Cholesterol

 Basic information about Cholesterol

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
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. Cholesterol is only found in animal products.
A cholesterol screening measures your level of HDL and LDL.  HDL is the "good" cholesterol which helps keep the LDL (bad) cholesterol from getting lodged into your artery walls.  A healthy level of HDL may also protect against heart attack and stroke, while low levels of HDL (less than 40 mg/dL for men and less than 50 mg/dL for women) have been shown to increase the risk of heart disease.
If you need to increase your HDL to your reach your goals, studies show that regular physical activity can help your body produce more HDLs.  Reducing trans fats and eating a balanced, nutritious diet is another way to increase HDL.  If these measures are not enough to increase your HDL to goal, your healthcare practitioner may prescribe a medication specifically to increase your HDLs
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.

 Good vs. Bad Cholesterol 

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.

 Hyperlipidemia

Managing hyperlipidemia means controlling cholesterol, triglycerides.
Hyperlipidiemia is a mouthful, but it’s really just a fancy word for too many lipids – or fats – in the blood.
That can cover many conditions, but for most people, it comes down to two better-known terms: high cholesterol and high triglycerides. Our bodies make and use a certain amount of cholesterol every day, but sometimes that system gets out of whack, either through genetics or diet. The “good cholesterol” – known as high-density lipoprotein, or HDL – helps coat the arteries like a protective oil, helping to prevent blockages. The “bad cholesterol,” low-density lipoprotein, or LDL – can lead to blockages if there’s too much in the body.
What’s the treatment?
If you’re diagnosed with hyperlipidemia, your treatment will vary based on which type of lipids that are too high, said Vincent Bufalino, chairman and chief executive of Midwest Heart Specialists in suburban Chicago and an American Heart Association volunteer. In any case, making healthy diet choices and increasing exercise are important first steps in lowering your high cholesterol. Avoid fatty foods and lower your overall daily calorie intake. Medication is also an effective tool in managing the condition when used in conjunction with healthy eating and regular exercise.
The combination of diet and regular physical activity is important even if you’re on medication for high cholesterol,” Dr. Bufalino said. “It’s the most critical piece.
Consulting a doctor is important, since each condition has it quirks. For people with high triglycerides, for example, alcohol can be particularly dangerous
Once I have it, can I reverse it?
Hyperlipidemia can be reversible in many cases through healthy eating and regular exercise.
Here are some tips on how to manage your risk of high cholesterol. 
Read food labels and choose foods with low cholesterol and saturated fat levels.  Dr. Bufalino recommends keeping daily cholesterol intake between 250 and 300 milligrams and make sure to limit saturated fat intake. 
Limit your intake of red meat and eggs to reduce your saturate fat and cholesterol.  Choose skim milk, lowfat or fat-free dairy products. Limit fried food, and use healthy oils in cooking, such as vegetable oil.
Increase the amount of fiber you eat.  A diet high in fiber can help lower cholesterol levels by as much as 10 percent, Dr. Bufalino said.
Check your family history of high cholesterol.  Are you more prone to high cholesterol based on genetics? If so, take steps to minimize your risk through diet and exercise.
Lose extra weight. A weight loss of 10 percent can go a long way to reversing, or lowering your risk of hyperlipidemia.

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 (View an animation of cholesterol). 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.
High blood cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. Your cholesterol level can be affected by your age, gender, family health history and diet.
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.
The American Heart Association recommends 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.
How To Get Your Cholesterol Tested
Cholesterol plays a major role in a person's heart health. High blood cholesterol is a major risk factor for coronary heart disease and stroke. That's why it's important for all people to know their cholesterol levels. They should also learn about their other risk factors for heart disease and stroke.
How is cholesterol tested?
A small sample of blood will be drawn from your arm. If your doctor has ordered other tests to be run at the same time as your cholesterol test, all the samples will usually be taken at the same time. Your blood sample is then analyzed by a laboratory.
Your doctor will tell you if you should fast (avoid consuming food, beverages and medications, usually for nine to 12 hours) before your blood test. If you aren't fasting when the blood sample is drawn, only the values for total cholesterol and HDL cholesterol will be usable. That's because the amount of LDL (bad) cholesterol level and triglycerides can be affected by what you've recently consumed.
Your test report will show your cholesterol level in milligrams per deciliter of blood (mg/dL). Your doctor must interpret your cholesterol numbers based on other risk factors such as age, family history, smoking and high blood pressure.
Your LDL (bad) cholesterol levels will be needed to determine your treatment plan if your total cholesterol is 200 mg/dL or greater, or if your HDL is less than 40 mg/dL. If you weren't fasting for your first test, your doctor may need to send you for another test.
What do your cholesterol levels mean?
How often should I have my cholesterol checked?
The American Heart Association endorses the National Cholesterol Education Program (NCEP) guidelines for detection of high cholesterol: All adults age 20 or older should have a fasting lipoprotein profile — which measures total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides — once every five years. The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III or ATP III) was released in 2001. It recommends that everyone age 20 and older have a fasting "lipoprotein profile" every five years. This test is done after a 9–12-hour fast without food, liquids or pills. It gives information about total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
You may need to have your cholesterol checked more often than every five years if one or more of these situations applies to you:  
    Your total cholesterol is 200 mg/dL or more.
    You are a man over age 45 or a woman over age 50.
    Your HDL (good) cholesterol is less than 40 mg/dL.
    You have other risk factors for heart disease and stroke.
If a fasting lipoprotein profile isn't possible, the values for total cholesterol and HDL cholesterol are still useful. If your total cholesterol is 200 mg/dL or more, or your HDL cholesterol is less than 40 mg/dL (for men) or less than 50 mg/dL (for women), you need to have a follow-up lipoprotein profile done to determine your LDL cholesterol and triglyceride levels. Your healthcare provider will set appropriate management goals based on your LDL cholesterol level and your other risk factors. See What Your Cholesterol Levels Mean for information on what your levels should be.
Where should I have my cholesterol checked?
It's best to have your regular doctor run your cholesterol test. Overall risk factors such as your age, family history, smoking history and high blood pressure must be considered when interpreting your results — and your regular doctor is most likely to have all that information. Once you know your numbers, your doctor should recommend a treatment and prevention plan, as well as follow-up testing to make sure the plan is getting you to your cholesterol goals.
If you're admitted to the hospital for a major coronary event, your LDL cholesterol should be measured on admission or within 24 hours. However, it may take four to six weeks before your fasting lipid profile stabilizes and you can get accurate results. Your doctor will determine whether to start drug treatment at discharge.
If you have your cholesterol checked at public screenings, make sure a reputable company does the screening. Remember that your cholesterol level is just part of your overall cardiovascular risk profile, and your other risk factors must be considered. You should share the screening results with your healthcare professional so your tests can be properly interpreted, and an appropriate treatment and prevention plan developed.
Be sure to review your test results with your doctor so you can understand and follow your treatment plan. Ways to control or lessen Cholesterol:
Good eating habits It is very important to follow good eating habits in order to lower your cholesterol.
Regular exercising Experts recommend at least 30 minutes or more of moderate-intensity physical activity five days a week for at least 12 weeks for significant cholesterol reduction.
Weight loss and maintaining it You can lower your LDL (bad cholesterol) and elevate your HDL (good cholesterol) just by dropping some pounds.
avoiding tobacco smoke.