High Cholesterol

WHAT YOU SHOULD KNOW

High cholesterol is the best known of all the many threats to a healthy heart. When excess amounts of this waxy, fat-like substance build up along the walls of the arteries, you face a dramatically higher risk of a complete blockage, leading to a heart attack or stroke.

At normal levels, cholesterol is not a bad thing. On the contrary, it's an essential raw material used by the body to build cell walls and produce hormones such as estrogen and testosterone. The body produces its own supply of cholesterol in the liver, and it's found naturally in all animal products (such as meats, eggs, milk, and cheese). It poses a problem only when the body is unable to use or eliminate excessive supplies.

As one of a variety of fatty substances in the body, cholesterol is classified as a lipid. It is carried through the bloodstream attached to proteins, forming complexes called lipoproteins. There are two major types of lipoproteins: the low-density lipoproteins (LDL) commonly known as "bad" cholesterol, and the high-density lipoproteins (HDL) usually dubbed "good" cholesterol. It's the "bad" LDL cholesterol that tends to form deposits on the artery walls. HDLs, on the other hand, help to clear excess cholesterol from the bloodstream. The ideal situation to aim for, then, is a low level of LDL cholesterol, a high level of HDL cholesterol, and a moderate total of both.

Cholesterol is measured in milligrams per deciliter of blood. According to the National Cholesterol Education Program, a desirable target profile consists of:

• A total blood cholesterol level of less than 200
• An LDL level of:
• • less than 100 if you have heart disease
  • less than 130 if you're at risk of heart disease
  • less than 160 if your risk of heart disease is low
• An HDL level greater than 40

You are generally considered at risk of heart disease if two or more of the following factors apply to you:

• Cigarette smoking
• High blood pressure
• Low HDL cholesterol (below 40)
• A family history of early heart disease (before 55 in a man, or 65 in a woman)
• Your own age (over 45 if you're man, over 55 if you're a woman)

Causes

The tendency to build up high cholesterol may run in families, but excessively high levels are usually the result of a poor diet high in saturated fats and calories, combined with little or no exercise. In some cases, an elevated cholesterol level may be associated with an undiagnosed medical condition, such as hypothyroidism (low thyroid function) or diabetes.

Signs/Symptoms

High cholesterol rarely gives any warning signs. If there's a tremendous excess, some people develop soft, yellowish skin growths called xanthomas, usually in the area near the eyes. Some men develop impotence as the arteries begin to clog up.

Care

The first line of attack on high cholesterol is a change in lifestyle and diet. Regular exercise, weight control, and a diet low in cholesterol and animal fat are often all that's needed to bring cholesterol levels into the safety range. If these measures fail to do the job, your doctor can then prescribe a cholesterol-lowering drug such as Lescol, Lipitor, Mevacor, Pravachol, and Zocor. Remember, though, that these drugs shouldn't be used as a substitute for a healthy diet. They pose a slight risk of damage to the liver and can harm a developing baby if taken during pregnancy.

For those who suffer severe, hereditary high cholesterol, a procedure called LDL apheresis is an option. Over several hours, blood is removed from the body, chemically cleansed of LDL cholesterol, then returned to the body. This treatment can reduce LDL cholesterol levels by 50 to 80 percent, but it's required every two to three weeks. Talk with your doctor in detail about the benefits of this type of therapy, as it can be both time-consuming and costly.

Risks

Your chances of a heart attack rise dramatically when your cholesterol gets even moderately out of line. Generally speaking, a man with a total blood cholesterol level of 240 is twice as likely to suffer a heart attack as a man with a level of 200, all other factors being equal. A level of 300 carries five times the risk.

WHAT YOU SHOULD DO

• If your doctor prescribes a cholesterol-lowering drug, be sure to take it regularly, even though you can't feel its effects. Remember, too, that the drug is only one part of the treatment. For best results, you need to maintain good eating and exercise habits in addition to taking the drug.
• If you are overweight, work with a doctor or a registered dietitian to design a personalized nutrition plan to help you lose weight and keep it off.
• Eat a variety of fruits, vegetables, whole grain breads, cereals, and beans on a daily basis.
• Use only low-fat or skim milk, cheeses, sour cream, and yogurt.
• When eating meat, choose lean cuts and take small portions. Cook chicken without the skin. Add more fish to your diet.
• Limit your intake of high-fat and cholesterol-rich foods such as french fries, fast foods, sausage, bacon, and hot dogs.
• Do not fry foods. Instead, bake, broil, boil, grill, steam, roast, poach, or microwave.
• Read food labels carefully and avoid foods that contain hydrogenated vegetable oils, cocoa butter, coconut or palm oil, beef fat, and lard.
• Cook and bake with vegetable oils such as canola, sunflower, corn, soybean, peanut, and olive oils.
• Eat at least one meatless meal per day.
• Cook with egg whites or egg substitutes instead of whole eggs.
• Exercise regularly. Good exercises to aid in lowering cholesterol include walking, jogging, cycling, swimming, aerobics, and dancing. Find an activity you enjoy and do it 3 to 4 times per week for at least 20 to 30 minutes at a time.
• Smoking increases the risk of heart disease, so when you have high cholesterol it's doubly important to quit. If you have trouble, ask your doctor for quit-smoking aids.
• Have your blood cholesterol checked periodically by your doctor or a reputable lab to monitor your progress. Home cholesterol testing kits may alert you to a high cholesterol problem, but they are not as comprehensive as one performed by a lab or your physician's office. The National Cholesterol Education Program recommends routine testing once every five years. If you have a history of high cholesterol, your doctor may recommend more frequent testing.

Call Your Doctor If...

• You notice small, yellowish skin growths.
• You develop symptoms such as pain in the lower legs, dizziness, or an unsteady gait. These could be signs of heart trouble associated with high cholesterol.

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