Cholesterol is a soft, waxy substance found in your bloodstream and in all of your body’s cells. It plays an important role in keeping your body healthy in several ways:

• Cholesterol helps to repair cell membranes
• It manufactures vitamin D on your skin’s surface
• It’s involved in production of hormones like estrogen and testosterone
• Cholesterol helps cell connections in the brain that are important for learning and memory

Too much cholesterol, however, can lead to heart disease.

How do I know if I have high cholesterol?
People with high cholesterol levels may not have any symptoms until blockage in the arteries becomes severe and causes chest pain, heart attack, or stroke. The best way to know if your cholesterol levels are high is to have your cholesterol checked once every five years after the age of 20.

Can high cholesterol be treated?
Yes. It can be treated and controlled. Changing your lifestyle is important to control high cholesterol. Medications may also be used to help control high cholesterol.

Do I need to worry about lowering my blood cholesterol now that I’m over 65?
Yes. Older Americans have the nation’s highest rate of coronary heart disease, or CHD, and can benefit greatly from lowering elevated cholesterol levels. Cholesterol lowering also has been shown to reduce the risk of strokes. For seniors who do not have heart disease, cholesterol lowering reduces their high risk of developing CHD. Older people should have their cholesterol numbers (total cholesterol, LDL, HDL, and triglycerides) measured once every five years. They can keep their cholesterol low by following an eating pattern such as a Mediterranean diet, which is lower in saturated fat, total fat, and cholesterol, being physically active, and maintaining a healthy weight.

Should I be concerned about my child’s blood cholesterol?
Yes. Everyone older than age two should care about cholesterol to reduce the risk of developing heart disease as an adult. Children as well as adults can improve the health of their hearts by following a low-saturated-fat and low-cholesterol diet, avoiding obesity, and being physically active.

Guidelines endorsed by the American Academy of Pediatrics suggest that even if children do not have a family history of heart disease they should have their cholesterol levels tested between the ages of nine and 11, and then again between the ages of 17 and 21. Healthcare providers believe that this early testing and control of cholesterol levels in childhood can help reduce the risks of heart disease in adulthood.

How useful is it to know my cholesterol ratio?
Although the cholesterol ratio can be a useful predictor of heart disease risk, it is more important for treatment purposes to know the value for LDL and HDL separately. This is because both LDL and HDL cholesterol separately affect your risk of heart disease. The levels of both types may need to be improved by treatment. The ratio is useful if it helps you and your doctor keep the entire picture of your LDL and HDL levels in mind, but it should not take the place of knowing your separate LDL and HDL levels.

Is a Mediterranean diet a heart healthy diet and what does it consist of?
Yes, the Mediterranean diet is a heart healthy diet. Traditionally, the Mediterranean diet focuses on a high intake of fruits, vegetables, olive oil, nuts, legumes, seeds, herbs, and whole grains. The diet also includes a moderate amount of wine, fish or seafood, and poultry along with a reduced intake of red meat, processed meats, and sweets.

The Mediterranean diet encourages use of mono- and poly-unsaturated fatty acids while discouraging use of saturated and trans fats. Those who consume alcohol on a regular basis should include wine as their main source of alcohol. Although alcohol is recommended in moderate amounts, it is important to consider personal history, including history of habitual drinking, as well as religious beliefs, personal preferences, and a family history of alcoholism.

What food should I avoid when trying to lower cholesterol?
Recommendations for foods and beverages to be avoided include limiting and/or eliminating butter, cream, margarine, cold meat, duck, carbonated and/or beverages with added sugar, pastries, industrial baked goods, industrial desserts, French fries and potato chips, and cakes or sweets that are not homemade. Additionally, cured ham, red meat with all visible fat removed, and cured and/or high-fat cheeses should be limited to less than one serving per week.

My last cholesterol level was within my goal. Does that mean I do not have to worry about my cholesterol any more?
High cholesterol and heart disease are not cured, but are only controlled by diet and physical activity, and in some cases by drug therapy. Stopping your treatment quickly returns your cholesterol to the level that existed before therapy was started.

How does tobacco use and smoking affect my cholesterol?
Tobacco use has several harmful effects on cholesterol. Smoking reduces HDL, or “good,” cholesterol and in all likelihood changes LDL, or “bad,” cholesterol to a form that promotes the buildup of deposits in the walls of the coronary arteries. In addition, smoking has harmful effects on the heart and blood vessels. In these ways, smoking substantially raises the risk for coronary heart disease if you are healthy, and multiplies that risk many more times if you have other risk factors, such as high blood cholesterol. All in all, smoking is the leading preventable cause of death.

How can I raise my HDL, or “good,” cholesterol?

• Quit smoking. The more you smoke, the lower your HDL cholesterol is likely to be.
• Lose weight if you’re overweight. Being overweight is often associated with low HDL levels.
• Increase physical activity. This has a slow but steady elevating effect on HDL, which tends to rise in direct proportion to the amount of physical activity per week.

Are medications used for lowering cholesterol safely?
In general, yes. However, like all medications, drugs used to lower cholesterol can have side effects and must only be taken under the guidance of a healthcare provider. The benefits generally outweigh the risks when these medications are used by people who have a high risk of developing coronary heart disease, or CHD.

I’m young and healthy. Do I need to have my cholesterol checked?
If you are a male who is older than 35, or a female who is older than 45, it’s recommended that you have a risk screening that includes a lipid profile and risk calculation. Checking your cholesterol and discussing any abnormalities with your healthcare provider can help you make lifestyle changes, such as eating right, being physically active, and controlling your weight, to prevent heart disease.

Who should be on lipid lowering medication?
If you have a history of a heart attack, angina, or other evidence of coronary heart disease or vascular disease, such as stroke or claudication, you should be on an aggressive lipid-lowering program to help prevent further events.

What lifestyle changes decrease the risk of atherosclerosis?
Three top lifestyle behaviors are associated with premature death — smoking, an unhealthy diet, and an inactive lifestyle. If you smoke, now is a great time to quit. Ask your primary care provider to help you get appropriate tobacco cessation medication or support.

Learn about a healthy diet, such as a Mediterranean diet that limits the amount of saturated fat and cholesterol, and begin a moderate exercise program of 30 minutes or more of a moderate intensity activity on most days of the week. Additional attention should be paid to weight loss if you are over weight, limiting alcohol intake to one or two drinks a day, and reducing the amount of stress in your life.

What is a lipoprotein profile and how should it be done?
Lipid levels may be obtained in a fasting or non-fasting state. But a non-fasting lipoprotein is recommended to find out your cholesterol numbers if you are a male over 35 years of age or a female over 45 years of age. This test gives information about your:

• Total cholesterol
• LDL, or bad, cholesterol — the main source of cholesterol buildup and blockage in the arteries
• HDL, or good, cholesterol — helps keep cholesterol from building up in the arteries
• Triglycerides, or TG, which is another form of fat in your blood

When should repeat lipid screening occur?
If initial lipid screening reveals a total cholesterol of < 200 mg/dL or LDL < 130 mg/dL AND an HDL cholesterol > 35mg/dL, in the absence of other risk factors or diabetes, repeat screening should occur within five years.

What is a normal lipid profile?
A normal lipid profile depends on risk factors for heart disease. The more risk factors you may have, the lower your target LDL level should be. Healthcare providers recommend the following levels:

LDL cholesterol:

• Below 130 mg/dL if you don’t have diabetes and have few risk factors for heart disease, and
• Below 100 mg/dL or below 70 mg/dL if you have diabetes, heart disease, or atherosclerosis

HDL cholesterol:

• Above 40 mg/dL for men and above 50 mg/dL for women

TG:

• Below 150 mg/dL

Your healthcare provider can work with you to set your target goals.

Are there reasons for abnormal lipids?
There are some health conditions that can lead to a high level of LDL. Hypothyroidism, chronic renal failure, and nephrotic syndrome are known to cause an elevated LDL. Further evaluation for these conditions would include tests that measure a thyroid-stimulating hormone, or TSH, a BUN/creatinine test, and a urine dipstick test.

The most common causes of secondary high triglyceride levels include alcohol abuse, diabetes, kidney problems, hypogonadism, obstructive liver disease, and hypothyroidism. Treating these conditions will improve the abnormally high levels. Certain medications can also have a negative impact on the lipid profile. These medications include progestins, estrogens, androgens, anabolic steroids, coticosteroids, cyclosporine, and retinoids. These medications may raise cholesterol and/or triglyceride levels.

How can I monitor my cholesterol levels?
Your doctor can order a non-fasting blood cholesterol test to check your total cholesterol and HDL cholesterol. Alternatively, a fasting test, when you don’t eat food for eight to 12 hours, will provide the additional possibility of measuring triglycerides and LDL cholesterol levels.

What are triglycerides?
Triglycerides are another type of lipid or fat. Most of the fat in your body is stored as triglycerides. If you have high triglyceride levels, you may have “hyperlipidemia” or excess triglycerides in the bloodstream. This also tends to run in families. If you have hyperlipidemia, you are more prone to heart disease than someone with low levels.

How does alcohol affect cholesterol?
In some studies, limited or moderate use of alcohol is linked with higher HDL, or “good” cholesterol, levels. However, because of other risks, the benefit isn’t great enough to recommend drinking alcohol to everyone.

If you drink, do so in moderation. People who consume moderate amounts of alcohol have a lower risk of heart disease than non-drinkers do. However, increased consumption of alcohol can cause other health dangers, such as alcoholism, high blood pressure, obesity, stroke, cancer, and others. Given these risks, the American Heart Association cautions people against increasing their alcohol intake or starting to drink if they don’t already do so. Check with your provider for advice on consuming alcohol in moderation.

When should I call my provider?

• If you experience severe muscle aches and weakness
• If you experience abdominal pain, dark urine, or yellowing of the skin and eyes
• If you experience blurred vision, loss of vision, or see flashing lights
• If you experience a severe headache
• If you have weakness or paralysis on one side of the body or face
• If you develop chest discomfort (pressure, squeezing, fullness or pain in the center of the chest)
• If you develop discomfort in one or both arms, back, neck, or jaw
• If you develop shortness of breath
• If you break out in a cold sweat, become nauseous, or become light-headed