Cholesterol

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.

Reducing High Cholesterol

The main goal of cholesterol reducing 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 reduce your cholesterol:
Therapeutic Lifestyle Changes (TLC)--includes a cholesterol reducing diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above goal.
Drug Treatment--if cholesterol reducing drugs are needed, they are used together with TLC treatment to help lower your LDL.
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.


Reducing Cholesterol With Therapeutic Lifestyle Changes (TLC)
TLC is a set of things you can do to help reduce 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 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 reducing margarines and salad dressings) 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 1% 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 reduce your cholesterol, you will need to continue your cholesterol 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 reducing including statins, bile acid sequestrants, nicotinic acid, and fibric acids. 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.
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.

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.

Cholesterol Categories

Category I, Highest Risk, your LDL goal is less than 100 mg/dL. If your LDL is 100 or above, you will need to begin the TLC diet. If your LDL is 130 or higher, you will need to start drug treatment at the same time as the TLC diet. If your LDL is 100 to 129, you may also need to start drug treatment together with the TLC diet. Even if your LDL is below 100, you should follow the TLC diet on your own to keep your LDL as low as possible.
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.

Why High Blood Cholesterol Levels are Dangerous
By Kim Beardsmore
Cholesterol, like fat, cannot move around the bloodstream on its own because it does not mix with water. The bloodstream carries cholesterol in particles called lipoproteins that are like blood-borne cargo trucks delivering cholesterol to various body tissues to be used, stored or excreted. But too much of this circulating cholesterol can injure arteries, especially the coronary ones that supply the heart. This leads to accumulation of cholesterol-laden "plaque" in vessel linings, a condition called atherosclerosis.

When blood flow to the heart is impeded, the heart muscle becomes starved for oxygen, causing chest pain (angina). If a blood clot completely obstructs a coronary artery affected by atherosclerosis, a heart attack (myocardial infarction) or death can occur.
Are you at risk? Cardiovascular disease is still one of the greatest health problem affecting western countries. According to the American Heart Foundation, over 70 million Americans have cardiovascular disease (CVD). The national cost of is nearly $400 billion and every 45 seconds an American has a stoke.
Certain risk factors increase your chances of developing cardiovascular disease.
   • Overweight
   • High blood cholesterol
   • Insufficient physical activity
   • High blood pressure
   • Smoking
   • Excessive alcohol intake
   • Diabetes

Many people have multiple risk factors for heart disease and the level of risk increases with the number of risk factors. By reducing these risk factors you can largely prevent the onset of cardiovascular disease. On its own elevated blood cholesterol is not necessarily a problem, but coupled with one or more other risk factors for heart disease, it is often the straw that breaks the camel's back.
It is, therefore, very important to know what your cholesterol levels are and to keep them at a healthy level before you have any problems.

High risk cholesterol

If your total cholesterol level is 240 or more, it's definitely high. You have a higher risk of heart attack and stroke. In fact, you should have your LDL and HDL cholesterol tested. Ask your doctor for advice. Close to 20 percent of the U.S. population has high blood cholesterol levels.

Borderline-high risk
People whose total cholesterol is 200 to 239 mg/dL have borderline-high cholesterol. About a third of American adults are in this group, while almost half of adults have total cholesterol levels below 200 mg/dL. In fact, people who have a total cholesterol of 240 mg/dL have twice the risk of coronary heart disease as people whose cholesterol level is 200 mg/dL. Does physical activity affect cholesterol?

Other factors that affect blood cholesterol levels:

Heredity - High cholesterol often runs in families. Even though specific genetic causes have been identified in only a minority of cases, genes still play a role in influencing blood cholesterol levels. If your parents have high cholesterol, you need to be tested to see if your cholesterol levels are also elevated.

Age and gender - Before menopause, women tend to have total cholesterol levels lower than men at the same age. Cholesterol levels naturally rise as men and women age. Menopause is often associated with increases in LDL cholesterol in women.

Stress
- Studies have not shown stress to be directly inked to cholesterol levels. But experts say that because people sometimes eat fatty foods to console themselves when under stress, this can cause higher blood cholesterol.

Excess weight - Being overweight tends to increase blood cholesterol levels. Losing weight has been shown to help lower levels. A greater risk of increased cholesterol levels occurs when that extra weight is centered in the abdominal region, as opposed to the legs or buttocks.
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