Cholesterol is both good and poor. At normal levels, it is an important material for the body. If blood concentrations get too high, however, it becomes a silent danger which puts people at risk of heart attack.
Cholesterol is present in every cell of the body and has important natural roles in food digestion, hormone production, and vitamin D generation. It is created by the body but it is also ingested in food by men. In appearance it is waxy and fat-like.
There are two types of cholesterol:
- low-density lipoproteins (LDL), or “bad” cholesterol
- high-density lipoproteins (HDL), or “good” cholesterol
We’ll explain the role of cholesterol in this article. We’ll also explore the causes and effects of high cholesterol, diagnosis, and avoidance of it.
Fast facts on cholesterol:
- Cholesterol is an important substance created by the body but often eaten by humans in foods.
- High-cholesterol risk factors include family history and modifiable diet and exercise lifestyle choices.
- Having high cholesterol usually does not cause any symptoms.
- If changes in lifestyle are ineffective or cholesterol levels are very high, a doctor can prescribe a lipid-lowering drug, such as a statin.
What is cholesterol?
Cholesterol is a material based on gasoline. It doesn’t combine with the water-based blood.
Through lipoproteins, it flows around the body.
There are two types of lipoprotein which carry cholesterol parcels:
- Low-density lipoprotein (LDL): Cholesterol that travels in this way is unhealthful or “bad” cholesterol.
- High-density lipoprotein (HDL): Cholesterol that is present in HDL is known as “good” cholesterol.
Cholesterol has four primary functions, without which we could not survive.
- contributing to the structure of cell walls
- making up digestive bile acids in the intestine
- allowing the body to produce vitamin D
- enabling the body to make certain hormones
Causes of high cholesterol
High cholesterol is an important risk factor for heart disease and a source for heart attacks.
A build-up of cholesterol is part of a cycle called atherosclerosis, which narrows arteries. Plaques form in atherosclerosis, which cause blood flow obstruction.
Reducing the dietary fat intake helps control cholesterol levels. Particularly limiting foods which contain:
- Cholesterol: This is present in animal foods, meat, and cheese.
- Saturated fat: This occurs in some meats, dairy products, chocolate, baked goods, deep-fried, and processed foods.
- Trans fats: This occurs in some fried and processed foods.
Excess weight or obesity can also lead to greater levels of LDL in the blood. Genetic factors can help with high cholesterol levels. People with the family hypercholesterolemia inherited disorder have very high LDL levels.
Other conditions which can cause high levels of cholesterol include:
- liver or kidney disease
- polycystic ovary syndrome
- pregnancy and other conditions that increase levels of female hormones
- underactive thyroid gland
- drugs that increase LDL cholesterol and decrease HDL cholesterol, such as progestins, anabolic steroids, and corticosteroids
High cholesterol symptoms
A individual with high levels of cholesterol often does not have any signs or symptoms, but routine screening and frequent blood testing may help identify high levels.
A individual who refuses to undergo tests may have an unwarned heart attack because they did not know they had high cholesterol levels. Daily testing will help lower the risk.
Cholesterol in foods
A Harvard Health report identified 11 cholesterol-lowering foods which actively lower cholesterol levels:
- barley and whole grains
- eggplant and okra
- vegetable oil (canola, sunflower)
- fruits (mainly apples, grapes, strawberries, and citrus)
- soy and soy-based foods
- fatty fish (particularly salmon, tuna, and sardines)
- foods rich in fiber
Adding these to a balanced diet can help keep cholesterol in check.
The same report also lists foods that are bad for cholesterol levels. These include:
- red meat
- full-fat dairy
- hydrogenated oils
- baked goods
Levels and ranges
Total cholesterol levels in adults are considered to be safe, below 200 milligrams per deciliter (mg / dL).
- A reading between 200 and 239 mg/dL is borderline high.
- A reading of 240 mg/dL and above is considered high.
LDL cholesterol levels should be less than 100 mg/dL.
- 100–129 mg/dL is acceptable for people with no health problems but may be a concern for anyone with heart disease or heart disease risk factors.
- 130—159 mg/dL is borderline high.
- 160–189 mg/dL is high.
- 190 mg/dL or higher is considered very high.
HDL levels should be kept higher. The optimal reading for HDL levels is of 60 mg/dL or higher.
- A reading of less than 40 mg/dL can be a major risk factor for heart disease.
- A reading from 41 mg/dL to 59 mg/dL is borderline low.
Preventing high cholesterol
Individuals who want to lower their cholesterol levels or maintain an acceptable level should make four essential lifestyle decisions.
- eat a heart-healthy diet
- regularly exercise
- avoid smoking
- achieve and maintain a healthy weight
These actions will lower the risk of heart failure and heart attack.
Since 2013, recommendations for lowering or preventing high cholesterol have concentrated on treating the risks associated with lifestyle, particularly when young.
Since 2018, new recommendations published in the Journal of the American College of Cardiology have also encouraged doctors to address the following factors with individuals which may increase a person’s risk:
- family history and ethnicity
- certain health conditions that increase the risk of high cholesterol, such as chronic kidney disease or chronic inflammatory conditions
Taking these factors into account will lead to a more comprehensive approach to treating elevated cholesterol levels and avoiding them.
How can high cholesterol be treated?
There are a number of ways to treat high cholesterol; these include:
Drug treatment can rely on the cholesterol level and other risk factors for a person with high cholesterol levels.
Usually guidelines begin with diet and exercise, but people with a higher risk of a heart attack may need to use statins or other medicines.
Statins are the number one category of medicines that reduce cholesterol. In the United States the statins available on prescription include:
- atorvastatin (brand named Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor, Altoprev)
- pravastatin (Pravachol)
- rosuvastatin calcium (Crestor)
- simvastatin (Zocor)
Apart from statins, a doctor may prescribe:
- selective cholesterol absorption inhibitors
Researchers observed in 2017 that ezetimibe, a new medication, could substantially reduce the risk of a major cardiovascular event in people with a high risk of such events. Etezimibe decreases the lipid levels by reducing the cholesterol absorption in the intestine.
The revised authors have listed another new form of drug: subtilisin / kexin 9 (PCSK9) pro-protein convertase inhibitors. There is evidence that these drugs are effective in lowering cholesterol levels, especially when an individual uses them with ezetimibe.
In 2018, new guidelines proposed a phased approach, based on how high the risk is
If a person has already had a cardiovascular incident, such as a heart attack, a doctor may suggest using both ezetimibe and statin. The Guidelines also prescribe the introduction of a PCSK9 inhibitor for those at very high risk.
The guidelines also remember, however, that PCSK9 inhibitors are costly, and insurance providers can not cover their expenses. This choice is likely to be for those with a very high risk only, for that reason.
The use of statins has caused some debate, as they may have side effects like other medications.
- statin-induced myopathy (a muscle tissue disease)
- a slightly greater risk of diabetes and diabetes complications, though this is hotly debated
A person should not stop taking a statin without speaking to a doctor, as they may increase their risk of cardiovascular problems.
A doctor might recommend:
- switching to a different medication
- increasing efforts to reduce cholesterol through lifestyle changes
Complications of high cholesterol
People have in the past targeted reducing cholesterol to a target level, for example, below 100 mg / dL, but this is no longer the case.
Randomized, randomized clinical trials did not provide enough evidence to support a clear target for treatment.
Most physicians can also use goals to help direct the therapy, however.
10-year risk of a heart attack
Cholesterol levels play a major role in the likelihood that a person will suffer a heart attack within the next 10 years.
The National Heart, Lung, and Blood Institute offers a cardiovascular risk calculator online.
It measures the risk according to these factors, using research evidence:
- cholesterol levels
- smoking status
- blood pressure
This calculator is regarded as an important method for determining cholesterol levels and their risk by guidelines published in 2018.