Cholesterol is a waxy, fat-like substance found in every cell of the body. It is essential for the production of hormones, vitamin D, and substances that help digest food. The body gets cholesterol from two sources: the liver, which produces all the cholesterol the body needs, and dietary intake from animal foods.
Cholesterol is transported in the body by particles called lipoproteins (a type of cholesterol).
There are three main components of cholesterol:
1. Low-density lipoprotein (LDL)
Sometimes called “bad” cholesterol, LDL carries most of the cholesterol in the blood to be stored for future use. High levels of LDL cause cholesterol to build up on the walls of arteries, leading to plaque formation.
Too much LDL can lead to a buildup of cholesterol (plaque) on the walls of blood vessels, causing them to narrow or harden and restrict blood flow. This condition is called atherosclerosis.
Narrowing of the blood vessels leading to the heart can cause coronary artery disease, angina, and heart attacks. A heart attack occurs when plaque breaks off, separates from the blood vessel wall, and blocks an artery. Narrowing of the blood vessels leading to the brain can cause a stroke.
2. High-density lipoprotein (HDL)
Known as “good” cholesterol, HDL carries cholesterol from the body to the liver, where it is removed. The more HDL you have in your blood, the better protected you are from plaque buildup in your arteries.
When your HDL cholesterol is too low, harmful cholesterol stays in your arteries instead of being transported to the liver and eventually eliminated from your body.
3. Triglycerides (TC)
This is the most common type of fat in your body. Triglycerides have a dual function, both storing and transporting fat in your blood. When you eat too many calories (especially sugar and alcohol), they are stored as triglycerides.
Like LDL, excess triglycerides increase your risk of heart disease. High triglyceride levels are dangerous for your heart health because they increase the likelihood of hardening of the arteries, which increases your risk of heart disease, stroke, and heart attack.
Total cholesterol/HDL (TC/HDL) is the ratio used to measure your heart risk for total HDL cholesterol.
What should do if your cholesterol is too high?
There are two main tools for controlling cholesterol: medications and lifestyle changes. Making recommended lifestyle changes can improve your cholesterol by 5% to 10%, but medications have been shown to lower LDL-cholesterol by 20% to 55%. Therefore, medications are often required in combination with lifestyle changes, such as quitting smoking and increasing exercise.
Different types of medications lower LDL and triglycerides, raise HDL, and reduce the amount of cholesterol absorbed in the digestive system. A patient may be taking more than one cholesterol-lowering drug at the same time.
1. Cholesterol-lowering drugs
All patients with established coronary heart disease or diabetes should be treated with a statin. Statins are safe and effective for lowering cholesterol. Some patients may need a second drug.
2. Triglyceride-lowering drugs
The drug treatment guidelines for high triglycerides are not as clear as those for cholesterol. However, fibrates are the drugs of choice for lowering very high triglycerides in people with relatively normal cholesterol levels. The most potent fibrates can lower triglycerides by up to 40%. Statins are effective for both cholesterol and triglycerides. Successful treatment requires consistent blood sugar control in people with diabetes and avoidance of alcohol, oral estrogens, and retinoids.
3. Low HDL Treatment
The B vitamin niacin can increase HDL by 30% (and often increases the percentage even higher with long-term treatment). This is the most effective way to increase HDL levels.
Medication is usually prescribed if you are at high risk for CVD or if you are at average risk and have additional risk factors. If you have been prescribed medication, it is important to follow the plan your doctor has set up for you.
Remember:
- Never stop taking your medication just because you feel better.
- Write down any symptoms you may be experiencing so you can discuss them with your doctor.
- Keep track of your medications, especially if you take multiple pills. A pill card can help.
- Take your medications on time and regularly so they stay effective.
4. Lifestyle changes
For most people, medication alone is not enough. Most of your cholesterol comes from the foods you eat, but controlling your cholesterol involves more than just paying attention to what you eat.
Important lifestyle changes to lower cholesterol include:
- Eating a healthy diet high in fiber and low in saturated fat, trans fat, and cholesterol
- Losing weight
- Increasing exercise
- Quitting smoking
- Managing diabetes
