that measures your level of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (a type of fat in your blood). A small sample of blood will be drawn from your arm and sent to be analyzed in a laboratory. Your doctor will tell you if you should fast) before your blood test. If you aren’t fasting when the blood sample is drawn, only the values for total cholesterol and HDL cholesterol will be usable. That’s because the amount of LDL (bad) cholesterol level and triglycerides can be affected by what you’ve recently consumed. Your test report will show your cholesterol level in milligrams per deciliter of blood (mg/dL). Your doctor will interpret your cholesterol numbers based on other risk factorssuch as age, family history, smoking and high blood pressure.

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Symptoms of High Cholesterol

High cholesterol doesn’t have any symptoms. The only way to detect it is with a blood test. Since high cholesterol doesn’t have symptoms, often the first sign of this condition is a heart attack, a stroke or a  transient ischemic aattack—which is a mini stroke that passes quickly. If you have any of these symptoms, don’t wait. Call 911 or other emergency services.

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irrecgular heartbeat.
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Prognosis

High cholesterol levels can lead to hardening of the arteries, known as arteriolosclerosis. This occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques. Over time, these plaques can block the arteries and cause heart disease, stroke, and other symptoms or problems throughout the body. Disorders that are passed down through families often lead to higher cholesterol levels that are harder to control. A change in diet and medications may be able to control cholesterol levels.

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Living With High Cholesterol

No matter what is causing your heart’s health to be compromised, there are things you can do to improve it:

  • Stop smoking. An estimated 20% of all deaths due to heart disease are directly linked to smoking.
  • Keep your blood pressure under control. People with high blood pressure are at an elevated risk for heart disease. About 50% of ischemic strokes (caused by a blockage of the artery to the brain) are caused by high blood pressure.
  • Manage your weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for coronary artery disease (CAD) at a given age.
  • Engage in regular cardiovascular exercise. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack. Speak with your doctor about the right routine for you.
  • If you have diabetes, keep your blood sugar levels under control. People with diabetes are twice as likely to have a heart attack or stroke. 
  • Eat a healthy diet. Opt for high fiber foods such as fruits, vegetables, and whole grains, as well as omega-3 oils such as cold water fish and salmon), and mono- and polyunsaturated fats. But limit saturated fats and avoid trans fats, often found in fried foods, processed foods, and commercial baked goods.
  • Limit salt. The American Heart Association recently reduced the amount of salt recommended for everyone to just 1,500 mg a day, which is about two-thirds of a teaspoon.
  • Control stress.
  • Tame alcohol intake. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Educate yourself about your condition so that you can know as much as you can about heart disease. This will help ensure you are getting the best treatment available, as well as train you to recognize any potentially harmful side effects or disease progression. 
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Screening

Because high cholesterol levels are a known precursor to more serious heart diseases, doctors generally screen for high cholesterol. Your doctor will most likely take a blood sample at your annual physical or write a prescription to get blood taken in a lab, where they will be able to determine your blood cholesterol level.

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Prevention

Especially if you have high cholesterol, you should take preventative measures against more serious heart disease. These include:

  • Quit smoking. An estimated 20% of deaths due to heart disease in the United States are linked directly to smoking.
  • Reduce your blood cholesterol. For every 1 percent reduction in high blood cholesterol, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Avoid or control hypertension. For every one-point reduction in diastolic blood pressure, there’s a 2 to 3 percent decline in the risk of heart attack.
  • Stay active. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack.
  • Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for CAD at a given age. Obesity also increases the risk for hypertension, and high blood cholesterol.
  • Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), is an important risk factor for heart disease.  According to the American Heart Association, heart disease and stroke are the number one cause of death for patients with type 2 diabetes, and adults with type 2 diabetes are two to four times more likely to have heart disease than those who do not. 
  • Consider a drink a day. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Take low-dose aspirin. The recommended regimen–a baby aspirin (81 milligrams) daily or half a regular aspirin (160 milligrams) very other day–can lower the risk of heart attack by about one-third by reducing the ability of platelets in the blood to stick together and thus form a clot. Aspirin can have side effects and isn’t right for everyone, so consult with your doctor.
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Medication And Treatment

For patients with high cholesterol, medications are most often prescribed along with diet and exercise regimens. These medications include:

Statins, which block the production of cholesterol in the liver, are the most common and effective medication used to treat high cholesterol. Statins include:

  • Simvastatin (Zocor)
  • Atorvastatin (Lipitor)
  • Lovastatin (Mevacor)
  • Pravastatin (Pravachol)
  • Rosuvastatin (Crestor).

Side effects of statins include:

  • Muscle pain or damage, known as myositis
  • Liver damage
  • Nausea
  • Vomiting
  • Diarrhea
  • Flushing (red coloration of skin) or rash
  • High blood sugar
  • Confusion

Aspirin. If you’ve had a heart attack or stroke or are at high risk for either, your doctor may prescribe aspirin therapy. Regular doses of aspirin can help thin blood and decrease the risk of heart attack and stroke.

Side effects of aspirin include:

  • Nausea
  • Stomach ulcers
  • Gastritis (inflammation of the stomach)
  • Abdominal pain
  • Liver disease (not typical)
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Complementary and Alternative Treatment

Supplements. The following list of supplements is offered by the University of Maryland Medical Center. Always check with your cardiologist or primary doctor before adding supplements to your regimen for treating and preventing heart failure. Many people with heart conditions take multiple medications including blood-thinning mediations, blood pressure medications, and others. The supplements below may interact with these (and other medications) and may not be right for people with certain medical conditions.

  • Magnesium is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium.
  • Carnitine. Early studies show L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure.
  • Coenzyme Q-10. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure.
  • Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with heart failure, injections of creatine (in addition to standard medical care) provided improvement in heart function and ability to exercise compared to those who received placebo.
  • Vitamin B1 (Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight, including muscle mass (called cachexia), and become deficient in many nutrients, including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine..
  • Amino acids. A few small studies suggest these amino acids might be helpful for heart failure, but more research is needed:
    • Arginine (needed for the body to make nitric oxide, which helps blood flow)
    • Taurine (helps heart muscle contract)

Stress reduction practices. Since stress is associated with heart disease, it’s prudent to try techniques to help reduce it. The following methods have been shown to reduce stress in some people:

  • Meditation
  • Yoga, Tai’ Chi, and other forms of moderate exercise such as walking
  • Deep breathing
  • Visualization
  • Biofeedback
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Care Guide

If you’ve been diagnosed with high cholesterol, you may want to follow these simple steps to reduce your overall risk of heart attack and more serious heart diseases:

  • If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system.
  • Avoid salt. Sodium promotes fluid retention. Avoid high-sodium foods, heavily processed foods and unnecessary salt.
  • Don’t forget to take your prescribed medications. Wearing a watch with an alarm, setting your smart phone alert, or keeping a labeled pill box on your dining table are helpful methods to remember.
  • Check other meds for potential side effects and interactions. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking.
  • Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems.
  • Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the heart work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath exercise can improve the oxygenation of blood and take workload off the heart.

Be open with your family and friends about your condition and consider joining a support group or on-line forum.

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When To Contact A Doctor

Since high cholesterol doesn’t have symptoms, often the first sign of this condition is a heart attack, a stroke, or a transient ischemic attack (TIA)—which is a mini stroke that passes quickly.

If you have any of these symptoms, don’t wait. Call 911 or other emergency services.

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

You should not hesitate to call 911 if you are experiencing any of these symptoms that come on suddenly. You could be having a STROKE.

  • Numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Vision changes.
  • Trouble speaking.
  • Confusion or trouble understanding simple statements.
  • Problems with walking or balance.
  • Severe headache that is different from past headaches.
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Questions For Your Doctor

In addition to your primary care physician, you may want to add a cardiologist (heart specialist), lipidologist (cholesterol management specialist), and a dietitian (nutritional expert) to your care team.

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Questions For A Doctor

You will probably have different questions to ask your doctor depending on your heart condition. Be open about all your concerns. If you’re having difficulty focusing, bring along a friend or family member. Below you’ll find general questions you might want to ask your doctor about heart disease as suggested by the American Heart Association.

QUESTIONS ABOUT MEDICATION

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • What happens if I miss a dose of my medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?

QUESTIONS ABOUT DIET

  • What kinds of foods should I eat?
  • What kinds of foods should I avoid?
  • Should I restrict my calories or fat intake to a certain level?
  • What are some cooking tips that I should follow?
  • What do I need to know about eating out?
  • Do I need to see a nutritionist or dietitian?
  • Are there any groups in the community that can help me with my nutrition goals?
  • How can I control the portions? How much salt may I eat?

QUESTIONS ABOUT EXERCISE

  • Can I exercise?
  • Can I play sports?
  • What are the best types of activities for me?
  • How much activity do I need?
  • Can I have sex?
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Resources

American Heart Association (AHA) offers you information about all heart conditions and includes an interactive library and an on-line high blood pressure calculator.

American Stroke Association (ASA) will give you a connection to local services, a free stroke magazine, and news and tips on how to adjust to life after stroke.

The National Coalition for Women with Heart Disease is devoted to women. You can get information about chapters in your state. It also offers listings of health care professionals who specialize in heart issues.

Heart Rhythm Society (HRS) will help you find a specialist who deals with heart rhythm issues like atrial fibrillation as well as a glossary of terms and other resources.

Heart Disease Support Groups. You may have to sign in.

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