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Cholesterol: Understanding and Managing HDL and LDL

Cholesterol is a waxy material that is produced naturally by the liver. It protects the nerves, produces hormones and makes cell tissues, according to the American Academy of Family Physicians. However, it's also possible to consume it through animal products, and too much of it can be a bad thing – which is why it's important to manage it and keep it at reasonable levels. In the United States, 35.7 million people have high cholesterol, according to the American Heart Association.

There are two kinds of cholesterol – HDL (high density lipoprotein) and LDL (low density lipoprotein). HDL is the good cholesterol that keeps LDL, the bad cholesterol, down, according to the American Heart Association. Too much LDL cholesterol can cause deposits to build up in the blood vessels, known as plaque, which decreases the amount of blood and oxygen going to the heart. This in turn can lead to heart disease and heart attack.

Cholesterol
Cholesterol plaque in artery (atherosclerosis): Top artery is healthy. Middle & bottom arteries show plaque formation, rupturing, clotting & blood flow occlusion.
Credit: Diamond Images | shutterstock

Symptoms & Causes

There are really no symptoms of high cholesterol. That's why the American Heart Association recommends getting your cholesterol checked at age 20, and then every five years after that. The doctor will be able to tell if the cholesterol levels have risen too quickly, and can then help with a treatment plan.

A diet rich in saturated fat, being overweight and not having much, or any, physical activity are all things that exacerbate bad cholesterol levels that narrow and harden the arteries. It's also caused, in part, by genetics (family history), as well as age and gender – women generally have lower LDL levels than men before menopause, but then those levels rise afterward, according to the National Heart, Lung and Blood Institute.

Smoking and diabetes are also risk factors for high cholesterol, according to the Mayo Clinic.

Diagnosis & Tests

A blood test is usually performed to test the levels of HDL and LDL cholesterol levels. A doctor may ask you to fast for 12 hours before taking the test. HDL levels that are below 40 mg/dL (meaning 40 miligrams in a deciliter of blood) or LDL levels that are above 200 mg/dL mean you are at risk of having high cholesterol. In general, LDL levels that are between 200 and 239 mg/dL mean you are at borderline risk of high cholesterol, and levels that are 240 mg/dL and higher mean you definitely have high cholesterol, according to the American Heart Association.

It's good to aim for a LDL level that is under 130 mg/dL, according to the Mayo Clinic. However, if you have other factors that put you at risk for heart disease, a minimum threshold may be 100 mg/dL instead. People who are high at risk include those who have had a heart attack or have neck, arm or leg artery blockages, according to the Mayo Clinic.

 

Treatments & Medications

Doctors will always recommend lifestyle changes first to treat high cholesterol, such as heating healthy, exercising and losing weight. However, there are medications that can help lower cholesterol, too. They include statins, which cause your liver to remove cholesterol from your bloodstream and arteries to reabsorb cholesterol, that are known under the brand names Lipitor, Lescol, Altoprev, Mevacor, Pravachol, Crestor and Zocor, according to the Mayo Clinic.

Another type of medication is the bile-acid-binding resin, which include the brand names Prevalite, Questran, Welchol and Colestid, according to the Mayo Clinic. This medication increases the liver's production of bile acids, thereby reducing the amount of cholesterol in the blood.

Cholesterol absorption inhibitors, like brand name Zetia, limit the body's absorption of cholesterol that gets put out into the bloodstream. These inhibitors combined with a statin, known as the drug Vytorin, decrease both absorption of and the production of cholesterol, according to the Mayo Clinic.

There are also some natural food and supplements that may help to lower cholesterol, according to the Mayo Clinic, including artichokes barley, garlic, oat bran, beta-sitosterol, blond psyllium (found in Metamucil) and sitostanol.

High-Cholesterol Prevention Strategies

The best way to prevent high cholesterol is the same way to treat high cholesterol – leading a healthy lifestyle. By losing weight, eating foods that are low in saturated fats, eliminating trans fats, eating whole grains, fruits, vegetables and fish and drinking alcohol in moderation, it's possible to keep cholesterol down, according to the American Heart Assocation. Regular exercise – 30 to 60 minutes a day – and leading a smoke-free lifestyle are also important methods to prevent high cholesterol.

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