DR. Z,

What exactly is cholesterol, and why do I need to be worried about it?

Cholesterol is a fatty substance that the body requires to make cells and hormones. This makes cholesterol imperative for our survival. Cholesterol gets a bad rap because it is in many of the foods we eat, and our body produces enough cholesterol. In other words we do not need the additional cholesterol from food intake. This extra cholesterol can produce a multitude of health problems. Cholesterol has multiple forms, the two main ones are, HDL (high density lipoprotein) and LDL (low density lipoprotein).

LDL is known as the bad cholesterol because when there is too much of it, it will remain in the blood stream, eventually sticking to the blood vessel walls. The space for blood to flow within the vessels will narrow due to these “fatty deposits” building up on the walls. If the blood flow slows down so does the delivery of oxygen to the heart, brain, muscles and other organs. To compensate for this the blood vessels will squeeze harder to move the blood, and over time the vessel walls harden from the extra work, making it more difficult for them to move blood through the body. The fat deposits can rupture from the vessel wall, which may lead to a blood clot that could block blood flow to the brain and or heart. This can cause a heart attack and or stroke.

There are not any signs or symptoms that your cholesterol is high. Your diet, family history, and lifestyle can be clues. However, there are some people who eat a healthy diet and exercise but still have high levels of LDL. For an unknown reason some individuals will produce more LDL, this is hereditary.

HDL is known as the good cholesterol because the theory is that it picks up the LDL and takes it back to the liver where it will be recycled to make more cells or excreted.

The only way to know if your cholesterol level is high is to get a blood test; this test is known as a lipid panel. Your provider will ask you to fast 8 hours prior to the blood test. The reason for this is after a meal or snack the body has not metabolized the fat and cholesterol, which could give an inaccurate result. The lipid panel includes total cholesterol, HDL, LDL, and triglycerides. Triglycerides are a form of fat that the body uses for energy, if a person eats more food than the body needs for energy it will be stored as fat in the body. Total cholesterol is HDL, LDL and VLDL (another form of cholesterol).

According to the American Heart Association the following are the optimal levels for total cholesterol, HDL, LDL, and triglycerides: total cholesterol below 200 mg/dL, HDL 60 mg/dL or above, LDL below 130 mg/dL in healthy individuals and below 70 mg/dL in those with risk factors. Triglycerides are suggested to remain lower than 150 mg/dL. To clarify providers will want the LDL level to be lowest in those that have diabetes, high blood pressure, smokers, and those that are overweight or have family history of heart disease.

High cholesterol is preventable in most cases with diet and exercise. Eating a diet with plenty of vegetables, fruit, whole grains, and low in fat is the best way to keep LDL and triglyceride levels low. There are several ways to raise HDL levels including: exercise, smoking cessation, and weight loss, which in turn will lower LDL. There are medications that can help lower LDL, raise HDL and lower triglycerides. The most common class of medications prescribed to lower LDL levels is the statins. The statins reduce the amount of LDL your liver produces, and they help improve the

function of the blood vessel walls. Before starting a statin, liver function must be determined first with a simple blood test. Some providers will suggest taking Omega 3 fatty acid supplements as well. It’s important to discuss diet, exercise and these medications with your provider to determine the most appropriate treatment

Most providers will order a cholesterol panel with your annual physical. If you have any concerns, or a family history of high cholesterol or heart disease, you should see your local medical home for further evaluation.

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