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Cholesterol Levels: What You Need to Know

Summary

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But if you have too much cholesterol in your blood, you have a higher risk of coronary artery disease.

How do you measure cholesterol levels?

If you are age 20 or older, you should have your cholesterol measured at least once every five years. A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your

  • Total cholesterol - a measure of the total amount of cholesterol in your blood. It includes the two types - low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
  • LDL (bad) cholesterol - the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol - HDL helps remove cholesterol from your arteries
  • Triglycerides - another form of fat in your blood that can raise your risk for heart disease, especially in women

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Here is what the numbers mean:

Total Cholesterol Level

Category

Less than 200mg/dL Desirable
200-239 mg/dL Borderline high
240mg/dL and above High
   

LDL (Bad) Cholesterol Level

LDL Cholesterol Category

Less than 100mg/dL Optimal
100-129mg/dL Near optimal/above optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very High
   

HDL (Good) Cholesterol Level

HDL Cholesterol Category

60 mg/dL and higher Considered protective against heart disease
40-59 mg/dL The higher, the better
Less than 40 mg/dL A major risk factor for heart disease


Triglycerides are not a type of cholesterol, but they are part of a lipoprotein panel (the test that measures cholesterol levels). A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

What affects my cholesterol levels?

A variety of things can affect cholesterol levels. These are some things you can do to lower your cholesterol levels:

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
  • Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL (bad) cholesterol, total cholesterol, and triglyceride levels. It also raises your HDL (good) cholesterol level.
  • Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.
  • Smoking. Cigarette smoking lowers your HDL (good) cholesterol. HDL helps to remove bad cholesterol from your arteries. So a lower HDL can contribute to a higher level of bad cholesterol.

Things outside of your control that can also affect cholesterol levels include:

  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL (bad) cholesterol levels tend to rise.
  • Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

How can I lower my cholesterol?

You can lower your LDL (bad) cholesterol with therapeutic lifestyle changes (TLC). The main parts of TLC are:

  • The TLC Diet. This diet is a low-saturated-fat, low-cholesterol eating plan. According to the plan, you should get less than 7 percent of your calories from saturated fat and eat less than 200mg of dietary cholesterol per day. The TLC diet encourages you to choose a variety of nutritious and tasty foods. Choose fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, poultry without the skin, and, in moderate amounts, lean meats. The TLC diet recommends only enough calories to stay at a desirable weight and avoid weight gain. If your LDL (bad) cholesterol is not lowered enough by reducing saturated fat and cholesterol intake, you should increase the amount of soluble fiber in your diet. You can also add foods that contain "plant sterols" or "plant stanols," such as cholesterol-lowering margarines.
  • Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL (good) cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
  • Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
  • Drug Treatment. Even if you take medicines to lower your cholesterol, you still need to continue with the lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of cholesterol-lowering drugs available, including
    • Statins, which block the liver from making cholesterol
    • Bile acid sequestrants, which decrease the amount of fat absorbed from food
    • Cholesterol absorption inhibitors, which decrease the amount of cholesterol absorbed from food and lower triglycerides
    • Nicotinic acid (niacin), which lowers LDL (bad) cholesterol and triglycerides and raises HDL (good) cholesterol. You should only use this type of medicine with a health care provider's supervision.
    • Fibrates, which lower triglycerides. They may also raise HDL (good) cholesterol. If you take them with statins, they may increase the risk of muscle problems.
    • Ezetimibe, which lowers LDL (bad) cholesterol. It works by blocking your intestine from absorbing cholesterol.

NIH: National Heart, Lung, and Blood Institute

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