Cholestrol

About Cholestrol
It may surprise you to know that cholesterol itself isn't bad. In fact, cholesterol is just one of the many substances created and used by our bodies to keep us healthy. Some of the cholesterol we need is produced naturally (and can be affected by your family health history), while some of it comes from the food we eat.

There are two types of cholesterol: “good” and “bad.” It’s important to understand the difference, and to know the levels of “good” and “bad” cholesterol in your blood. Too much of one type — or not enough of another — can put you at risk for coronary heart disease, heart attack or stroke.

Sources of Cholesterol
Cholesterol comes from two sources: your body and food. Your liver and other cells in your body make about 75 percent of blood cholesterol. The other 25 percent comes from the foods you eat.

LDL cholesterol is the “bad” cholesterol. When too much of it circulates in the blood, it can clog arteries, increasing your risk of heart attack and stroke.

LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different, so work with your doctor to find a treatment plan that's best for you.

LDL and HDL Cholesterol: What's Bad and What's Good?
Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids, along with triglycerides and Lp(a) cholesterol, make up your total cholesterol count, which can be determined through a blood test.

LDL (Bad) Cholesterol
When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result.

HDL (good) Cholesterol
About one-fourth to one-third of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol, because high levels of HDL seem to protect against heart attack. Low levels of HDL (less than 40 mg/dL) also increase the risk of heart disease. Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup.

Triglycerides
Triglyceride is a form of fat made in the body. Elevated triglycerides can be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60 percent of total calories or more). People with high triglycerides often have a high total cholesterol level, including a high LDL (bad) level and a low HDL (good) level. Many people with heart disease and/or diabetes also have high triglyceride levels.

Lp(a) Cholesterol
Lp(a) is a genetic variation of LDL (bad) cholesterol. A high level of Lp(a) is a significant risk factor for the premature development of fatty deposits in arteries. Lp(a) isn’t fully understood, but it may interact with substances found in artery walls and contribute to the buildup of fatty deposits.

What Can Cholesterol Do?
High cholesterol is one of the major controllable risk factors for coronary heart disease, heart attack and stroke. As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors (such as high blood pressure or diabetes) as well as high cholesterol, this risk increases even more. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the level of each risk factor, the more that factor affects your overall risk.

When too much LDL (bad) cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque, a thick, hard deposit that can narrow the arteries and make them less flexible. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, a heart attack or stroke can result.

Women and Cholesterol
The female sex hormone estrogen tends to raise HDL cholesterol, and as a rule, women have higher HDL (good) cholesterol levels than men do. Estrogen production is highest during the childbearing years. This may help explain why premenopausal women are usually protected from developing heart disease.

Women also tend to have higher triglyceride levels. Triglyceride levels range from about 50 to 250 mg/dL, depending on age and sex. As people get older, more overweight or both, their triglyceride and cholesterol levels tend to rise.

Postmenopausal hormone therapy (PHT) may benefit some women with osteoporosis or other medical conditions associated with menopause. However, the American Heart Association recommends that PHT not be used for cardiovascular prevention. The HERS trial of women who had previously had a heart attack showed that these women did not benefit from PHT. Recent clinical trials appear to confirm that PHT does not appear to reduce risk of cardiovascular disease and stroke in postmenopausal women. Women with a personal or family history of breast cancer or other endocrine-related cancers should not receive PHT either.

LDL (bad) cholesterol lowering drug therapy for most women with heart disease. Drug therapy should be combined with a diet low in saturated fat, trans fat, cholesterol and sodium, and rich in fruits, vegetables, whole-grain and high-fiber foods, and fat-free and low-fat dairy. Fish (such as salmon, trout or haddock) should be eaten twice a week. In addition, women should manage their weight, get regular physical activity and not smoke

Compelling evidence shows that the atherosclerotic process (buildup of fatty plaque in arteries) begins in childhood and progresses slowly into adulthood. Then it often leads to coronary heart disease, the leading cause of death in the United States

Despite substantial success in reducing deaths from coronary heart disease in the past two decades, this disease is still responsible for over 450,000 deaths a year in the United States. Over 43 percent of the people discharged from hospitals for coronary heart disease are under age 65. Many of these adults have children who may have coronary heart disease risk factors that need attention.

Evidence shows that:
Atherosclerosis or its precursors begin in young people.
Elevated cholesterol levels early in life may play a role in the development of adult atherosclerosis.
Eating patterns and genetics affect blood cholesterol levels and coronary heart disease risk.
Lowering levels in children and adolescents may be beneficial.
Cigarette smoking should be discouraged.
Regular aerobic exercise should be encouraged.
High blood pressure should be identified and treated.
Overweight should be avoided or reduced.
Diabetes mellitus should be diagnosed and treated.

Cholesterol levels in children and adolescents 2–19 years oldTotal cholesterol (mg/dL)
Acceptable — less than 170
Borderline — 170–199
High — 200 or greater

LDL cholesterol (mg/dL)
Acceptable — less than 110
Borderline — 110–129
High — 130 or greater

Common Misconceptions About Cholesterol
Cholesterol can be both good and bad, so it's important to learn the facts about what cholesterol is, how it affects your health and how to manage your blood cholesterol levels. Here are some common misconceptions, along with the true story, about cholesterol.

1. My choices about diet and physical activity are responsible for my cholesterol level.
Diet and physical activity contribute to overall blood cholesterol levels as well as the cholesterol that is made naturally by the body. The amount of LDL (bad) cholesterol in the blood is controlled in two important places — the liver and the intestines. The liver produces cholesterol (using it to make digestive — or bile — acids) and also removes cholesterol from the blood. The intestines absorb cholesterol, which comes from food and from bile. For some people, the liver produces more cholesterol than the intestines absorb. If this is the case for you, your physician may prescribe medicine to manage your cholesterol. However, a heart-healthy diet and regular physical activity are important to everyone for maintaining cardiovascular health. Have your cholesterol tested and work with your healthcare professionals on the plan that's best for you. Learn more about the sources of cholesterol.

2. Using margarine instead of butter will help lower my cholesterol.
Both margarine and butter are high in fat, so use both in moderation. From a dietary perspective, the major factor affecting blood cholesterol is how much saturated fat and trans fat is in the food. Limiting food high in saturated fat and trans fat may help lower your LDL (bad) cholesterol. Most vegetable oils and soft or liquid margarines have less saturated and trans fat than the solid spreads have, and are preferable to the stick forms of margarine for a heart-healthy diet. When selecting a margarine, it's best to choose one that has “0 g trans fat” on the Nutrition Facts label.

Remember that one change — like switching from butter to soft margarine — is a good step, but may not be enough to reduce your cholesterol to healthy levels. Other diet and lifestyle changes or medication may be needed, as your doctor recommends. Learn more about eating a healthy diet.

3. Thin people don’t have to worry about high cholesterol.
Any type of body can have high cholesterol. Overweight people are more likely to have high cholesterol, but thin people should also have their cholesterol checked regularly. Often people who don’t gain weight easily are less aware of how much saturated and trans fat they eat. Nobody can “eat anything they want” and stay heart healthy. Have your cholesterol checked regularly regardless of your weight, physical activity and diet. Learn more about what you can do to manage your cholesterol levels.

4. My doctor hasn’t said anything about my cholesterol, so I don’t have to worry.
Your health is your responsibility. Ask your healthcare professional if your cholesterol needs to be tested. Learn how to interpret all the numbers, including HDL (good) cholesterol, LDL (bad) cholesterol and triglyceride levels. If you’re in a high or borderline-high range, discuss options with your physician. Depending on your risk profile and your cholesterol levels, your doctor may recommend diet and lifestyle changes and/or medication. Follow all of your doctor's instructions, and have your cholesterol retested as your doctor recommends. See a list of questions to ask your doctor about cholesterol.

5. Since the nutrition label on my favorite food says there’s no cholesterol, I can be sure that it’s a “heart-healthy” choice.
Nutrition labels on food are very helpful when choosing heart-healthy foods, but you need to know what to look for. Many “low-cholesterol” foods contain high levels of saturated fat and/or trans fat — both of which contribute to high blood cholesterol. Even foods that claim to be “low-fat” may have a higher fat content than expected. Look for the amount of saturated fat, trans fat, cholesterol and total calories in a serving of the product. Also check how much a serving is. Often it’s smaller than you think. The first ingredient listed is the one used most in the product, so choose products where fats and oils appear later in the ingredient listing. The Food and Drug Administration now requires foods to be labeled for trans fats. Trans fats are found in variable amounts in most foods made with partially hydrogenated oils such as baked goods, cakes, cookies, crackers, pastries, pies, muffins, doughnuts, fried foods, shortening and some margarines and dairy products.

6. Since I started taking medication for my high cholesterol, I don’t have to worry about what I eat.
Drug therapy is usually prescribed for those who — despite adequate dietary changes, regular physical activity and weight loss — still have elevated levels of cholesterol, or those who have elevated risks for heart disease and stroke. Modern medications have come a long way in helping to control blood cholesterol levels, and some can target the cholesterol that your body makes on its own. But making diet and lifestyle changes — as well as taking the medication your doctor prescribes — is the best way to help prevent heart disease. You should still eat a heart-healthy diet and get at least 30 minutes of moderately vigorous physical activity on five or more days of the week. It’s also very important to take your medication exactly as your doctor has instructed so it can work most efficiently.

7. I recently read that eggs aren’t so bad for your cholesterol after all, so I guess I can go back to having my two eggs for breakfast every morning.
One egg contains about 213 milligrams of dietary cholesterol. The daily recommended cholesterol limit is less than 300 milligrams for people with normal LDL (bad) cholesterol levels. An egg can fit within heart-healthy guidelines for those people only if cholesterol from other sources — such as meats, poultry and dairy products — is limited. For example, eating one egg for breakfast, drinking two cups of coffee with one tablespoon of half-and-half each, lunching on four ounces of lean turkey breast without skin and one tablespoon of mayonnaise, and having a 6-ounce serving of broiled, short loin porterhouse steak for dinner would account for about 510 mg of dietary cholesterol that day — nearly twice the recommended limit. If you’re going to eat an egg every morning, substitute vegetables for some of the meat, or drink your coffee without half-and-half in the example above. And remember that many other foods, especially baked goods, are prepared with eggs — and those eggs count toward your daily cholesterol limit. People with high LDL blood cholesterol levels or who are taking a blood cholesterol-lowering medication should eat less than 200 mg of cholesterol per day. Learn more about cooking for lower cholesterol.

8. I’m a woman so I don’t have to worry about high cholesterol. It's a man’s problem.
Premenopausal women are usually protected from high LDL (bad) levels of cholesterol, because the female hormone estrogen tends to raise HDL (good) cholesterol levels. But cholesterol levels tend to increase as you age, and postmenopausal women may find that even a heart-healthy diet and regular physical activity aren’t enough to keep their cholesterol from rising. If you’re approaching menopause, it’s especially important to have your cholesterol checked and talk with your doctor about your options. You may still have high cholesterol levels even if you eat a heart-healthy diet, stay active, watch your weight and don't smoke or breathe others' smoke. If lifestyle changes alone don't work, your doctor may prescribe a cholesterol-lowering medication — be sure to take it as instructed. Learn more about women and cholesterol.

9. You don’t need to have your cholesterol checked until you reach middle age.
Everyone should start getting a cholesterol test at age 20, but it’s a good idea to start having cholesterol checked at an early age. Even children, especially those in families with a history of heart disease, can have high cholesterol levels. And evidence exists that these children are at greater risk for developing heart disease as adults. Lack of regular physical activity, poor dietary habits and genetics can all affect a child’s cholesterol levels. Parents and caregivers can help kids develop a heart-healthy lifestyle by serving foods low in saturated fat, trans fats and cholesterol; encouraging at least 60 minutes of physical activity on most (and preferably all) days; and stressing the importance of avoiding tobacco products. Learn more about safe levels of cholesterol in children.