About Cholesterol

It may surprise you to know that cholesterol itself isn't bad. In fact, cholesterol is just one of the many
substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is
produced naturally (and can be affected by your family health history), while some of it comes from the
food we eat.

There are two types of cholesterol: "good" and "bad." It's important to understand the difference, and to
know the levels of "good" and "bad" cholesterol in your blood. Too much of one type — or not enough of
another — can put you at risk for coronary heart disease, heart attack or stroke.

Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make
about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat. Cholesterol is
only found in animal products.

A cholesterol screening measures your level of HDL and LDL. HDL is the "good" cholesterol which helps
keep the LDL (bad) cholesterol from getting lodged into your artery walls. A healthy level of HDL may
also protect against heart attack and stroke, while low levels of HDL (less than 40 mg/dL for men and less
than 50 mg/dL for women) have been shown to increase the risk of heart disease.

If you need to increase your HDL to your reach your goals, studies show that regular physical activity can
help your body produce more HDLs. Reducing trans fats and eating a balanced, nutritious diet is another
way to increase HDL. If these measures are not enough to increase your HDL to goal, your healthcare
practitioner may prescribe a medication specifically to increase your HDLs.

LDL cholesterol is the "bad" cholesterol. When too much of it circulates in the blood, it can clog arteries,
increasing your risk of heart attack and stroke.

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother,
father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and
dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family,
lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different,
so work with your doctor to find a treatment plan that's best for you.

Good vs. Bad Cholesterol

Cholesterol can't dissolve in the blood. It has to be transported to and from the cells by carriers called
lipoproteins. Low-density lipoprotein, or LDL, is known as "bad" cholesterol. High-density lipoprotein, or
HDL, is known as "good" cholesterol. These two types of lipids, along with triglycerides and Lp(a)
cholesterol, make up your total cholesterol count, which can be determined through a blood test.

LDL (Bad) Cholesterol

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of
the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick,
hard deposit that can narrow the arteries and make them less flexible. This condition is known as
atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result.

HDL (Good) Cholesterol

About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL
cholesterol is known as "good" cholesterol, because high levels of HDL seem to protect against heart
attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts
think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed
from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing
its buildup.
Triglycerides
Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity,
physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates
(60 percent of total calories or more). People with high triglycerides often have a high total cholesterol
level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or
diabetes also have high triglyceride levels.

Lp(a) Cholesterol
Lp(a) is a genetic variation of LDL (bad) cholesterol. A high level of Lp(a) is a significant risk factor for the
premature development of fatty deposits in arteries. Lp(a) isn't fully understood, but it may interact with
substances found in artery walls and contribute to the buildup of fatty deposits.

What Your Cholesterol Levels Mean

The American Heart Association endorses the National Cholesterol Education Program (NCEP)
guidelines for detection of high cholesterol: All adults age 20 or older should have a fasting lipoprotein
profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and
triglycerides — once every five years. This test is done after a nine- to 12-hour fast without food, liquids
or pills. It gives information about total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and
triglycerides.

Your test report will show your cholesterol levels in milligrams per deciliter of blood (mg/dL). To determine
how your cholesterol levels affect your risk of heart disease, your doctor will also take into account other
risk factors such as age, family history, smoking and high blood pressure.

A complete fasting lipoprotein profile will show the following four results.

Your Cholesterol Levels

Your Total Blood (or Serum) Cholesterol Level

Total Cholesterol Level Category

Less than 200 mg/dL Desirable level that puts you at lower risk for coronary heart
disease. A cholesterol level of 200 mg/dL or higher raises your risk.
200 to 239 mg/dL Borderline high
240 mg/dL and above High blood cholesterol. A person with this level has more than
twice the risk of coronary heart disease as someone whose
cholesterol is below 200 mg/dL.

Your HDL (Good) Cholesterol Level

HDL Cholesterol Level Category

Less than 40 mg/dL Low HDL cholesterol. A major risk factor for heart disease.
(for men)
Less than 50 mg/dL
(for women)

60 mg/dL and above High HDL cholesterol. An HDL of 60 mg/dL and above is
 considered protective against heart disease.

With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men,
less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL
cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An
HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease. The mean level of
HDL cholesterol for American adults age 20 and older is 54.3 mg/dL.

Smoking, being overweight and being sedentary can all result in lower HDL cholesterol. To raise your
HDL level, avoid tobacco smoke, maintain a healthy weight and get at least 30-60 minutes of physical
activity more days than not.

People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart
attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL
cholesterol levels. Female sex hormones raise HDL cholesterol levels.

Your LDL (Bad) Cholesterol Level

The lower your LDL cholesterol, the lower your risk of heart attack and stroke. In fact, it's a better gauge
of risk than total blood cholesterol. In general, LDL levels fall into these categories:

LDL Cholesterol Level Category

Less than 100 mg/dL Optimal

100 to 129 mg/dL Near or above optimal

130 to 159 mg/dL Borderline high

160 to 189 mg/dL High

190 mg/dL and above Very high

Your other risk factors for heart disease and stroke help determine what your LDL level should be, as well
as the appropriate treatment for you. A healthy level for you may not be healthy for your friend or
neighbor. Discuss your levels and your treatment options with your doctor to get the plan that works for
you. The mean level of LDL cholesterol for American adults age 20 and older is 115.0 mg/dL.

Your Triglyceride Level

Triglyceride is the most common type of fat in the body. Many people who have heart disease or diabetes
have high triglyceride levels. Normal triglyceride levels vary by age and sex. A high triglyceride level
combined with low HDL cholesterol or high LDL cholesterol seems to speed up atherosclerosis (the
buildup of fatty deposits in artery walls). Atherosclerosis increases the risk for heart attack and stroke.

Triglyceride Level Category

Less than 150 mg/dL Normal

150–199 mg/dL Borderline high

200–499 mg/dL High

500 mg/dL and above Very high

Many people have high triglyceride levels due to being overweight/obese, physical inactivity, cigarette
smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent or more of
calories). High triglycerides are a lifestyle-related risk factor; however, underlying diseases or genetic
disorders can be the cause. The mean level of triglycerides for American adults age 20 and older is 144.2
mg/dl.

The main therapy to reduce triglyceride levels is to change your lifestyle. This means control your weight,
eat a heart-healthy diet, get regular physical activity, avoid tobacco smoke, limit alcohol to one drink per
day for women or two drinks per day for men and limit beverages and foods with added sugars. Visit your
healthcare provider to create an action plan that will incorporate all these lifestyle changes. Sometimes,
medication is needed in addition to a healthy diet and lifestyle.

A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic
syndrome increases the risk for heart disease and other disorders, including diabetes.

Why cholesterol Matters

What Can Cholesterol Do?

High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and
stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk
factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even
more. The more risk factors you have, the greater your chance of developing coronary heart disease.
Also, the greater the level of each risk factor, the more that factor affects your overall risk.

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of
the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick,
hard deposit that can narrow the arteries and make them less flexible. This condition is known as
atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.
High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other
risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more.
Your cholesterol level can be affected by your age, gender, family health history and diet.

Atherosclerosis

Atherosclerosis is a type of arteriosclerosis. The name comes from the Greek words athero (meaning
gruel or paste) and sclerosis (hardness). It's the term for the process of fatty substances, cholesterol,
cellular waste products, calcium and fibrin (a clotting material in the blood) building up in the inner lining of
an artery. The buildup that results is called plaque.

Arteriosclerosis is a general term for the thickening and hardening of arteries. Some hardening of arteries
normally occurs when people grow older.

Plaque may partially or totally block the blood's flow through an artery. Two things that can happen where
plaque occurs are:

 There may be bleeding (hemorrhage) into the plaque.

 A blood clot (thrombus) may form on the plaque's surface.

If either of these occurs and blocks the whole artery, a heart attack or stroke may result.

Atherosclerosis affects large and medium-sized arteries. The type of artery and where the plaque
develops varies with each person.

Atherosclerosis is a slow, progressive disease that may start in childhood. In some people this disease
progresses rapidly in their third decade. In others it doesn't become threatening until they're in their 50s or
60s.

How does atherosclerosis start?

It's a complex process. Exactly how atherosclerosis begins or what causes it isn't known, but some
theories have been proposed. Many scientists think atherosclerosis starts because the innermost layer of
the artery becomes damaged. This layer is called the endothelium. Three possible causes of damage to
the arterial wall are:

 Elevated levels of cholesterol and triglyceride in the blood

 High blood pressure
 Cigarette smoke

Cigarette smoke greatly aggravates and speeds up the growth of atherosclerosis in the coronary arteries,
the aorta and the arteries of the legs.

Because of the damage, over time fats, cholesterol, platelets, cellular debris and calcium are deposited in
the artery wall. These substances may stimulate the cells of the artery wall to produce still other
substances. This results in more cells accumulating in the innermost layer of the artery wall where the
atherosclerotic lesions form. These cells accumulate, and many of them divide. At the same time, fat
builds up within and around these cells. They also form connective tissue.

The innermost layer of the artery becomes markedly thickened by these accumulating cells and
surrounding material. If the wall is thickened sufficiently, the diameter of the artery will be reduced and
less blood will flow, thus decreasing the oxygen supply.
Often a blood clot forms and blocks the artery, stopping the flow of blood. If the oxygen supply to the
heart muscle is reduced, a heart attack can occur. If the oxygen supply to the brain is cut off, a stroke can
occur. And if the oxygen supply to the extremities occurs, gangrene can result.

Understand Your Risk for High Cholesterol

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother,
father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and
dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family,
lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different,
so work with your doctor to find a treatment plan that's best for you.

Woman and Cholesterol

The female sex hormone estrogen tends to raise HDL cholesterol, and as a rule, women have higher HDL
(good) cholesterol levels than men do. Estrogen production is highest during the childbearing years. This
may help explain why premenopausal women are usually protected from developing heart disease.

Women also tend to have higher triglyceride levels. Triglyceride levels range from about 50 to 250 mg/dL,
depending on age and sex. As people get older, more overweight or both, their triglyceride and
cholesterol levels tend to rise.

Postmenopausal hormone therapy (PHT) may benefit some women with osteoporosis or other medical
conditions associated with menopause. However, the American Heart Association recommends that PHT
not be used for cardiovascular prevention. The HERS trial of women who had previously had a heart
attack showed that these women did not benefit from PHT. Recent clinical trials appear to confirm that
PHT does not appear to reduce risk of cardiovascular disease and stroke in postmenopausal women.
Women with a personal or family history of breast cancer or other endocrine-related cancers should not
receive PHT either.

The American Heart Association recommends LDL (bad) cholesterol-lowering drug therapy for most
women with heart disease. Drug therapy should be combined with a diet low in saturated fat, trans fat,
cholesterol and sodium, and rich in fruits, vegetables, whole-grain and high-fiber foods, and fat-free and
low-fat dairy. Fish (such as salmon, trout or haddock) should be eaten twice a week. In addition, women
should manage their weight, get regular physical activity and not smoke.

Children and cholesterol

Compelling evidence shows that the atherosclerotic process (buildup of fatty plaque in arteries) begins in
childhood and progresses slowly into adulthood. Then it often leads to coronary heart disease, the leading
cause of death in the United States.

Despite substantial success in reducing deaths from coronary heart disease in the past two decades.
Coronary heart disease causes 406,351 deaths each year. An estimated 16.3 million (7.0%) U.S. adults
have coronary heart disease. . Many of these adults have children who may have coronary heart disease
risk factors that need attention.

Evidence shows that:

 Atherosclerosis or its precursors begin in young people.

 Elevated cholesterol levels early in life may play a role in the development of adult
atherosclerosis.
 Eating patterns and genetics affect blood cholesterol levels and coronary heart disease risk.
  Lowering levels in children and adolescents may be beneficial.
 Cigarette smoking should be discouraged.
 Regular aerobic exercise should be encouraged.
 High blood pressure should be identified and treated.
 Overweight should be avoided or reduced.
 Diabetes mellitus should be diagnosed and treated.

Cholesterol levels in children and adolescents 2-19 years old

Total cholesterol (mg/dL)
Acceptable — less than 170
Borderline — 170-199
High — 200 or greater

LDL cholesterol (mg/dL)

Acceptable — less than 110
Borderline — 110-129
High — 130 or greater

The American Heart Association endorses these guidelines of the National Cholesterol Education
Program (NCEP) guidelines for detection of high cholesterol: All adults age 20 or older should have a
fasting lipoprotein profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good)
cholesterol and triglycerides — once every five years.

Symptoms, Diagnosis & Monitoring of High Cholesterol

Even though high cholesterol may lead to serious heart disease, most of the time there are no
symptoms. This is why it is important to have your cholesterol levels checked by your doctor.

To reduce your risk of heart disease and stroke, work with your healthcare professionals to monitor and
maintain healthy cholesterol levels. Even if your cholesterol levels are good now, it's not too early to
develop healthy habits that can help keep your numbers in check.

How To Get Your Cholesterol Tested

Cholesterol plays a major role in a person's heart health. High blood cholesterol is a major risk factor for
coronary heart disease and stroke. That's why it's important for all people to know their cholesterol levels.
They should also learn about their other risk factors for heart disease and stroke.

How is cholesterol tested?

A small sample of blood will be drawn from your arm. If your doctor has ordered other tests to be run at
the same time as your cholesterol test, all the samples will usually be taken at the same time. Your blood
sample is then analyzed by a laboratory.

Your doctor will tell you if you should fast (avoid consuming food, beverages and medications, usually for
nine to 12 hours) before your blood test. If you aren't fasting when the blood sample is drawn, only the
values for total cholesterol and HDL cholesterol will be usable. That's because the amount of LDL (bad)
cholesterol level and triglycerides can be affected by what you've recently consumed.

Your test report will show your cholesterol level in milligrams per deciliter of blood (mg/dL). Your doctor
must interpret your cholesterol numbers based on other risk factors such as age, family history, smoking
and high blood pressure.
Your LDL (bad) cholesterol levels will be needed to determine your treatment plan if your total cholesterol
is 200 mg/dL or greater, or if your HDL is less than 40 mg/dL. If you weren't fasting for your first test, your
doctor may need to send you for another test.

What do your cholesterol levels mean?

How often should I have my cholesterol checked?

The American Heart Association endorses the National Cholesterol Education Program (NCEP)
guidelines for detection of high cholesterol: All adults age 20 or older should have a fasting lipoprotein
profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and
triglycerides — once every five years. The Third Report of the Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III or ATP III) was released in 2001.
It recommends that everyone age 20 and older have a fasting "lipoprotein profile" every five years. This
test is done after a 9–12-hour fast without food, liquids or pills. It gives information about total cholesterol,
LDL cholesterol, HDL cholesterol and triglycerides.

You may need to have your cholesterol checked more often than every five years if one or more of these
situations applies to you:

 Your total cholesterol is 200 mg/dL or more.

 You are a man over age 45 or a woman over age 50.
 Your HDL (good) cholesterol is less than 40 mg/dL.
 You have other risk factors for heart disease and stroke.

If a fasting lipoprotein profile isn't possible, the values for total cholesterol and HDL cholesterol are still
useful. If your total cholesterol is 200 mg/dL or more, or your HDL cholesterol is less than 40 mg/dL (for
men) or less than 50 mg/dL (for women), you need to have a follow-up lipoprotein profile done to
determine your LDL cholesterol and triglyceride levels. Your healthcare provider will set appropriate
management goals based on your LDL cholesterol level and your other risk factors. See What Your
Cholesterol Levels Mean for information on what your levels should be.

Where should I have my cholesterol checked?

It's best to have your regular doctor run your cholesterol test. Overall risk factors such as your age, family
history, smoking history and high blood pressure must be considered when interpreting your results —
and your regular doctor is most likely to have all that information. Once you know your numbers, your
doctor should recommend a treatment and prevention plan, as well as follow-up testing to make sure the
plan is getting you to your cholesterol goals.

If you're admitted to the hospital for a major coronary event, your LDL cholesterol should be measured on
admission or within 24 hours. However, it may take four to six weeks before your fasting lipid profile
stabilizes and you can get accurate results. Your doctor will determine whether to start drug treatment at
discharge.

If you have your cholesterol checked at public screenings, make sure a reputable company does the
screening. Remember that your cholesterol level is just part of your overall cardiovascular risk profile, and
your other risk factors must be considered. You should share the screening results with your healthcare
professional so your tests can be properly interpreted, and an appropriate treatment and prevention plan
developed.

Be sure to review your test results with your doctor so you can understand and follow your treatment plan.
The American Heart Association hasn't taken a position on cholesterol home testing devices.
Several devices are on the market. Some measure only total cholesterol. Others measure total
cholesterol and high-density lipoprotein (HDL) or "good" cholesterol. One measures low-density
lipoprotein (LDL) or "bad" cholesterol, HDL cholesterol and triglycerides (blood fats).

Prevention and treatment of high cholesterol levels

Too much cholesterol in the blood can lead to cardiovascular disease. Cardiovascular disease is the No.
1 cause of death in the United States. 2,200 Americans die of cardiovascular disease each day, an
average of one death every 39 seconds. The good news is, you can lower your cholesterol and reduce
your risk of heart disease and stroke. Take responsibility for managing your cholesterol levels. Whether
you've been prescribed medication or advised to make diet and lifestyle changes to help manage your
cholesterol, carefully follow your doctor's recommendations.

Lifestyle Changes
Your diet, weight, physical activity and exposure to tobacco smoke all affect your cholesterol level — and
these factors may be controlled by:

 eating a heart-healthy diet,

 enjoying regular physical activity, and
 avoiding tobacco smoke.

Know Your Fats

Knowing which fats raise LDL cholesterol and which ones don't is the first step in lowering your risk of
heart disease.

Cooking for Lower Cholesterol

It's not hard to whip up recipes that fit with the low-saturated-fat, low-cholesterol eating plan
recommended by scientists to help you manage your blood cholesterol level and reduce your risk of heart
disease and stroke.

Understand Drug Therapy Options

For some people, lifestyle changes alone aren't enough to reach healthy cholesterol levels. Your doctor
may prescribe medication. Learn about:

 types of cholesterol-lowering drugs

 tips for taking medications

Avoid Common Misconceptions

We have created a list of the common misconceptions, along with the true story, about cholesterol.

Work with Your Doctor

It takes a team to develop and maintain a successful health program. You and your healthcare
professionals each play an important role in maintaining and improving your heart health. Know how to
talk with your doctor about your cholesterol levels and be sure you understand all instructions. Follow
your plan carefully, especially when it comes to medication — it won't work if you don't take it as directed.
And learn how to make diet and lifestyle changes easy and lasting.