High Cholesterol
- What is Cholesterol?
- Types of Cholesterol
- High Cholesterol causes & risk factors
- Symptoms
- The dangers of high cholesterol
Did you know…?
- Women over the age of 55 tend to have higher cholesterol levels than men.
- Body uses cholesterol to make hormones, vitamin D, and substances that help digest foods.
- High blood cholesterol is a major risk factor for heart disease.
- High cholesterol is a "silent" condition that rarely causes symptoms.
- Anger can raise cholesterol levels. According to Ohio State University researchers, there's evidence that people who respond rigidly to anger-provoking events are likely to wind up with significantly elevated levels of artery-damaging cholesterol.
Cholesterol is a waxy, fat-like substance (lipid) that occurs naturally in all parts of the body. The body needs some cholesterol to work properly, but if a person has too much of cholesterol in the blood, it can stick to the walls of arteries. This is called plaque.
The cholesterol in a person's blood originates from two major sources:
- Dietary intake
- Liver production
Dietary cholesterol comes mainly from meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol content, while foods of plant origin contain no cholesterol. After a meal, cholesterol is absorbed by the intestines into the blood circulation and is then packaged inside a protein coat. This cholesterol-protein coat complex is called a chylomicron.
The liver is capable of removing cholesterol from the blood circulation as well as manufacturing cholesterol and secreting cholesterol into the blood circulation. After a meal, the liver removes chylomicrons from the blood circulation. In between meals, the liver manufactures and secretes cholesterol back into the blood circulation.
Blood is watery, and cholesterol is fatty. Just like oil and water, the two do not mix. To travel in the bloodstream, cholesterol is attached to a protein and carried in small packages called lipoproteins. Lipoproteins are made of fat (lipid) on the inside and proteins on the outside. Lipoproteins can be high density (HDL), low density (LDL) or very low density (VLDL), depending on how much protein there is in relation to fat.
LDL - Low Density Lipoprotein
Most of the body's cholesterol is transported as LDL. This is made up
of mostly fat and a small amount of protein.
LDL cholesterol is called "bad" cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.
HDL - High Density Lipoprotein
A small amount of cholesterol is transported as HDL, which is mostly made
up of protein and a small amount of fat.
HDL cholesterol is called the "good" cholesterol because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high level of HDL cholesterol (low LDL/HDL ratios) are desirable
Triglycerides
Triglycerides are a different type of fat, which mostly come from fats
in your food. Energy that is eaten and not used immediately is converted
into triglycerides and transported to fat cells for storage. This is an
important source of stored energy. Although most triglycerides are stored
in fat tissue, low levels are also found in the blood. They are carried
in the blood as very low density lipoproteins (VLDL).
Total cholesterol is the sum of LDL cholesterol, HDL cholesterol, VLDL cholesterol, and IDL (intermediate density) cholesterol.
Blood cholesterol is measured in milligrams per deciliter of blood (mg/dL).
| Total cholesterol level | |
|---|---|
| Less than 200 mg/dL | Desirable |
| 200-239 mg/dL | Borderline high |
| 240 mg/dL or higher | High |
| LDL-cholesterol | |
|---|---|
| Less than 100 mg/dL | Optimal |
| 100-129 mg/dL | Near optimal / above optimal |
| 130-159 mg/dL | Borderline high |
| 160-189 mg/dL | High |
| 190 mg/dL or higher | Very high |
| HDL-cholesterol | |
|---|---|
| 60 mg/dL or higher | High |
| Less than 40 mg/dL | Low |
High Cholesterol causes & risk factors
There are several factors that may contribute to high blood cholesterol level. The following factors are the most important:
- Low-fiber high-fat diet. While it is true that saturated fats - found in butter, cheese and beef - raise total cholesterol levels[3], trans fats go a step further. Trans fats not only raise total cholesterol levels, they also deplete HDL cholesterol, which helps protect against heart disease[1].
- Sedentary lifestyle. Lack of exercise may increase LDL cholesterol and decrease HDL cholesterol. Even short-term physical inactivity may produce increases in total cholesterol and triglycerides[2].
- Family history (Genetics). Genetics plays a key role in determining the rate at which cholesterol is produced and removed from the bloodstream. People are at a higher risk of high cholesterol if they have a direct male relative aged under 55 or a female relative aged under 65 affected by heart disease.
- Excess weight. Carrying excess body weight generally increases the LDL cholesterol level.
- Age. The chances of developing high cholesterol increase as people age. Blood cholesterol levels naturally begin to rise after age 20. This rise is probably a result of the body's decreased ability to rid itself of excess cholesterol.
- Sex. The gender affects the age when people are at the most risk of developing high cholesterol levels. In general, men tend to develop high cholesterol at a younger age than women. Before menopause, women have lower total blood cholesterol levels and higher HDL cholesterol levels than men, making them less likely to have coronary artery disease (CAD). After menopause, women's LDL cholesterol levels typically increase substantially because of hormonal changes, and their risk for CAD increases along with their risk for high cholesterol. Menopausal women and men about age 50 have cholesterol levels that increase at around the same rate.
- Smoking. Cigarette smoking damages the walls of the blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower the level of HDL cholesterol. Even inhaling others' cigarette smoke (secondhand smoke) has been shown to lower HDL cholesterol.
- Polycystic ovarian syndrome. Women with this disorder, particularly those who are obese, appear to be at increased risk for high triglyceride and low HDL levels. This risk may be due to higher levels of the male hormone testosterone in these women.
- Hypothyroidism. People with hypothyroidism (low thyroid levels) are at higher risk for high total and LDL cholesterol, triglycerides, and other lipids associated with heart disease. Some experts suggest that patients with high cholesterol should be evaluated for thyroid function before they are given cholesterol-lowering drugs. Research is mixed on whether mild hypothyroidism (subclinical hypothyroidism) is associated with unhealthy cholesterol levels.
Medications that may cause high cholesterol levels as a side effect:
| Drug | Incidence |
|---|---|
| Abilify Tablets | 1% or less |
| Accuretic Tablets | Rare |
| Accutane Capsules | |
| Aceon Tablets (2 mg, 4 mg, 8 mg) | 0.3% to 1% |
| Aciphex Tablets | |
| Agenerase Capsules | |
| Aldara Cream, 5% | 1.9% |
| Ambien Tablets | Rare |
| Amerge Tablets | Rare |
| Amnesteem Capsules | 7% |
| Arimidex Tablets | 2% to 7% |
| Axert Tablets | Rare |
| Benicar HCT Tablets | |
| Benicar Tablets | Greater than 0.5% |
| Bextra Tablets | 0.1% to 1.9% |
| Calcijex Injection | |
| Carbatrol Capsules | Occasional |
| Casodex Tablets | 2% to 5% |
| Celebrex Capsules | 0.1% to 1.9% |
| CellCept Capsules, Intravenous, Oral Suspension, Tablets | 3% to 41.2% |
| Chemet Capsules | 4.2% to 10.4% |
| Cipro I.V. Pharmacy Bulk Package | Less than 1% |
| Cipro I.V. | Infrequent |
| Cipro | |
| Coreg Tablets | 1% to 4% |
| Crixivan Capsules | 0.9% |
| Cymbalta Delayed-Release Capsules | Infrequent |
| Delatestryl Injection | |
| Diflucan Injection | |
| Diflucan Oral Suspension | |
| Diflucan Tablets | |
| Effexor Tablets | 5.3% |
| Effexor XR Capsules | 5.3% |
| Estratest | |
| Evoxac Capsules | Less than 1% |
| Exelon Capsules | Infrequent |
| Exelon Oral Solution | Infrequent |
| Femara Tablets | 3% |
| Floxin Tablets | |
| Gabitril Tablets | Infrequent |
| Gengraf Capsules | Less than 3% |
| Geodon Capsules | Infrequent |
| Hectorol Capsules, Injection | |
| Humira Injection | 6% |
| Hyzaar | |
| Inspra Tablets | 0.3% to 1% |
| Kaletra | 9% to 20% |
| Leukine | 17% |
| Lexapro Oral Solution | Infrequent |
| Lexapro Tablets | Infrequent |
| Lupron Depot 3.75 mg | 7% |
| Lupron Depot 7.5 mg | Greater than or equal to 5% |
| Micardis HCT Tablets | |
| Micardis Tablets | More than 0.3% |
| Myfortic Tablets | 3% to less than 20% |
| Neoral Oral Solution | Less than 3% |
| Neoral Soft Gelatin Capsules | Less than 3% |
| Neurontin Capsules, Oral Solution, Tablets | Rare |
| Noroxin Tablets | |
| Norvir | 36.5% to 44.8% |
| Oxandrin Tablets | |
| Paxil CR Controlled-Release Tablets | |
| Paxil | Rare |
| Permax Tablets | Infrequent |
| Plavix Tablets | 4% |
| Prevacid Delayed-Release Capsules | |
| Prevacid NapraPAC | |
| Prevacid SoluTab Delayed-Release Orally Disintegrating Tablets | |
| Prevacid for Delayed-Release Oral Suspension | |
| Prevpac | |
| Prinzide Tablets | |
| Prograf Capsules and Injection | 3% to 15% |
| Prozac Pulvules and Liquid | Infrequent |
| Rapamune Oral Solution and Tablets | 38% to 46% |
| Requip Tablets | Infrequent |
| Rilutek Tablets | Rare |
| Risperdal Consta Injection | Infrequent |
| Rocaltrol | |
| Rythmol SR Capsules | |
| Sonata Capsules | Infrequent |
| Spiriva HandiHaler | 1% to 3% |
| Sustiva Capsules | |
| Targretin Capsules | 32.1% to 62.3% |
| Tasmar Tablets | Infrequent |
| Tegretol/Tegretol-XR | Occasional |
| Testred Capsules, 10 mg | |
| Teveten HCT Tablets | Less than 1% |
| Teveten Tablets | Less than 1% |
| Thalomid Capsules | |
| Ticlid Tablets | |
| Timolide Tablets | |
| Travatan Ophthalmic Solution | 1% to 5% |
| Uniretic Tablets | Less than 1% |
| VFEND I.V. | Less than 1% |
| VFEND Oral Suspension | Less than 1% |
| Vaseretic Tablets | |
| Vesanoid Capsules | Up to 60% |
| Vioxx | Greater than 0.1% to 1.9% |
| Zoladex 3-month | |
| Zoladex | |
| Zoloft | Approximately 3% |
| Zyprexa Tablets | Rare |
| Zyprexa ZYDIS Orally Disintegrating Tablets | Rare |
Having a high cholesterol level does not cause symptoms. Most people find out they have high cholesterol when they have their blood cholesterol measured as part of a medical check-up. Alternatively, it may be identified after other health problems, such as heart disease, have been diagnosed.
The dangers of high cholesterol
High blood cholesterol (hypercholesterolemia) causes an accumulation of plaque on the inner walls of the arteries, leading to atherosclerosis, the narrowing of the arteries, and a restriction of blood's ability to pass through them unhindered and deliver oxygen and other essential nutrients to various parts of the body.
As plaque builds up, the arteries narrow and harden until eventually blood flow is obstructed. If the obstruction is so severe that oxygen can't reach a portion of the heart or brain, the result is a heart attack or stroke. This can happen quite suddenly if a small blood clot lodges in the narrowed artery and cuts off blood flow.
Benefits of lowering LDL cholesterol include
- Reducing or stopping the formation of new cholesterol plaques on the artery walls
- Reducing existing cholesterol plaques on the artery walls
- Widening narrowed arteries
- Preventing the rupture of cholesterol plaques, which initiates blood clot formation
- Decreasing the risk of heart attacks
- Decreasing the risk of strokes
More information about High Cholesterol:
Sources & References
- 1. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. American Journal of Clinical Nutrition. 2003 May;77(5):1146-55.
- 2. Hamburg NM, McMackin CJ, Huang AL, Shenouda SM, Widlansky ME, Schulz E, Gokce N, Ruderman NB, Keaney JF Jr, Vita JA. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arteriosclerosis, Thrombosis, and Vascular Biology. 2007 Dec;27(12):2650-6. Epub 2007 Oct 11
- 3 . Merchant AT, Kelemen LE, de Koning L, Lonn
E, Vuksan V, Jacobs R, Davis B, Teo KK, Yusuf S, Anand SS; SHARE and
SHARE-AP investigators. Interrelation of saturated fat, trans fat, alcohol
intake, and subclinical atherosclerosis. Am J Clin Nutr. 2008 Jan;87(1):168-74.
PubMed