High Cholesterol and Heart Disease—Causes, Risks and Treatment
High Cholesterol, Just The Facts
Every day, millions of Americans live with cholesterol levels that could put them at risk for heart attack or stroke. In fact, less than 1 in 3 adults with high LDL “bad” cholesterol have the condition under control, and less than half (48%) are receiving treatment to lower LDL levels. Individuals with high cholesterol levels are twice as likely to develop heart disease than those with normal numbers. This is a frightening statistic, given the fact that heart disease is the number one killer in the United States, even ahead of cancer and diabetes.
High Cholesterol In The Making
What is cholesterol and why do we need it?
Contrary to popular belief, cholesterol is not inherently a bad thing. In fact, our bodies need this soft, waxy, fat-like substance, contained in each of our cells. Cholesterol is necessary to produce cell membranes, important hormones, vitamin D, and certain substances such as bile acids that aid in the digestion of fat. Beyond that, cholesterol is also needed for memory formation and neurological function. While the body is able to create all the cholesterol it needs on its own, food consumed also contains the fat-like substance. Cholesterol is easily carried through the bloodstream by lipoproteins made up of fat and proteins.
Types of Cholesterol, The Good, The Bad, The Ugly
Two types of lipoproteins exist, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Both deliver cholesterol to and from cells. While a healthy balance of both types of cholesterol is actually optimal, LDL cholesterol is often referred to as “bad cholesterol”. This is because low-density lipoprotein leads to plaque build up in arteries and a condition known as atherosclerosis. Plaque build up causes a narrowing of the arteries, which could lead to heart attack, stroke, or peripheral artery disease. High-density lipoprotein, or HDL is known as “good cholesterol” because of its ability to act as a scavenger, carrying bad cholesterol out of arteries and to the liver. Once there, it can be broken down and released from the body.
Triglycerides are also linked to fat build up in artery walls and are the most common type of fat circulating in the blood, from excess energy provided by the diet. When combined with low HDL or high LDL, the risk of heart attack and stroke multiplies.
How Does High Cholesterol Cause Heart Disease?
When too much of the waxy substance, cholesterol circulates in the blood, it begins to stick to artery walls causing a build up that hardens. When this occurs, arteries restrict oxygen carrying, blood flow to the heart and can eventually block it altogether. When it is restricted, chest pains may occur. If it is blocked, however, a heart attack will result. The build up of plaque in the arteries begins in childhood and continues through adulthood, lining the walls with the sticky substance that eventually hardens. Because the process is so gradual, many people don’t recognize the serious medical condition created, until it’s too late.
What Factors Affect High Cholesterol Levels?
There are many factors that impact cholesterol levels. Some of these are within the control of individuals, while others are not.
- Diet—Certain fats such as saturated fat, and cholesterol from foods consumed, cause LDL cholesterol levels in the blood to rise. By reducing these in the diet, “bad” blood cholesterol levels decrease. By adding foods that naturally raise “good” HDL levels, total cholesterol levels improve.
- Weight—Excess weight not only increases the risk of heart disease, but further increases “bad”cholesterol levels as well. By losing weight, low-density lipoprotein (LDL) levels, total cholesterol levels, and triglyceride levels can be reduced, and high-density lipoproteins can be increased
- Physical Activity—Sedentary lifestyles put individuals at higher risk for heart disease. Regular physical activity can lower LDL cholesterol and raise HDL cholesterol levels significantly. Just 30 minutes of physical activity daily can not only help individuals lose weight, but also fight against heart disease.
Other factors that seriously affect blood cholesterol levels include:
- Age and Gender—As we age, cholesterol levels rise naturally. Although plaque build up begins in childhood, adults are the usual recipients of its negative effects. Before the onset of menopause, women generally have lower total cholesterol levels than men. After menopause however, women’s low-density lipoprotein levels tend to rise.
- Heredity—Genetics play an important role in the amount of cholesterol our bodies make. High cholesterol can run in families.
Cholesterol Levels and Ranges
The following numbers, as represented by the National Heart, Lung, and Blood Institute, help individuals compare and monitor cholesterol levels, as well as gauge risk for heart disease.
|Total Cholesterol Level||Category|
|Less than 200 mg/dL||Desirable|
|200-239 mg/dL||Borderline High|
|240 mg/dL and above||High|
* Cholesterol is measured in milligrams (mg) per deciliter (dL) of blood.
|LDL Cholesterol Level||LDL Cholesterol Category|
|Less than 100 mg/dL||Optimal|
|100-129 mg/dL||Near optimal/above optimal|
|130-159 mg/dL||Borderline High|
|190 mg/dL and above||Very High|
*Triglycerides can raise the risk of heart disease in individuals. Levels above 150 mg/dl may require treatment.
Treating High Cholesterol, Naturally and Medically
Lifestyle—Changes including diet, weight control, exercise, and the cessation of smoking are an individual’s first line of defense in treating high cholesterol levels. For some, this may be enough to reduce LDL (bad cholesterol) and total cholesterol, while raising (HDL (good cholesterol) levels.
Many dietary approaches work to protect health, including the Mediterranean diet that incorporates fruits, vegetables, and fats that are healthy. Fiber-rich foods, low in sugar such as whole grains, legumes, and nuts, are also recommended for heart health as well.
Regular aerobic exercise, five days a week, for a duration of 30 minutes is beneficial to heart health. Resistance (weight) training in addition to aerobic exercise may be helpful as well.
Moderate alcohol intake (1-2 glasses per day) can help increase “good” HDL levels however; individuals with high triglyceride levels should limit use since alcohol can increase blood triglycerides.
Statins are a line of drugs often prescribed to treat high cholesterol in individuals. These may slow the rate of atherosclerotic progression, but do not actually reverse heart disease. Statins lower LDL levels and have some affect on lowering triglycerides and increasing HDL levels. Statins work by inhibiting liver enzymes, specifically, HMG-CoA reductase, used by the body to produce cholesterol.
Fibrates help break up the particles that come together to make triglycerides. They are not as effective as statins, but are an alternative choice for individuals who cannot tolerate statins well.
Bile-Acid Binding Resins
Bile-acid binding resins, essentially bind to bile in the digestive tract and excrete it from the body. The liver then extracts cholesterol from the bloodstream in order to produce more bile.
Ezetimibe (Zetia) is used to block cholesterol absorption from food.
Lovaza is an omega-3 fish oil, prescribed to lower triglycerides.
If you’re one of the millions of Americans living with high cholesterol or elevated triglyceride levels you cannot afford to ignore your numbers. By making permanent lifestyle changes that include a heart healthy diet, moderate regular exercise, and optimal weight control, you may not only lower your risk for future heart disease, but could avoid a life-threatening heart attack or stroke altogether.
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