High Cholesterol: What It Is and How to Lower It

Cholesterol is a waxy substance that your body needs to make hormones, vitamin D, and bile acids, which help digest fat. However, having too much cholesterol in your blood can increase your risk of heart disease and stroke. This is because excess cholesterol can build up in your arteries and form plaque, which narrows and hardens the arteries. This can reduce blood flow and oxygen to your heart and brain, leading to chest pain, heart attack, or stroke.

Types and Levels of Cholesterol

There are two main types of cholesterol in your blood: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is often called the “bad” cholesterol, because it carries cholesterol from your liver to your cells, where it can accumulate and cause damage. HDL is often called the “good” cholesterol, because it carries cholesterol from your cells back to your liver, where it can be removed from your body.

The levels of cholesterol in your blood are measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). The optimal levels of cholesterol for most adults are:

• Total cholesterol: less than 200 mg/dL (5.2 mmol/L)
• LDL cholesterol: less than 100 mg/dL (2.6 mmol/L)
• HDL cholesterol: 60 mg/dL (1.6 mmol/L) or higher
• Triglycerides: less than 150 mg/dL (1.7 mmol/L)

Triglycerides are another type of fat in your blood that can also contribute to plaque formation and increase your risk of heart disease. They are usually measured along with cholesterol as part of a lipid profile test.

Causes and Risk Factors of High Cholesterol

High cholesterol can be caused by a combination of genetic and lifestyle factors. Some of the common causes and risk factors of high cholesterol are:

• Family history: If you have a parent or sibling with high cholesterol, you may have inherited a condition called familial hypercholesterolemia, which affects how your body processes cholesterol and increases your risk of early heart disease.
• Diet: Eating too much saturated fat, trans fat, cholesterol, and refined carbohydrates can raise your LDL and triglyceride levels and lower your HDL levels. Saturated fat is found in animal products, such as meat, cheese, butter, and cream. Trans fat is found in processed foods, such as pastries, cookies, cakes, and fried foods. Cholesterol is found in animal products, such as eggs, liver, and shellfish. Refined carbohydrates are found in white bread, white rice, sugar, and soda.
• Weight: Being overweight or obese can increase your LDL and triglyceride levels and lower your HDL levels. Excess fat, especially around your waist, can also affect your liver’s ability to regulate cholesterol production and removal.
• Physical activity: Being physically inactive can lower your HDL levels and increase your LDL and triglyceride levels. Regular exercise can help you lose weight, improve blood circulation, and lower your blood pressure and cholesterol levels.
• Smoking: Smoking can damage your blood vessels and lower your HDL levels. It can also increase your blood pressure and make your blood more likely to clot, which can lead to heart attack or stroke.
• Age and sex: As you get older, your cholesterol levels tend to rise. Women tend to have lower cholesterol levels than men before menopause, but higher levels after menopause, due to hormonal changes.

Symptoms and Diagnosis of High Cholesterol

High cholesterol does not usually cause any symptoms until it leads to a heart attack or stroke. Therefore, it is important to check your cholesterol levels regularly, especially if you have any of the risk factors mentioned above. You can check your cholesterol levels by doing a blood test, which is usually done after fasting for 9 to 12 hours. Your doctor will interpret your test results and advise you on your risk of heart disease and stroke, and how to lower your cholesterol levels if needed.

Treatment and Prevention of High Cholesterol

The treatment and prevention of high cholesterol mainly involve lifestyle changes and medication. Some of the ways to lower your cholesterol levels and reduce your risk of heart disease and stroke are:

• Eat a healthy diet: Choose foods that are low in saturated fat, trans fat, cholesterol, and refined carbohydrates, and high in fiber, protein, and healthy fats. Some examples of healthy foods are fruits, vegetables, whole grains, beans, nuts, seeds, fish, poultry, and low-fat dairy products. You can also use herbs, spices, vinegar, and lemon juice to add flavor to your food instead of salt, butter, or cream.
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity physical activity per week, such as brisk walking, cycling, swimming, or dancing. You can also do some strength training exercises, such as lifting weights, push-ups, or squats, at least twice a week, to build muscle and burn fat.
• Lose weight: If you are overweight or obese, try to lose 5 to 10% of your body weight in the first 6 months of treatment, and maintain a healthy weight thereafter. You can do this by eating fewer calories than you burn, and by increasing your physical activity. You can also use a calorie calculator or a food diary to track your calorie intake and expenditure.
• Quit smoking: If you smoke, quit as soon as possible. You can ask your doctor for help, or use nicotine replacement products, such as patches, gums, or lozenges, to ease your withdrawal symptoms. You can also join a support group, or use online resources, such as smokefree.gov, to get tips and advice on how to quit smoking.
• Limit alcohol: If you drink alcohol, limit your intake to no more than one drink per day for women and two drinks per day for men. One drink is equivalent to 12 oz (355 mL) of beer, 5 oz (148 mL) of wine, or 1.5 oz (44 mL) of liquor. Drinking too much alcohol can raise your triglyceride levels and blood pressure, and damage your liver and heart.
• Take medication: If lifestyle changes are not enough to lower your cholesterol levels, your doctor may prescribe medication to help you. There are different types of medication that work in different ways to lower your cholesterol levels, such as statins, bile acid sequestrants, fibrates, niacin, and ezetimibe. Your doctor will decide which medication is best for you, based on your cholesterol levels, risk factors, and medical history. You should take your medication as directed, and inform your doctor of any side effects or interactions with other drugs or supplements.

Summary

High cholesterol is a condition that can increase your risk of heart disease and stroke. It is caused by a combination of genetic and lifestyle factors, and it does not usually cause any symptoms until it leads to a heart attack or stroke. You can lower your cholesterol levels and reduce your risk of heart disease and stroke by eating a healthy diet, exercising regularly, losing weight, quitting smoking, limiting alcohol, and taking medication if needed. You should also check your cholesterol levels regularly and consult your doctor for advice and guidance.