High blood cholesterol and triglycerides

Definition

Lipid disorders are when you have excess fatty substances in your blood. These substances include cholesterol and triglycerides. Having a lipid disorder makes you more likely to develop atherosclerosis and heart disease.

Causes, incidence, and risk factors

Cholesterol can be bound to fat and protein at different densities. Two main types include:

• Low-density lipoproteins (LDL) -- bad cholesterol
• High-density lipoproteins (HDL) -- good cholesterol

In general, you want your LDL to be LOW, and your HDL to be HIGH.

High cholesterol and other lipid disorders can be inherited (genetic) or associated with:

• Fatty diets
• Diabetes, hypothyroidism, Cushing's syndrome, and kidney failure
• Certain medications, including birth control pills, estrogen, corticosteroids, certain diuretics, and beta-blockers
• Lifestyle factors, including habitual, excessive alcohol use and lack of exercise, leading to obesity.

People who smoke and also have high cholesterol are at even greater risk for heart disease. Lipid disorders are more common in men than women.

Symptoms

There are no symptoms.

Signs and tests

A fasting lipid test (lipoprotein test) breaks down cholesterol into four groups:

• Total cholesterol
• Low density lipoproteins (LDL) -- bad cholesterol
• High density lipoproteins (HDL) -- good cholesterol
• Triglycerides

In general, a total cholesterol value over 200 mg/dL may indicate a greater risk for heart disease. However, LDL levels are a better predictor of heart disease and determine how your high cholesterol should be treated.

How you are treated also depends on whether you have any of these additional risk factors for heart disease:

• Diabetes
• Poorly controlled high blood pressure
• Currently smoke
• Being male and over age 45 or female and over age 55
• Having a first-degree female relative diagnosed with heart disease before age 65 or a first-degree male relative diagnosed before age 55.
• Metabolic syndrome (high triglycerides, low HDL, and obesity)

Discuss your results with your health care provider to determine the best therapy for your lifestyle.

Other tests to help determine your risk for heart disease are:

• Lipoprotein(a) analysis
• C-reactive protein analysis

Laboratory tests may be performed to identify secondary causes of lipid disorders if a lipoprotein test is elevated.

Treatment

There are steps that everyone can take to improve their cholesterol levels and help prevent heart disease and heart attack. Here's the bottom line:

• Choose foods low in saturated fat. (See cholesterol for more information.)
• Exercise regularly.
• Lose weight if you are overweight.
• Get routine health checkups and cholesterol screenings.

If your cholesterol levels are high, these recommendations are very important steps for bringing your cholesterol under control.

If lifestyle changes do not help, or if your cholesterol level is severely elevated, your doctor may consider drug therapy. Your doctor will start or consider medication when:

• Your LDL cholesterol is 190 mg/dL or higher.
• Your LDL cholesterol is 160 mg/dL or higher AND you have one risk factor for heart disease.
• Your LDL cholesterol is 130 mg/dL or higher AND you have either diabetes or two other risk factors for heart disease.
• Your LDL cholesterol is 100 mg/dL or higher AND you have heart disease. (If you have diabetes, even if you don't have known heart disease, medication may be considered for an LDL cholesterol of 100 mg/dL)
• Your LDL cholesterol is greater than 70 mg/dL AND you have had a recent heart attack or have known heart disease along with diabetes, current cigarette smoking, poorly controlled high blood pressure, or the metabolic syndrome (high triglycerides, low HDL, and obesity).

There are several types of drugs available to help lower blood cholesterol levels, and they work in different ways. Some are better at lowering LDL (bad) cholesterol, some are good at lowering triglycerides, while others help raise HDL (good) cholesterol.

The most commonly used drugs for treating high LDL cholesterol are called statins. Other drugs that may be used include bile acid resins, cholesterol absorption inhibitors, fibrates, probucol, and nicotinic acid.

If you are prescribed medication, do not stop taking it without consulting your doctor.

Expectations (prognosis)

If you are diagnosed with high cholesterol, you will probably need to continue lifestyle changes and drug therapy throughout your life. Periodic monitoring of your blood levels is necessary. Reducing high cholesterol levels will slow the progression of atherosclerosis.

Complications

Possible complications of high cholesterol include:

• Atherosclerosis
• Coronary artery disease
• Stroke
• Heart attack or death

Calling your health care provider

Have your cholesterol checked every 5 years or so, starting between the ages of 20 and 30. If you have high cholesterol or other risk factors for heart disease, make appointments as recommended by your doctor.

Prevention

To help prevent high cholesterol:

• Maintain a healthy body weight
• Eat a well-balanced, low-fat diet
• Limit cholesterol intake

Illustrations

Cholesterol producers

Coronary artery disease

Page Content:

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