Cholesterol and the liver

Contents

6 Things Besides Food That Can Cause High Cholesterol

As a family physician in Alexandria, Virginia, I’m routinely asked by patients, “What should I eat to lower my cholesterol?”

It’s an important question. Cholesterol is a waxy, fat-like substance in all your cells. When you have too much of it, it can stick to the lining of your blood vessels, limit blood flow and increase your risk of heart attack and stroke. Making dietary changes can help, so I offer my patients at Franconia Family Medicine some standard, good advice: limit saturated fat and eat more veggies, beans and whole grains.

I also tell my patients that diet may not be the only cause – or even the main cause – of their high cholesterol. These are six factors besides food that can increase your risk of high cholesterol.

Obesity. When you hear the word “obese,” you probably think of an extremely large person. The reality is that obesity occurs well before that point. It’s defined as having a body mass index of 30 or greater, which describes around 40 percent of U.S. adults, according to the Centers for Disease Control and Prevention. Excess weight can increase the amount of LDL, or “bad” cholesterol, in your blood.

Lack of exercise. If you don’t get 30 minutes of some type of exercise every day, it’s time to start. Exercise helps boost your body’s HDL, or “good” cholesterol, which is associated with a lower risk for cardiovascular disease. Exercise also helps your body get rid of some LDL, moving it from the blood to the liver, where it then gets used for digestion or expelled from the body.

Cigarettes. Smoking cigarettes can lower HDL levels. In addition, it can damage the walls of your blood vessels. The roughed-up walls “catch” cholesterol particles, which can build up and become plaques. When these plaques cause arteries to narrow and restrict blood flow, the condition is called atherosclerosis. You may already know that term, since it’s the typical cause of heart attacks and strokes.

Diabetes. Like cigarette smoking, type 2 diabetes tends to lower good cholesterol. It also raises LDL and triglycerides, a type of blood fat. In people with diabetes, the combination of low HDL, high LDL and high triglycerides is known as “diabetic dyslipidemia.” This condition increases the risk of early heart disease.

A large waistline. Whether you’re overweight or even an average weight, the size of your waistline matters for your health. If you’re a man, your risk of high cholesterol increases when your waist circumference (how big your waist is all the way around) is at least 40 inches. If you’re a woman, the number is 35 inches.

Genetics. Some people have an inherited form of high cholesterol. The most common one is called familial hypercholesterolemia, and it affects about 1 in 500 people. In other words, it’s not very common. But if you have very tough-to-treat high cholesterol, it’s something you and your doctor should talk about.

Whatever the reasons for your high cholesterol, various lifestyle changes, sometimes with the addition of medications, can effectively lower it. However, I know I’m in good company when I tell my patients there’s so much more to health than cholesterol numbers. That’s why MDVIP-affiliated physicians, including my family practice in Alexandria, give patients a unique panel of tests – including advanced tests for cholesterol and inflammation – as part of the annual MDVIP Wellness Program.

This blog reflects the medical opinion of Dr. Bret Wohler, an MDVIP-affiliated, board-certified family practice physician, and not necessarily the opinion of all physicians in the MDVIP national network.

High Cholesterol (Hypercholesterolemia)

What Is It?

Published: April, 2019

Cholesterol is a fatty substance that occurs naturally in the body. It performs several vital functions. It is needed to make the walls surrounding the body’s cells and is the basic material that is converted to certain hormones. Your body makes all the cholesterol you need. You need only a small amount of fat in your diet to make enough cholesterol to stay healthy.

The fat and cholesterol you eat are absorbed in the intestine and transported to the liver. The liver converts fat into cholesterol, and releases cholesterol into the bloodstream. There are two main types of cholesterol: low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) and high-density lipoprotein (HDL) cholesterol (the “good” cholesterol).

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Cholesterol in the Blood

Facts about cholesterol

Cholesterol is a fat-like, waxy substance that can be found in all parts of your body. It helps your body make cell membranes, many hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. Your liver makes all the cholesterol your body needs.

Cholesterol and other fats are carried in your bloodstream as spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

What is LDL (low-density lipoprotein) cholesterol? What is HDL (high-density lipoprotein) cholesterol?
LDL (‘bad”) cholesterol is a type of fat in the blood that contains the most cholesterol. It can contribute to the formation of plaque buildup in the arteries (atherosclerosis). This is linked to higher risk for heart attack and stroke. You want your LDL to be low. To help lower it:

  • Avoid foods high in saturated fat, dietary cholesterol, and extra calories
  • Exercise
  • Maintain a healthy weight
  • Stop smoking
HDL (“good”) cholesterol helps to remove cholesterol from the blood. This keeps plaque from building up in your arteries. You want your HDL to be as high as possible. Some people can raise HDL by:

  • Exercising for at least 30 minutes 5 times a week
  • Quitting smoking
  • Not eating saturated fats
  • Losing weight

Others may need medicine. Because raising HDL is complicated, you should work with your healthcare provider on a treatment plan.

Checking your blood cholesterol level

A cholesterol screening is an overall look at the fats in your blood. Screenings help find people at risk for heart disease. It is important to have what is called a full lipid profile to show the actual levels of each type of fat in your blood: LDL, HDL, triglycerides, and others. Talk with your healthcare provider about when to have this test.

What is a healthy blood cholesterol level?

High blood cholesterol is a significant risk factor for heart disease and stroke. You can lower your risk by getting more exercise, losing weight if you are overweight, quitting smoking, and eating a healthy diet. But blood cholesterol is very specific to each person. Your healthcare provider will determine your total cholesterol and LDL goals based on other risk factors. For that reason, a full lipid profile is an important part of your health history and important information for your healthcare provider to have.

What treatments are available for high cholesterol?

Medical treatment may include:

  • Changing risk factors. Some risk factors that can be changed include lack of exercise and poor eating habits.

  • Cholesterol-lowering medicines. Medicines are used to lower fats in the blood, particularly LDL cholesterol. Statins are a group of medicines that can do this. They include simvastatin, atorvastatin, and pravastatin. Two other types of medicines that lower cholesterol levels are bile acid sequestrants such as colesevelam, cholestyramine, and colestipol, and nicotinic acid (niacin).

Statistics about cholesterol

High cholesterol is a risk for many Americans. Consider these statistics:

  • According to the American Heart Association (AHA), about 95 million American adults have total blood cholesterol levels of 200mg/dl and higher. Of those, about 28.5 million American adults have a level of 240 or above.

  • High cholesterol levels early in life may play a role in developing atherosclerosis as an adult.

  • According to the AHA, high blood cholesterol that runs in families will affect the future of an unknown but probably large number of children.

What are triglycerides?

Triglycerides are another class of fat found in the bloodstream. The bulk of your body’s fat tissue is in the form of triglycerides.

Triglyceride levels and heart disease

The link between triglycerides and heart disease is being studied. But many people with high triglycerides also have other risk factors, like high LDL levels or low HDL levels.

What causes elevated triglyceride levels?

High triglyceride levels may be caused by health conditions like diabetes, hypothyroidism, kidney disease, or liver disease. Dietary causes of high triglyceride levels may include drinking a lot of alcohol, and eating foods containing cholesterol, saturated fat, and trans fat.

Cholesterol Disorders

Alternative names: Hyperlipidemia, Hyperlipoproteinemia, Hypolipidemia, Hypolipoproteinemia

What are cholesterol disorders?
What are the signs of cholesterol disorders?
What causes cholesterol disorders?
How does my doctor tell if I have a cholesterol disorder?
How are cholesterol disorders treated?

What are cholesterol disorders?

Cholesterol is essential for life, and is found in the body cells of all animals, including humans. Your body needs cholesterol to work properly. Two cholesterol disorders are hyperlipidemia, and hypolipidemia.

Hyperlipidemia means you have an unusually high level of fat (lipids) in your blood. This puts you at risk for many health problems, including heart attack and stroke. It is sometimes called high blood cholesterol.

Hypolipidemia means you have an unusually low level of fat in your blood. It is sometimes called low blood cholesterol.

What are the signs of cholesterol disorders?

In a patient with high blood cholesterol, LDL cholesterol builds up in the inner walls of the arteries that carry blood to the heart and brain. Although many people with high cholesterol levels have no symptoms, this narrowing of the arteries (arteriosclerosis) can cause angina (chest pain), heart attack, and stroke.

Low blood cholesterol rarely causes symptoms, but it may indicate the presence of another disorder.

What causes cholesterol disorders?

High blood cholesterol

When you eat meat, eggs, and dairy products – any food that comes from an animal – you are adding cholesterol to your blood. A diet high in saturated fat and cholesterol is just one thing that may cause high blood cholesterol. Other factors include:

  • Being overweight
  • Not exercising regularly
  • Overuse of alcohol
  • Family history. High blood cholesterol can be an inherited condition.
  • Age and sex. As you age, your LDL (“bad cholesterol”) level rises. After age 55, women have higher LDL levels than men.
  • Diseases like diabetes, hypothyroidism, Cushing’s syndrome, and kidney failure
  • Medications like birth control pills, beta-blockers, estrogen, corticosteroids, and certain diuretics

Low blood cholesterol

Hypolipidemia can be caused by several things:

  • Hypothyroidism
  • Anemia (a low amount of red blood cells)
  • Malnutrition, or a lack of food
  • Liver disease
  • The body being unable to absorb food (malabsorption)
  • Rare genetic conditions, such as hypobetalipoproteinemia and abetalipoproteinemia
  • Tangier disease

How does my doctor tell if I have a cholesterol disorder?

Blood cholesterol tests tell how much fat is in your blood. A total cholesterol level test measures both your LDL (low-density lipoprotein, or “bad cholesterol,”) and HDL (high-density lipoprotein, or “good cholesterol”) levels in milligrams per deciliter (mg/dL).

Normal total cholesterol levels are below 200 mg/dL. HDL levels should be above 40 mg/dL. Triglyceride levels also should be below 200 mg/dL.

How are cholesterol disorders treated?

High blood cholesterol

Lifestyle

    To reduce cholesterol in your blood:

  • Follow a healthful diet, eating foods low in total fat and saturated fat
  • Maintain a healthful weight
  • Exercise at least three times a week, for 30 minutes at a stretch
  • Have your total cholesterol rechecked in one to two years if:
    • Your cholesterol reading was above 240 mg/dL
    • You have other risk factors for heart disease, such as high blood pressure, diabetes, or being overweight

Medications

  • Statins lower LDL (“bad cholesterol”) levels
  • Bile Acid Sequestrants (seh-KWES-trants) are sometimes prescribed with statins, and help lower LDL cholesterol levels
  • Nicotinic (Nick-o-tin-ick) Acid lowers LDL cholesterol and triglycerides, and raises HDL (“good” cholesterol) levels
  • Fibrates lower triglyceride levels, and may increase HDL levels
  • Ezetimibe blocks cholesterol absorption, and lowers LDL cholesterol

Low blood cholesterol

Treatment focuses on the root causes of hypolipidemia

Disclaimer

Serum cholesterol is a significant and independent mortality predictor in liver cirrhosis patients

Background and Aim. Accurate assessment of cirrhotic patient’s prognosis is essential for decisions regarding the course of treatment. Therefore we aimed to confirm and quantify the predictive value of serum cholesterol and serum triglycerides in liver cirrhosis patients.

Material and methods. We performed a retrospective observational cohort study on consecutive patients with liver cirrhosis (n = 191). Relevant clinical and laboratory variables were obtained from patients‘ charts and patients were followed for two months. Mortality was the main outcome.

Results. Thirty-eight patients died in the follow-up period. Significant difference was observed in the level of total serum cholesterol between surviving and deceased patients (2.27 ± 1.02 mmol/L vs. 2.97 ± 1.00 mmol/L, P < 0.0001 respectively). Cholesterol was confirmed as a significant predictor of mortality in univariate logistic regression analysis, and independent predictor beside bilirubin, creatinine and MELD score in multivariate logistic regression analysis. Addition of serum cholesterol level to a prognostic model based on total bilirubin, creatinine and INR increased its accuracy by 4%. Adding cholesterol to the MELD score improved prediction accuracy by 3%. There was no significant difference in serum levels of triglycerides between surviving and deceased patients.

Conclusion. Serum cholesterol is a routinely measured parameter, which has independent prognostic value in patients with liver cirrhosis.

Experimental Drug Reverses Fatty Liver Disease, Cuts Cholesterol

Researchers at Yale School of Medicine have announced that an experimental drug reversed a condition in nonhuman primates that is a precursor to heart disease and type 2 diabetes (T2D), while also driving down levels of low-density lipoprotein (LDL) cholesterol.
The drug, called controlled-release mitochondrial protonophore (CRMP), works by activating mitochondria in the liver to mediate metabolic syndrome and other related abnormalities. CRMP successfully caused the liver to use excess energy, causing protons to flow from the mitochondria, but without the same chemical effect on the body that would normally occur when the mitochondria are activated.
In the Yale study, CRMP therapy reversed non-alcoholic fatty liver disease (NAFLD), a condition that has been on the rise among Americans as obesity rates have increased. When this condition progresses, it can result in liver cell damage, or nonalchoholic steatohepatitis (NASH). Right now there are no approved therapies for NAFLD, according to the National Institutes of Health. However, there have been studies involving existing therapies to treat NAFLD.
Last year, results from the E-LIFT trial appeared in Diabetes Care, and showed that empagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, reduces liver fat. The study’s author, Mohammad Shafi Kuchay, MBBS, MD, said at the time that the E-LIFT results and other data suggest that patients diagnosed with T2D who also have NAFLD should be treated first with empagliflozin (Jardiance, from Eli Lilly and Boehringer-Ingelheim).
In this study, the researchers used positional isotopomer nuclear magnetic resonance tracer analysis to show that treatment with 5 mg/kg of CRMP increased the rate of hepatic mitochondrial fat oxidation by 40%. After 6 weeks, the obese rhesus macaques treated with CRMP saw lower liver triglycerides that happened independent of changes in body weight, body temperature, changes in food intake, or any adverse reactions. The treatment was also associated with a 20% to 30% drop in fasting plasma triglycerides and LDL cholesterol in the nonhuman primates who had insulin resistance, the researchers reported.
“Lifestyle changes such as diet and exercise are still the primary course of treatment for metabolic syndrome, NAFLD, and type 2 diabetes, but in most cases this approach is not effective in the long run so there is a great need for novel therapies,” senior author Gerald I. Shulman, professor of cellular and molecular physiology at Yale School of Medicine, said in a statement.
Funding for the study came from the National Institutes of Health and Gilead Sciences.
Reference
Goedeke L, Peng L, Montalvo-Romeral V, et al. Controlled-release mitochondrial protonophore (CRMP) reverses dyslipidemia and hepatic steatosis in dysmetabolic nonhuman primates. Science Transl Med. 2019;11(512):eaay0284. doi:10.1126/scitranslmed.aay0284.

LDL: The “Bad” Cholesterol

Cholesterol is a waxy, fat-like substance that’s found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are LDL and HDL?

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

  • LDL stands for low-density lipoproteins. It is sometimes called the “bad” cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
  • HDL stands for high-density lipoproteins. It is sometimes called the “good” cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

How can a high LDL level raise my risk of coronary artery disease and other diseases?

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Since your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

How do I know what my LDL level is?

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

  • The first test should be between ages 9 to 11
  • Children should have the test again every 5 years
  • Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

  • Younger adults should have the test every 5 years
  • Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What can affect my LDL level?

Things that can affect your LDL level include

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise
  • Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
  • Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
  • Smoking. Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
  • 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.
  • Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
  • Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV/AIDS medicines, can raise your LDL level.
  • Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV/AIDS can cause a higher LDL level.
  • Race. Certain races may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than whites.

What should my LDL level be?

With LDL cholesterol, lower numbers are better, because a high LDL level can raise your risk for coronary artery disease and related problems:

LDL (Bad) Cholesterol Level LDL Cholesterol Category
Less than 100mg/dL Optimal
100-129mg/dL Near optimal/above optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very High

How can I lower my LDL level?

There are two main ways to lower your LDL cholesterol:

  • Therapeutic lifestyle changes (TLC). TLC includes three parts:
    • Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples of eating plans that can lower your cholesterol include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
    • Weight Management. If you are overweight, losing weight can help lower your LDL cholesterol.
    • Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
  • Drug Treatment. If lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. The medicines work in different ways and can have different side effects. Talk to your health care provider about which one is right for you. While you are taking medicines to lower your cholesterol, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

Health Problems That Raise Cholesterol Levels

More than 73 million American adults have high cholesterol, according to the Centers for Disease Control and Prevention (CDC), but no two cases of high cholesterol are exactly alike.

Many people have high cholesterol because of physical inactivity or a diet too high in saturated fats, or because it runs in the family. But having other health conditions can also cause high cholesterol levels, especially conditions that affect your metabolism, such as diabetes (high blood sugar) or hypothyroidism (an underactive thyroid).

High Cholesterol: The Big Picture

When the body’s metabolism — the process by which the body turns food into energy — is affected by a health problem, cholesterol levels in the blood are often affected, too. Figuring out the best way to treat high cholesterol starts with understanding why it’s happening; identifying other health problems is a primary consideration.

“When we see people who come in for assessment of an elevated form of LDL cholesterol or triglycerides, we always want to look for associated metabolic abnormalities,” says cardiologist Stephen J. Nicholls, PhD, professor of cardiology at the University of Adelaide in Australia.

High cholesterol treatment is about “managing not just one risk factor in our patients, but the whole picture,” says Dr. Nicholls. “It’s often important to keep that in mind when you’re looking at a patient and their cholesterol levels.”

Health Conditions That Lead to High Cholesterol

A number of health conditions can lead to high cholesterol levels, and high cholesterol is a major risk factor for heart disease, including heart attack. Knowing your risk is the first step to prevention.

Health conditions known to increase cholesterol levels include:

  • Diabetes (insufficient production of the hormone insulin)
  • Obesity
  • Kidney disease
  • Cushing syndrome (an excess production of hormones)
  • Hypothyroidism (an underactive thyroid)
  • Liver diseases including cirrhosis and nonalcoholic steatohepatitis
  • Alcoholism

These health conditions raise cholesterol levels for different reasons. First, the levels of cholesterol and triglycerides in the blood essentially reflect the body’s metabolism of the fat that we eat in a day, says Nicholls.

“Diabetes and thyroid disorders can affect the way we metabolize cholesterol and triglycerides,” which then has a direct effect on triglyceride and cholesterol levels in the blood, he says. So when these conditions slow down metabolism, the body isn’t able to process everything it needs to, including fats and cholesterol.

In conditions like alcoholism and liver disease, the liver is not functioning at full capacity, so it can’t metabolize all of the saturated fat from the diet and the cholesterol that the body produces. Because of this, cholesterol builds up in the blood, Nicholls explains.

How to Prevent High Cholesterol

If you have any of the health conditions listed above, you’re at risk for developing high cholesterol — but you can take steps to prevent it. Getting regular exercise and improving your diet by reducing your intake of foods high in saturated fat (like butter, full-fat dairy, and fats from animal products) can go a long way to keep cholesterol levels down and protect your heart health.

Discuss your risk of high cholesterol with your doctor. Monitoring your cholesterol levels with a simple blood test is important for getting to a healthy goal and lowering your risk of heart attack. Your doctor may recommend that you take a cholesterol-lowering medication, if needed, to get to the cholesterol level that’s best for you to keep your risk of heart disease as low as possible.

Why Cholesterol Matters for Women

What’s more, many women are at risk for high cholesterol and don’t realize it. “Approximately 45 percent of women over the age of 20 have a total cholesterol of 200 mg/dl and above, which is considered elevated — but a survey by the American Heart Association found that 76 percent of women say they don’t even know what their cholesterol values are,” Michos says.

Scarier still: Triglycerides, a type of blood fat typically measured alongside cholesterol, are even more risky in women compared with men. This is a problem because women’s cholesterol levels can fluctuate quite a bit after menopause and tend to increase with age, putting us at greater risk of heart disease and stroke. Knowing your cholesterol numbers and how to control them is a big step toward staying healthy.

Understanding the Highs and Lows of Cholesterol

You know that too much is dangerous. But what is cholesterol, anyway? Where does it come from? And is it all bad?

Cholesterol is a waxy substance that is found in every cell in the body. It’s either made by the body or absorbed from food. Your body needs cholesterol to make important steroid hormones such as estrogen, progesterone and vitamin D. It’s also used to make bile acids in the liver; these absorb fat during digestion.

So some cholesterol is necessary. Problem is, you can have too much of a good thing. Excess cholesterol in the bloodstream can deposit into the body’s arteries. These deposits are called plaques and result in atherosclerosis, or hardening of the arteries. This is the major cause of heart attacks, strokes and other vascular problems.

Your total cholesterol level is a measure of the total amount of cholesterol circulating in your bloodstream, which includes two major components:

  • LDL cholesterol: LDL stands for “low-density lipoprotein.” This is known as the “bad” cholesterol, which directly contributes to plaque buildup in the arteries.
  • HDL cholesterol: HDL stands for “high-density lipoprotein.” It has been called “good” cholesterol because experts think it might help the body get rid of LDL cholesterol.

So bits of this stuff circulate through your system, and here’s what happens: The bad parts – the LDL particles – like to stick to the lining of your arteries, like soap scum in pipes. As it sticks there, it generates an inflammatory response and your body starts converting it into plaque. Plaque in your blood vessels makes them stiffer and narrower, restricting blood flow to vital organs such as your brain and heart muscle, leading to high blood pressure. Additionally, chunks can break off and cause a heart attack or a stroke. And guess what? This buildup can start as early as your 20s.

What to Know About Triglycerides

In addition to cholesterol, you might hear your doctor mention triglycerides, another kind of fat found in the bloodstream. Women should pay particular attention to this. “A high level of triglycerides seems to predict an even greater risk for heart disease in women compared with men,” says Michos.

When you take in more calories than you need, your body converts the extra calories into triglycerides, which are then stored in fat cells. Triglycerides are used by the body for energy, but excess triglycerides increase the risk of heart disease. Drinking a lot of alcohol and eating foods containing simple carbohydrates (sugary and starchy foods), saturated fats and trans fats contributes to high triglycerides. High levels may also be caused by health conditions such as diabetes, an underactive thyroid, obesity, polycystic ovary syndrome or kidney disease.

Triglycerides also circulate in the bloodstream and contribute to plaque formation. Many people with high triglycerides have other risk factors for atherosclerosis, including high LDL levels or low HDL levels, or abnormal blood sugar (glucose) levels. Genetic studies have also shown some association between triglycerides and cardiovascular disease.

Take a look at your lifestyle

Odds are, there are lifestyle changes you can make to improve your cholesterol numbers. That’s true because, more often than not, unhealthy behaviors are the main culprits behind high cholesterol.

Your body naturally produces all the LDL (bad) cholesterol it needs. An unhealthy lifestyle – not enough exercise, too many unhealthy foods – makes your body produce more LDL cholesterol than it needs. This is the cause of high LDL cholesterol for most people.

Behaviors that can negatively affect your cholesterol levels include:

  • Unhealthy diet
  • Lack of physical activity
  • Smoking or exposure to tobacco smoke
  • Excess weight

Stopping or reversing these unhealthy lifestyle factors can help improve your cholesterol numbers.

How to prevent and treat high cholesterol.

Heredity can play a role

Some people inherit genes from their mother, father or even grandparents that cause them to have too much cholesterol. This is called familial hypercholesterolemia. The severity of FH is related to the duration and degree of LDL cholesterol in the blood. FH is dangerous because it can cause premature atherosclerotic heart disease.

If your cholesterol numbers are concerning, check your family history for problems related to high cholesterol.

Make the changes worth making

If you have high blood cholesterol, making lifestyle modifications is a great first step to lower your risk of heart disease. If those steps don’t reduce your risk enough, your doctor may prescribe medications to help.

Remember: Making even modest changes now can help to prevent significant medical challenges later. Do all that you can to reduce your risk for the serious consequences of heart attack and stroke.

Lowering LDL Cholesterol

Do you know your cholesterol numbers? They are too high for more than half of all American adults. The culprit is LDL cholesterol—low-density lipoproteins, the bad kind—in their blood. Manufactured by the liver, cholesterol is a critical building block of cell walls, hormones, and digestive juices. But overly high LDLs are a major cardiovascular risk. Along with liquified fat, dead cells, and other cellular trash, they can form deposits within the walls of the coronary arteries; as these deposits, or plaques, grow, they may bulge into the artery, interfering with blood flow. If one ruptures and a clot forms, a heart attack or stroke is likely. If you haven’t had your cholesterol checked with a quick blood test, now would be a good time. Adults are advised to get their levels tested at least once every five years.

Reducing the risk from high LDLs can be accomplished in either of two ways: by lowering the amount of LDLs produced by the body, or by increasing the rate at which LDLs are sent back to the liver to be destroyed. Statins and other drugs can reduce LDL production by as much as 70 percent. Dietary changes usually produce less-dramatic effects but are important, especially cutting back on foods high in saturated fats, which promote LDL formation. Limiting high-cholesterol foods like egg yolks and liver helps, but isn’t likely to make a big dent. Speeding up the rate of getting LDLs out of circulation relies on pushing up the level of HDLs—high-density lipoproteins, the good cholesterol—because shuttling LDLs back to the liver is their main job. But raising good cholesterol is much harder than lowering the bad variety. Want details on reducing your LDLs and bumping up your HDLs? Keep reading.

This section has more information on:

  • Lowering LDL Cholesterol Without Drugs
  • 10 Ways to Lower LDL and Raise HDL
  • Lowering LDL Without Drugs

    Joseph Keenan, a cardiology researcher and professor emeritus at the University of Minnesota, has a love-hate relationship with statins. On the one hand, he prescribes them to many patients. On the other, he can’t use them to control his own dangerously high cholesterol. Like many of the 25 percent or so of patients prescribed statins who abandon them within six months, Keenan has had unpleasant side effects, such as muscle spasms, and blood tests indicate muscle damage. “It came as a shock,” he says of finding out he’d have to do without his Lipitor.

    What recourse do people like Keenan have? Some doctors, such as Steven Nissen of the Cleveland Clinic, are so convinced of statins’ lifesaving power that they first require patients to try all six before considering them intolerant. Next, patients might try a nonstatin drug such as Zetia, which lowers cholesterol by inhibiting its absorption in the intestine. But there are other weapons besides drugs in the cholesterol wars. For those intolerant of statins—and for people taking them as well—the following strategies can help defeat unhealthy cholesterol.

    Diet. The foundation of any cholesterol-lowering regimen is a balanced diet. That doesn’t mean you have to buy only products whose labels scream “low cholesterol.” In fact, says Christopher Gardner, a researcher at Stanford University who specializes in nutrition, a varied diet that emphasizes plants, fish, legumes, whole grains, and fruits is significantly better at lowering problematic cholesterol than a more conventional diet of prepared foods equally low in saturated fats and cholesterol. Why? Components of plant-based diets actively interact to improve cholesterol profiles, he suggests. That said, you’ll still want to limit your intake of red meat, eggs, and cheese.

    The so-called Mediterranean diet, the dash (Dietary Approaches to Stop Hypertension) diet, and the Ornish Diet (which is particularly low in meat and dairy) are variations on this approach. One study found that a balanced diet did just as well as a statin at reducing bad cholesterol. Dean Ornish, the founder of the Preventive Medicine Research Institute in Sausalito, Calif., has shown that his multipronged approach (diet, exercise, stress reduction, and social support), while not easy to maintain, can lower LDL by nearly 40 percent and even cause plaques in arteries to shrink—which not even statins have been proven to do.

    Exercise. Regular exercise is also critical. Some studies show that regular aerobic exercise for a period of about 12 weeks can modestly increase beneficial HDL cholesterol—between 5 and 10 percent, and more for some people. Your triglyceride level and blood pressure should respond, too. Shoot for at least 30 minutes of moderate aerobic exercise five to seven days a week.

    Supplements. Natural food stores and the Internet are awash with products claiming to improve cholesterol profiles. For most, there is little or no evidence of an effect on cholesterol levels (though some—Omega-3 fatty acids, for example—have not been studied rigorously enough to say definitely that they don’t work).

    Notable exceptions worth exploring include niacin, plant sterols, and soluble fiber supplements. Though niacin can raise blood sugar and cause flushing, a daily dose can raise HDL levels by 15 to 35 percent and lower LDL levels by about 20 percent. Niacin has a risk of side effects, however, especially when combined with a statin. A daily serving of plant sterols (about 2 grams), in fortified foods such as margarine, orange juice, and rice milk, can also lower LDL by about 15 percent. Eating plenty of soluble fiber, which occurs naturally in products such as oats, nuts, flax, and psyllium husk and in dietary supplements such as Metamucil, can also drop LDL. Red rice yeast, a popular dietary supplement, also works. But be warned that it contains lovastatin, the active ingredient in Mevacor, a prescription statin, and is “essentially an unregulated statin,” says Robert Vogel, a cardiologist at the University of Maryland.

    Lifestyle interventions often don’t work nearly as well as a statin can. Exercise, a better diet, and supplements can generally reduce bad cholesterol by 20 to 40 percent, compared with 60 to 70 percent for statins. But Keenan estimates that 70 percent of people with problematic cholesterol levels could gain control with lifestyle changes alone. He has. His LDL levels are down by about 60 percent thanks to diet, exercise, niacin and other supplements. That’s as good a job, he says, as Lipitor did.

    By Adam Voiland, 2/6/2008

    10 Ways to Lower LDL and Raise HDL

    Your doctor tells you that your level of LDL—the “bad” type of cholesterol—is too high, and, in a double whammy, he says that your level of HDL—the “good” cholesterol—is too low. So, you wonder, is there anything you can do to decrease the bad while increasing the good?

    There are steps you can take to accomplish this. It’s much easier to push LDL down than to push HDL up, but it’s well worth the effort to strive to do both. A November study published in the Postgraduate Medical Journal found that increasing HDL levels in patients who are also aggressively lowering their LDL levels can reduce cardiovascular risk. An HDL level of 60 milligrams per deciliter or higher is believed to help protect against heart disease. Women’s risk for heart disease rises significantly at HDL levels below 47 mg/dL; men are at particular risk if their HDL level falls below 37 mg/dL.

    For LDL, a reading of 190 mg/dL or higher is considered to be very high, 160 to 189 is considered to be high, and 130 to 159 is considered to be borderline high. A level of 100 to 129 is considered to be near optimal; less than 100 is considered optimal for most people. But for those who are at very high risk for heart disease or have a history of heart trouble, a reading of less than 70 is preferred.

    Depending on your cholesterol levels, successfully reaching your target levels will probably take a combination of medication and lifestyle and dietary changes. Among the changes you’ll have to make: Stop smoking, work out, lose weight, and eat well, the PMJ study suggests.

    If you’re up to the task, here are 10 ways to lower your LDL and raise your HDL:

    1. Taking a statin can lower LDL by 10 percent (at the lowest dose) to 55 percent (at the highest dose), says Robert H. Eckel, professor of medicine at the University of Colorado-Denver and past president of the American Heart Association. A small percentage of people who take statins experience severe myopathy, which is muscle discomfort or weakness. Statins also bump up HDL, typically by 5 to 10 percent (that’s only 2 to 4 mg/dL, not enough to make much of a difference). Other types of cholesterol-lowering medications are sometimes prescribed in combination with statins.

    2. A cholesterol absorption inhibitor would be a likely next step for those who can’t take statins because of side effects, Eckel says. There is only one such drug—ezetimibe (Zetia). A 2003 study in the journal Pharmacotherapy found that when given alone or in combination with other cholesterol-lowering medications, ezetimibe reduced LDL by 15 to 20 percent and raised HDL, but, as with a statin, not by much—2.5 to 5 percent.

    3. Bile acid sequestrants can decrease LDL by about 10 to 20 percent, according to the National Heart, Lung, and Blood Institute. When combined with a statin, these medications can lower LDL by more than 40 percent. Medications in this class—cholestyramine, colestipol, and colesevelam—come in pill or powder form. The powder must be mixed with water or juice before being taken. These drugs offer an added benefit for diabetics: Recent research has shown they help to lower blood glucose levels.

    4. Nicotinic acid, also known as niacin, is a water-soluble B vitamin that lowers LDL by 10 to 20 percent and is the only drug that can have a real impact on HDL, says Eckel. According to the NHLBI, it can lift HDL levels by 15 to 35 percent. A study published this month in Current Medical Research and Opinion says that niacin and fibrates (explained below) are underutilized—either alone or in combination with statins—to treat low HDL and high triglycerides (a kind of fat in the blood). Because most people who take niacin experience flushing of the skin and a warm feeling, particularly on the face, neck, and ears, up to half of those taking the medication choose to stop it, according to the Mayo Clinic.

    5. Fibrates are mostly effective at lowering triglycerides and in heightening HDL levels, according to NHLBI. These drugs usually lower LDL by 10 to 20 percent, Eckel says. For those who take this type of medication, HDL increases are usually in the neighborhood of a modest 10 to 15 percent.

    6. Lose weight. This can lower LDL, though levels will go back up unless you make lasting dietary changes, Eckel says. Aim to lose 10 percent or more of your body weight. Keep in mind that while you’re losing weight, your HDL levels may fall, Eckel warns. But as you maintain your new body weight, your HDL will increase as long as you’ve lost at least 10 percent of your body weight. Try U.S. News’s 10-week workout routine to help you get started, and avoid these 7 mistaken beliefs that can prevent weight loss.

    Exercise itself can raise HDL, although usually not by a meaningful amount. “For sedentary people with low HDL cholesterol and heart disease, even a little bit of exercise can raise it—but not by a lot,” Eckel says. “For the average Susan or Joe, moderate aerobic activity needs to be accompanied by a change in body composition—less fat—to increase HDL.” There are a few caveats: Women who have abnormal menstrual periods have minimal increases in HDL, and too much resistance training may actually lower HDL cholesterol if not accompanied by some aerobic training.

    7. Limit saturated fats. Eating saturated fats—which are the main diet-linked cause of high cholesterol—tends to raise your HDL, but it also increases your LDL. These fats are mostly found in animal foods such as beef, lamb, poultry, pork, butter, cream, and milk, and in coconut and coconut oil, palm and palm kernel oil, and cocoa butter. “We think the bad cholesterol is more of a concern than the good cholesterol,” says Eckel, so it’s important to limit consumption of saturated fats. The American Heart Association recommends limiting saturated fat intake to less than 7 percent of your total daily calories. “A reduction in saturated fats by a moderate amount will reduce LDL,” Eckel says.

    8. Avoid trans fats, which have been purged from many prepared foods but are found in small quantities in some animal products. They also are formed during the hydrogenation process of making margarine, shortening, and cooking oils. Trans fats can increase LDL and decrease HDL. Vegetable oils that are partially hydrogenated are the source of about 75 percent of trans fatty acids in the American diet, according to the AHA. It’s easier now to find foods that contain little to no trans fats, as more attention is paid to how trans fats affect people’s health. Many restaurants are making an effort, and New York City and California have banned trans fats.

    As a rule, try to limit your intake of trans fats to less than 1 percent of your total calories on any given day, the AHA suggests. Read the nutrition facts label when you buy food to keep an eye on how much trans fat you’re consuming. “Look at the ingredients, and if ingredients say hydrogenated or partially hydrogenated, there are trans fats in there,” says Barry Franklin, director of cardiac rehabilitation at the William Beaumont Hospital in Royal Oak, Mich.

    9. Have an occasional drink. Drinking alcohol increases HDL levels slightly but doesn’t decrease LDL, according to NHLBI. Because drinking too much alcohol can result in alcoholism, damage to the liver and the heart muscles, high blood pressure, and high triglyceride levels, among other problems, it’s important to limit consumption. Men and women who consume alcohol should do so in moderation, which means one to two drinks daily for men and one drink for women, the AHA suggests.

    10. Quit smoking. There are plenty of reasons to stop, but one that’s not widely known is that smoking has been shown to decrease HDL levels. Smoking also makes it harder to work out, which means it is less likely you’ll reach healthful cholesterol goals. And that’s not all. Consider these other reasons why you should stop smoking right now.

    By January W. Payne, 5/27/2009

    More Articles on Cholesterol:

  • Does My Kid Really Need a Cholesterol Test?
  • Statins for Prevention? Taking a Cholesterol-Lowering Drug When Cholesterol Is Normal
  • 2 Ways to Lower Your Child’s Cholesterol Without Statins
  • The Skinny on Fats: What the Latest Research Says About What You Should Be Eating
  • The Cardiologist’s Perspective on Cholesterol
  • The Smart Take on Statins
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