High cholesterol is one of the most prevalent and dangerous medical conditions worldwide. The World Health Organization (WHO) reports that high cholesterol levels cause 2.6 million deaths globally. The Centers for Disease Control and Prevention (CDC) estimates that 86 million Americans have high cholesterol levels. 25 million of these 86 million people have dangerously elevated levels of cholesterol.

Complicating matters is that high cholesterol is hard to detect on its own. It is often called a “silent killer” as it causes few noticeable symptoms, meaning those managing the condition may not even know they have it. Fewer still receive treatment for it. Because of this, it’s essential to understand what high cholesterol is, its associated risks, and how to treat the condition.

High Cholesterol Basic Facts

Cholesterol is a form of lipid, a waxy substance that helps your body make cells, vitamins, and hormones. Your liver produces an enzyme that synthesizes cholesterol to help with these functions. As such, cholesterol is not inherently bad.

Not all cholesterol is the same. There are two types of cholesterol: high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). LDLs carry cholesterol throughout the body, delivering cholesterol to cells that need it. HDLs take excess LDLs back to the liver, where they are broken down and flushed from the body.

Even though LDLs play a critical role in healthy cell function, this type of cholesterol can build up when produced in excess. When extra LDLs accumulate, they turn into plaque. This plaque coats the walls of arteries and blood vessels, making it harder for blood to flow throughout the body.

This restricted blood flow can lead to complications such as:

• Heart disease
  
• Stroke
  
• Peripheral artery disease (PAD)
  
• Chest pain (angina)
  
• Heart attack
  
• High blood pressure
  
• Reduced blood flow to organs
  
• Increased risk of blood clots
  
  

High Cholesterol Causes

Uncontrollable and controllable factors lead to high cholesterol. High cholesterol is often genetic, meaning that it is a trait passed from parents to children.

Cholesterol levels are also affected by several other conditions, such as:

• Diabetes
  
• Kidney disease
  
• HIV/ AIDS
  
• Hypothyroidism
  
• Autoimmune conditions
  
  

Certain types of medication can also cause a change in cholesterol levels. Before taking any prescription medication, talk to your doctor about the risks associated with that drug.

In many cases, controllable risk factors cause high cholesterol.

Risk factors for elevated cholesterol include:

• Being overweight or having obesity
  
• Cigarette smoking
  
• Alcohol consumption
  
• Lack of physical activity
  
• Unhealthy diet
  
• Age
  
  

Detecting High Cholesterol

Like high blood pressure, high cholesterol causes few noticeable symptoms. This can make it hard to tell whether you manage elevated cholesterol levels. A blood test, known as a lipid panel, will measure the lipid levels in your blood. A lipid test is the primary tool health care providers use to diagnose high cholesterol.

A lipid panel test is performed by taking a blood sample via a serum sample. This blood is sent to a lab to measure lipid levels. Medical professionals perform these tests at a primary care facility. Before your appointment, you may be asked to fast for 9–12 hours. Usually, this means no food or water for the ordered period of time.

Blood will be drawn via a needle inserted into your arm during the test. An elastic band will be wrapped around your upper arm to encourage blood pooling in the veins. A lipid panel requires a small amount of blood to be deposited into a vial or tube for testing. After this, the needle will be removed, and the puncture site will be cleaned and bandaged.

You will get your results within a few days. The results of a lipid test are often measured as follows:

Total Cholesterol - lower is better:

• Below 200 milligrams per deciliter (mg/dL) is considered healthy
  
• 200 to 239 mg/dL is borderline high
  
• 240 mg/dL is high
  
  

HDL (Good Cholesterol) - higher is better:

• 60 mg/dL or higher is best -- High HDL levels protect against heart disease
  
• 40 to 59 mg/dL is a healthy level of HDL
  
• Less than 40 mg/dL is low, which can increase the risk of heart disease
  
  

LDL ("bad cholesterol") - lower is better:

• Less than 100 mg/dL is ideal, especially for individuals who have coronary heart disease
  
• 100 to 129 mg/dL is optimal for individuals at risk of coronary artery disease
  
• 130 to 159 mg/dL is OK for individuals with little risk of coronary artery disease
  
• 160 to 189 mg/dL is high
  
• 190 mg/dL or more is very high
  
  

Triglycerides - lower is better:
150 mg/dL or less is desirable
151 to 200 mg/dL is borderline high
200 to 499 mg/dl is high, which increases your risk of heart disease
Over 500 mg/dl is very high

The National Heart, Lung, and Blood Institute (NHLBI) recommends that adult men receive a lipid panel test every 1-2 years between the ages of 45-65. Women should be tested every 1-2 years between the ages of 55-65. Adults over 65 should receive a lipid panel test every year.

Ways to Lower Cholesterol Levels

If a lipid test shows your lipid levels are too high, your health care provider will work with you on a treatment plan to lower them. This may include medication and certain lifestyle adjustments.

Two primary types of medication are used to lower lipid levels in the body. Statins treat high levels of low-density lipoproteins, while fibrates are used to lower triglycerides – which can help reduce cholesterol levels.

Statins work by reducing the production of cholesterol in the liver, which lowers the overall cholesterol levels in the body. Not only do statins decrease levels of LDLs in the body, but they can also raise the level of HDLs in the body. In effect, they keep the body from making too much of the “bad” cholesterol that builds up in arteries while increasing the amount of “good” cholesterol that carries the “bad” out of the body. This dual action, diet, and exercise have effectively lowered overall cholesterol levels in patients.

FDA-approved statins include:

• Atorvastatin (generic for Lipitor)
  
• Lovastatin (generic for Mevacor)
  
• Pravastatin (generic for Pravachol)
  
• Rosuvastatin (generic for Crestor)
  
• Simvastatin (generic for Zocor)
  
  

Fibrates activate the peroxisome proliferator-activated receptors (PPARs), proteins that control the metabolism of triglycerides. In other words, fibrates reduce the production of triglycerides, which lowers overall lipid levels in the body. They also increase the production of lipoprotein lipase, which breaks down triglycerides. Unlike statins, fibrates’ mechanism of action has little direct effect on low-density lipoproteins. However, the reduction of triglycerides and the increased production of lipid-lowering substances have been shown to reduce LDL levels. Finally, fibrate drugs can stimulate the production of apolipoproteins, which help create HDL cholesterol.

FDA-approved fibrates include:

• Fenofibrate (generic for Fenoglide, Triglide, and TriCor)
  
• Gemfibrozil (generic for Lopid)
• Fenofibric Acid (generic for Trilipix)
  
• Bezafibrate
  
  

Medication is never prescribed alone. Many providers will prescribe certain lifestyle adjustments before prescribing medicines or will prescribe these changes along with medication.

Lifestyle adjustments used to lower cholesterol levels include:

• Eat a healthy diet: Increase your intake of fruits, vegetables, and whole grains. These foods contain cholesterol-lowering compounds while also being high in soluble fiber. Soluble fiber helps keep your digestive tract from absorbing too much cholesterol. Eating more healthy foods while limiting the consumption of processed foods, animal fats, and salt is one of the most effective ways to lower cholesterol.
  
• Exercise: Regular exercise can help lower cholesterol levels by increasing high-density lipoprotein (HDL) cholesterol levels, often referred to as "good" cholesterol. Exercise also promotes the body's metabolism of triglycerides and aids in weight management, which can contribute to healthier cholesterol levels. Additionally, physical activity has been shown to enhance the function of enzymes involved in cholesterol breakdown.
  
• Maintain a healthy weight
  
• Quit smoking
  
• Minimize or cease alcohol intake
  
• Manage stress: Effectively managing stress can lower cholesterol levels by preventing the body from releasing excessive stress hormones like cortisol. When stress levels are high, the body produces more LDL cholesterol. Deep breathing, meditation, spending time with loved ones, and other stress management techniques can lower cholesterol levels.
  
  

High cholesterol levels can lead to severe complications when left untreated. If you have a family history of high cholesterol or just want more information, book an online doctor appointment on Sesame to talk to a licensed health care provider. Don’t wait to have your lipid levels checked. Get a jump on high cholesterol by scheduling an appointment today.

Sources:

• NHS (n.d.). High Cholesterol. NHSinform. https://www.nhsinform.scot
  
• National Heart, Lung, and Blood Institute (2022, March 24). What is Blood Cholesterol? NIH.gov. https://www.nhlbi.nih.gov/
  
• National Heart, Lung, and Blood Instutute (2022, March 24). Blood Cholesterol -- Treatment. NIH.gov. https://www.nhlbi.nih.gov/