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Jennifer Larsen, M.D. |
High cholesterol increases your risk for heart attacks and strokes. Increasingly, we realize you need to know more than just your total cholesterol number.
Cholesterol is carried in several particles in your blood, called lipoproteins. These lipoproteins shuttle cholesterol from your gut where it has been absorbed, to the liver where it may be stored or re-packaged, to other tissues where it may be needed to make hormones or for storage.
You can make your own cholesterol, if you don’t take in any in your diet. Some of the cholesterol is carried in good particles, called high-density lipoprotein or HDL. Your heart disease risk is lower when your HDL is high — even if it raises your total cholesterol.
If the cholesterol is in low-density lipoprotein particles or LDL, it is considered “bad cholesterol.” As LDL-cholesterol increases, so does heart disease risk. So it is important to know what type of cholesterol is elevated when your total cholesterol is high.
The current recommendations of the American Heart Association and National Cholesterol Education Program is that routine cholesterol screening begin in young adulthood (20 years of age or older) and continue regularly according to risk.
Screening should ideally be done with a fasting lipid profile, which includes not only a total cholesterol but an HDL and LDL cholesterol measurement as well. A minimum screen would be a total and HDL cholesterol. This can be done without fasting.
Risk is generally determined first based on LDL concentration. An individual’s LDL goal will vary depending on their number of risk factors. These risk factors include other lipid values, age, high blood pressure, smoking status, diabetes and family history of early heart disease.
Individuals with known heart disease or multiple risk factors should have a lower goal than those with few risk factors.
The LDL goal for those with known heart disease is less than 70 mg/dl. Those with diabetes and/or multiple risk factors should have an LDL less than 100 mg/dl. Everyone should ideally have an LDL less than 130 mg/dl.
Depending on the individual’s risk factors and how high their LDL is, the individual will be recommended to consider weight loss, diet changes and exercise. However, should the number of risk factors and the LDL level be too high for these methods to sufficiently reduce cholesterol, then a cholesterol-lowering medication would also be considered.
Several other factors — excessive alcohol consumption, low thyroid function, or other diseases and medications — can increase your cholesterol, so these must be taken into consideration if your cholesterol or lipids are abnormal. Genetics also may cause you to have elevated LDL cholesterol — even when you are following a healthy lifestyle.
Cholesterol lowering medications are very effective in reducing deaths as well as serious events such as heart attacks and strokes. They are absolutely vital to maintaining good health for many individuals.
Jennifer Larsen, M.D., is chief of the Diabetes, Endocrinology, and Metabolism Section of the University of Nebraska Medical Center’s Department of Internal Medicine. She also is director of The Nebraska Medical Center Diabetes Center.