Cholesterol

Your body needs some cholesterol. But if you have too much, it starts to build up in your arteries. (Arteries are the blood vessels that carry blood away from the heart.) This is called hardening of the arteries, or atherosclerosis. It is usually a slow process that gets worse as you get older.

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How Is High Blood Cholesterol Treated?

The main goal of cholesterol-lowering treatment is to lower your low-density lipoprotein (LDL) level enough to reduce your risk for having a heart attack or diseases caused by hardening of the arteries.

In general, the higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack.

Some people are at high risk for heart attack because they already have heart disease. Other people are at high risk for developing heart disease because they have diabetes or a combination of risk factors for heart disease. Follow the steps below to find out your risk for getting heart disease. Talk with your doctor about lowering your risk.

Check the list to see how many of the risk factors you have. These are the risk factors that affect your LDL goal:

Cigarette smoking
High blood pressure or if you are on blood pressure medicine
Low high-density lipoprotein cholesterol
Family history of early heart disease
Age

Use your medical history, number of risk factors, and risk score to find your risk for developing heart disease or having a heart attack according to the table below.

If You Have	You Are in Category	And Your LDL Goal Is
Heart disease, diabetes, or a risk score higher than 20%	I. High risk	Less than 100 mg/dL*
Two or more risk factors and a risk score 10–20%	II. Moderately high risk	Less than 130 mg/dL
Two or more risk factors and a risk score lower than 10%	III. Moderate risk	Less than 130 mg/dL
One or no risk factors	IV. Low to moderate risk	Less than 160 mg/dL

*Some people in this category are at very high risk because they have just had a heart attack or because they have a combination of heart disease together with diabetes, risk factors that are severe, or metabolic syndrome. If you are at very high risk, your doctor may set your LDL goal even lower, to less than 70 mg/dL. Your doctor may also set the LDL goal at this lower level if you have heart disease alone.

After following the above steps, you should have an idea about your risk for getting heart disease or having a heart attack. There are two main ways to lower your cholesterol in order to lower your risk:

Therapeutic Lifestyle Changes - includes a cholesterol-lowering diet, physical activity, and weight management. TLC is for anyone whose LDL is above goal.

Drug Treatment - if cholesterol-lowering drugs are needed, they are used together with TLC treatment to help lower your LDL.

Your doctor will set your LDL goal. The higher your risk for heart disease, the lower your LDL goal will be. Using the following guide, you and your doctor can develop a possible plan for treating your high blood cholesterol.

Category I, high risk, your LDL goal is less than 100 mg/dL.*

Your LDL Level	Treatment
If your LDL is 100 or above	You will need to begin the TLC Diet together with drug treatment.
Even if your LDL is below 100	You should follow the TLC Diet on your own to keep your LDL as low as possible.

* Your LDL goal may be set even lower, to less than 70 mg/dL, if you are at very high risk or if you have heart disease. If you have this lower goal and your LDL is 70 mg/dL or higher, you will need to begin the TLC Diet together with drug treatment.

Category II, moderately high risk, your LDL goal is less than 130 mg/dL.

Your LDL Level	Treatment
If your LDL is 130 mg/dL or above	You will need to begin the TLC Diet.
If your LDL is 130 mg/dL or more after 3 months on the TLC Diet	You may need drug treatment along with the TLC Diet.
If your LDL is less than 130 mg/dL	You will need to follow the Heart Healthy Diet.

Category III, moderate risk, your LDL goal is less than 130 mg/dL.

Your LDL Level	Treatment
If your LDL is 130 mg/dL or above	You will need to begin treatment with the TLC Diet.
If your LDL is 160 mg/dL or more after you have tried the TLC Diet for 3 months	You may need drug treatment along with the TLC Diet.
If your LDL is less than 130 mg/dL	You will need to follow the Heart Healthy Diet.

Category IV, low to moderate risk, your LDL goal is less than 160 mg/dL.

Your LDL Level	Treatment
If your LDL is 160 mg/dL or above	You will need to begin the TLC Diet.
If your LDL is still 160 mg/dL or more after 3 months on the TLC Diet	You may need drug treatment along with the TLC Diet.
If your LDL is less than 160 mg/dL	You will need to follow the Heart Healthy Diet.

Lowering Cholesterol With TLC

TLC is a set of lifestyle changes you can make to help lower your LDL cholesterol.

The TLC Diet, which recommends:

- - Limiting the amount of saturated fat, trans fat, and cholesterol you eat.
- - Eating only enough calories to achieve or maintain a healthy weight.
- - Increasing the soluble fiber in your diet. For example, apples are good sources of soluble fiber.

- - Adding cholesterol-lowering foods, such as margarines that contain plant sterol or stanol esters that can help lower cholesterol.

Weight management:

- Losing weight if you are overweight can help lower LDL. Weight management is especially important for those with a group of risk factors that includes raised triglyceride and/or reduced HDL levels and being overweight with a large waist measurement (40 inches or more for men and 35 inches or more for women). This is called metabolic syndrome and it raises your risk for getting heart disease.

Physical activity:

- Regular physical activity is recommended for everyone. It can help raise HDL levels and lower LDL levels, and is especially important for those with raised triglyceride and/or reduced HDL levels who are overweight with a large waist measurement. Aim for at least 30 minutes of moderate-intensity activity, such as brisk walking, on most, and preferably all, days of the week.

Cholesterol-Lowering Medicines

If your blood cholesterol level is higher than it should be, your doctor will probably advise you to try to bring it down with diet and exercise first. For many people, diet and exercise changes can cause their cholesterol level to begin dropping after two to three weeks and to fall 30 to 55 points over three months.

If, after three months of healthy eating and regular exercise, your cholesterol level is still too high, your physician may suggest additional changes to help you lower the fat and cholesterol in your diet even more. If these changes in diet and exercise do not bring your blood cholesterol level down to a healthy level within six months, your physician may prescribe a cholesterol-lowering medication.

Many excellent medications have been developed in recent years. These medications work by different means:

- Some reduce the amount of cholesterol the liver makes.
- Some reduce the amount of dietary cholesterol that is absorbed from food

Types of medication that may be prescribed to lower cholesterol include:

Niacin. This B vitamin is found in foods and in multi-vitamin supplements. In high doses, available by prescription, niacin lowers LDL (the bad cholesterol) and raises HDL (the good cholesterol). Minor side effects are flushing or tingling skin, itching, and headache.

Bile-acid sequestrants. These medications help to limit the liver's production of cholesterol. Common bile-acid sequestrants include colestipol (Colestid) and cholestyramine (Questran). The most common side effects include digestive problems such as constipation, gas, and upset stomach.

HMG-CoA reductase inhibitors, also called statins, which are the newest medications available to lower cholesterol.