About Your Diagnosis
Hypercholesterolemia is a high cholesterol level in the blood. High
blood cholesterol is one of the risk factors for atherosclerosis (hardening
of the arteries) and heart disease. Heart disease from atherosclerosis
and coronary artery disease is the leading cause of death in the United
Cholesterol is a lipid, a type of fat. It performs many normal functions
in the body. Cholesterol is made in the liver for involvement in the
formation of hormones. It is also part of the cell structure. It transports
fats in the blood stream. Cholesterol is part of fat-protein structures
in the blood called lipoproteins. Lipoproteins are classified on the
basis of their density from very low-density lipoproteins (VLDLs) to
high-density lipoproteins (HDLs). The more cholesterol in the lipoprotein,
the denser is the cell. VLDLs are mostly fat and can clog the arteries.
Denser lipoproteins, the HDLs, can help remove fats (lipids) from the
bloodstream. That is why HDLs are considered the good cholesterol.
Living With Your Diagnosis
Cholesterol levels are determined by means of analysis of blood samples.
Most persons with high blood cholesterol have no symptoms. The fat deposits
in their blood vessels do not produce symptoms until the vessels are
nearly closed or become clogged. Some persons with high cholesterol
have xanthomas, which are small fatty deposits under the skin.
A desirable cholesterol level is less than 200 milligrams per deciliter
(mg/dl). If your cholesterol level is less than 200 mg/dl, have your
level checked every 3 to 5 years.
A borderline high cholesterol level is 200 to 239 mg/dl. A borderline
high cholesterol level is especially important if you have two or more
other risk factors for cardiac disease (male sex, female sex after menopause
without estrogen replacement, age older than 55 years, family history
of heart disease, smoking, obesity, diabetes, high blood pressure, lack
of activity, and high fat and cholesterol intake). You need to try to
lower your blood cholesterol to a desirable level.
A cholesterol levels greater than 240 mg/dl is considered high, and
this by itself is a risk factor for heart disease. You need to lower
your cholesterol level.
Some genetic conditions can cause high or low cholesterol and high or
low levels of HDLs. Women tend to have higher HDL levels because of
the influence of the female hormone estrogen. HDL levels can be increased
with endurance exercise, low body fat (leanness), consumption of moderate
amounts of alcohol (particularly those with high flavinoids such as
red wine), and with insulin and lipid-lowering drugs. HDL levels are
made decreased by male hormones, menopause (lack of the female hormone
estrogen), obesity, a sedentary lifestyle, a high triglyceride level,
diabetes, and cigarette smoking.
Because it is produced in the body by the liver, no one needs to consume
cholesterol. The best way to lower cholesterol level is to decrease
intake and promote removal by raising levels of HDLs. Diseases such
as diabetes must be carefully monitored and managed.
Lipid-lowering drugs are used to treat persons who are unsuccessful
at reducing blood cholesterol levels. Continuation of the measures discussed
earlier is important even after starting the lipid-lowering medicines.
The main classes of medicines for management of hypercholesterolemia
include bile acidbinding resins, nicotinic acid, statins (HMG
CoA reductase inhibitors), and fibric acid (gemfibrozil).
Bile acidbinding resins are the primary treatment of most patients
who need drugs; they include cholestyramine and colestipol. These drugs
increase the passage of cholesterol into the intestines for removal
through the colon (large bowel). Nicotinic acid (niacin) helps lower
VLDL levels and increase HDL levels. The statins (atovarstatin, fluvastatin,
lovastatin, pravastatin, simvastatin) decrease production of cholesterol
and LDLs. Gemfibrozil helps increase the removal of VLDL.
These medicines each can have an unpleasant taste and can cause nausea,
abdominal pain, and diarrhea or constipation. Niacin can cause facial
flushing and itching. It cannot be used by persons with liver disease,
diabetes, or gout.
* Lower your cholesterol and raise your HDLs as follows by eating a
diet low in cholesterol and saturated fats.
* Eat fruits and vegetables and high-fiber foods such as oat bran. Cook
with oils high in polyunsaturated fats such as safflower oil, sunflower
oil, and corn oil (omega-6 fatty acids).
* Eat fish, because fish oils contain omega-3 fatty acids, which may
help lower cholesterol.
* Stop smoking.
* Lose weight to lower body fat. This is best accomplished through dietary
changes (reducing calories and fat) and participating in regular aerobic
exercise such as walking, jogging, bicycling, or swimming. The exercise
should be done for at least 30 minutes a day 3 to 4 days per week. Exercise
helps lower your body weight and body fat, helps control your blood
pressure, strengthens the heart, and helps most persons with diabetes
control the disease.
* Ask your physician if you should take estrogen replacement therapy.
Postmenopausal women can obtain cardiac protective benefits from estrogen
replacement (if they do not smoke and have no history of clotting disorders
or breast or gynecologic cancer). Consume moderate amounts of alcohol
(usually a glass or two of red wine a day). Not everyone should consume
alcohol. Discuss this with your physician.
* Take your medications as directed.
* Do not forget to treat any other medical conditions and take your
regular medications as directed.
When to Call Your Doctor
* If you have hypercholesterolemia, have regular follow-up visits with
your doctor to monitor your blood cholesterol and heart disease. Discuss
the progress of your diet and exercise and any side effects of your
For More Information
The American Heart Association has information on healthy-heart diets.
Call 1-800-242-8721 and ask for the literature department.