The Good and the Bad of High Cholesterol

Has your doctor told you that your cholesterol is high? If so, you are not alone. Millions of Americans have high cholesterol. Some know that they do, and some do not. It is important to learn as much as you can about this condition and how it is treated so that you can live a long and healthy life. Fortunately, there are many steps you can take to help yourself if your cholesterol is higher than it should be.

Why Is Too Much Cholesterol in the Blood Harmful?

Having some cholesterol in your blood is good for you and your body. The higher your cholesterol level is, however, the higher is your chance of getting heart disease, the number 1 killer of Americans.

High cholesterol causes a waxy buildup in the blood vessels over time. It slows and sometimes blocks the flow of blood to your heart. Because blood carries oxygen, too little oxygen to the heart can cause chest pain or even a heart attack. So lowering your cholesterol can lower your chances of getting heart disease.

How Do I Know If I Have High Cholesterol?

Everyone age 20 and older should have a blood cholesterol test at least once every 5 years. This simple test usually is done in the morning after you have had nothing to eat since the night before. It gives information about the following fats in your blood:

• Total cholesterol (good and bad cholesterol together)
• Low-density lipoprotein (LDL) cholesterol (bad cholesterol)
• High-density lipoprotein (HDL) cholesterol (good cholesterol)
• Triglycerides (another kind of blood fat)

Your doctor will give you numbers for each of these important fats. These numbers represent the total number of milligrams (mg) of cholesterol per deciliter (dL) of blood (mg/dL).

Total Cholesterol Numbers

• The numbers, ideally, should be lower than 200 mg/dL
• Numbers between 200 and 239 are called borderlinehigh
• Numbers 240 and greater are considered high

LDL Numbers

• Numbers less than 100 are best
• Numbers between 100 and 129 are good
• Numbers from 130 to 159 are borderline-high
• Numbers from 160 to 189 are high
• Numbers 190 and greater are very high

HDL Numbers

For HDL, however, the difference between "good" and "bad" switches.

• Numbers less than 40 are bad
• Numbers greater than 60 are good

Triglyceride Numbers

The numbers are similar to LDL numbers.

• Numbers less than 150 are normal
• Numbers from 150 to 199 are borderline-high
• Numbers 200 and greater are high

What do all these numbers mean? The most important number to know is your LDL number, because this one has the most to do with your chances of developing heart disease. LDL is the bad type of cholesterol that causes the buildup of plaque in your blood vessels.

Are There Other Risk Factors for Heart Disease?

There are other risk factors that make you more likely to have heart problems, too. These risk factors include the following:

• Smoking cigarettes
• Having untreated high blood pressure
• Having low levels of good cholesterol
• Your age (45 years or older if you are a man, 55 years or older if you are a woman)
• Family history of early heart disease

The more of these risk factors you have, along with a higher LDL number, the more important it is to lower your LDL number.

How Can I Lower My Bad Cholesterol?

There are many factors that affect cholesterol that you can change, and some that you cannot change. Although taking medication can lower cholesterol, addressing poor health habits in your lifestyle is always helpful. Factors that you can do something about include the following:

• What you eat—saturated fat and cholesterol in foods raise your cholesterol level
• How much you weigh—losing weight raises HDL and lowers LDL, triglycerides, and total cholesterol
• How much you exercise—regular exercise for 30 minutes a day, at least 3 days a week, can lower LDL and raise HDL

What If I Need Medications to Control My Cholesterol?

There are 5 major types of medicines that can be used alone or in combination to lower your bad cholesterol and keep you healthy. Your doctor or pharmacist can give you more information and answer any questions you may have about them. These 5 main types are as follows:

• Bile acid sequestrants (medicines that help lower LDL; usually used with other medicines)
• Ezetimibe (a drug that lowers LDL; blocks cholesterol from food; may be used with other medicines)
• Fibrates (drugs that lower triglycerides; may increase HDL)
• Nicotinic acid (a drug that lowers LDL and triglycerides; raises HDL)
• Statins (drugs that are very good at lowering LDL; are safe for most people)

These main types of cholesterol medications work in different ways to lower cholesterol levels in the blood. If you take any of these medications, you must follow up regularly with your doctor to make sure that they are working correctly, and you must make healthy lifestyle changes.

Even if you need medications to lower your cholesterol, it is still important to practice good health habits. Doing so can keep your medicine dose down and lower your risk of heart disease even more.Working with your doctor and pharmacist will help you lower your cholesterol and keep you safe and healthy!

Dr. Newman is a senior pharmacy officer with the US Public Health Service/Federal Bureau of Prisons at the US Medical Center for Federal Prisoners, Springfield, Mo.

The opinions expressed in this article are those of the author and do not necessarily represent those of the US Public Health Service or the Federal Bureau of Prisons.