High Cholesterol (Hyperlipidemia)

High blood cholesterol, also known a hyperlipidemia, is a significant risk factor in heart disease. Genetics, diet, physical activity, stress, weight, and certain medical conditions all contribute to an individual's cholesterol level.

What Is Cholesterol?

Two main types of fats (lipids) are found in the blood: cholesterol and triglycerides (lipoproteins). Cholesterol is an essential component of all human cell membranes. Triglycerides are necessary to help transfer energy from food into body cells.

There are two types of cholesterol: 

• LDL (low-density lipoprotein), also called "bad cholesterol," can change the structure of the innermost layer of an artery's wall. Elevated LDL levels are associated with the formation of atherosclerotic plaque, fatty material that hardens and blocks the artery, impeding or stopping blood flow.
• HDL (high-density lipoprotein), also called "good cholesterol," helps remove LDL cholesterol from the bloodstream. 

For most people, healthy cholesterol levels are as follows:

• HDL - greater than 40 milligrams per deciliter (mg/dl).
• LDL - less than 130 milligrams per deciliter (mg/dl).

For those who have coronary artery disease (CAD) and/or other risk factors for heart disease or heart attack, lower cholesterol levels may be more appropriate. Your physician can determine your risk and advise you.

Managing High Cholesterol

Cholesterol levels may rise and fall based on the types of fat you eat, the amount of exercise you do, your weight, and your lifestyle. Increased physical activity, weight loss, smoking cessation, decreasing alcohol intake, and proper diet can help lower blood cholesterol and reduce heart disease risk. Your physician may advise you to make changes in your diet as well as suggest an exercise and weight-reduction plan specific to your needs. 

In some cases, there may be a family history of elevated fats in the blood, causing conditions that cannot be managed by diet or exercise alone. Certain medical conditions like thyroid disease, kidney disease, diabetes, lupus, polycystic ovary syndrome, and HIV can also contribute to high cholesterol. Because blood cholesterol is very specific to each individual, a full lipid profile combined with your medical history will provide your physician with important information to help guide your treatment. 

Lipid (fat) lowering therapy may be recommended to help reduce the progression of atherosclerotic disease. The National Cholesterol Education Program III (NCEP-III) guidelines recommend a target goal of LDL cholesterol at less than 130 mg/dl. However, if you have a higher risk for heart disease, an LDL of below 100 is ideal. The optimal goal for your LDL cholesterol can depend on other risk factors. Your physician will consider your individual risk factors to help determine what is best for you. 

Your physician may determine that you require a medication to maintain a specific cholesterol level in addition to dietary and exercise changes. There are several types of medications used to decrease cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Studies have shown that certain statins can decrease the thickness of the carotid artery wall, increase the size of the lumen (opening) of the artery, and reduce vascular inflammation thought to be a cause of atherosclerosis.

Because atherosclerosis may progress to the point of narrowing or blocking blood vessels, another type of medication may be used to prevent narrowing or blockage caused by blood clots. Antiplatelet medications (platelets are blood cells that stick together to prevent bleeding) may be used to decrease the "stickiness" of platelets and help prevent blood clots from forming inside blood vessels. Such medications include aspirin, clopidogrel (Plavix®), or dipyridamole (Persantine®).

Many times, high cholesterol can be managed by your primary care physician. Individuals with higher risk levels for heart disease or with other medical conditions may need to consult a cardiologist.