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High cholesterol (Hypercholesterolemia)

ABCMD definition of High cholesterol (Hypercholesterolemia): When the amount of cholesterol (a fat-like substance) is too high in the blood.

What is Cholesterol?
Despite all of the talk and importance about lowering your cholesterol, believe it not some is actually good! Cholesterol is a very important material in your body as it is needed for many processes. One of which is that it helps make cells, or the building blocks of every inch of your body (you would be nowhere without it). Because of its importance, cholesterol is not only absorbed by your body with meals, but it is also made within your body as well (your liver is a big producer).

Your doctor should order a blood test called a “fasting lipid panel” every 5 years beginning at the age of 20 and on. This test is one that measures the levels of all of the types of cholesterol (both good and bad) in your blood after a period of fasting (not eating for 6-12 hours). Read about fasting lipid panels here.

Types of cholesterol
All of the different types of cholesterol can be confusing. Below is a list of the different types of cholesterol we measure with a fasting lipid panel and why they are important.

1. LDL (Low Density Lipoprotein): This type of cholesterol is the bad type. Think LDL = Lousy. This is the type of cholesterol that gets stuck in your blood vessels and causes the formation of plaques (blockages in the road that can cause heart attacks, strokes, etc).

2. HDL (High Density Lipoprotein): This is the good type of cholesterol, the higher the better. HDL, as opposed to LDL, is protective against those plaques we just talked about. Think HDL = Happy. Your goal for HDL should be greater than 40 (mg/dL).

3. TG (Triglycerides): This is also a bad type of cholesterol, although not the big one like LDL. High TGs increase the risk of plaque formation, heart attacks, strokes and even pancreatitis (a potentially deadly and extremely painful inflammation of your pancreas).

What is considered “high cholesterol?”
Doctors use the cut-offs listed below to determine what is considered high:

1. Total Cholesterol: Any total cholesterol greater than 240 (mg/dL). Less than 200 is considered normal.
2. Triglycerides: Any TG greater higher than 200 (mg/dL). Less than 150 is considered normal.
3. LDL: Now this gets a little trickier as what is considered high LDL really depends on the patient and what other medical illnesses they have. For example, if you are a healthy 25 year old, a LDL level of 150 is not as big of a deal as if the same level were found in a 60 year old diabetic patient. In fact for that 25 year old that would be normal and for the 60 year old diabetic, that is unacceptable. The way doctors determine what a specific patient’s goal LDL level should be is by looking at what “risk factors” the patient has. If you are an otherwise health person your goal LDL is only less than 160 (mg/dL). However if you have known plaques in your heart or diabetes, your goal LDL level drops as low 70 (mg/dL).

Why does it matter if my cholesterol is high?
High cholesterol increases your risk of Atherosclerosis, or the development of plaques in your blood vessels. These plaques can not only put a “block in the road,” so to speak, but they can also burst open as they grow and cause heart attacks (if the plaques are in blood vessels in your heart) or strokes (if the plaques are in the blood vessels in your brain).

In order to prevent these plaques from forming, you need to keep your bad cholesterol (LDL) as low as possible, as this is the form of cholesterol that forms the plaques in the first place. At the same time, you want your good cholesterol (HDL) to be as high as possible as this is the form of cholesterol that is protective against the formations of plaques in your blood vessels.

So how do I improve my cholesterol?
Your doctor’s first recommendations for high cholesterol, like high blood pressure, will usually be lifestyle changes. In fact, these changes should really be made and tried for a period of 3 to 6 months before medications are started. Such changes include increasing exercise, stopping smoking, decreasing calorie intake, losing weight, improving your diet to include less cholesterol & saturated fats, and decreasing alcohol intake to a moderate level (less than 1 drink per day). These changes alone can make big differences so give them a try! One of the best ways to increase your good cholesterol (HDL) is by exercising and one of the best ways to decrease your bad cholesterol (LDL) is by improving your diet.

If you have tried making lifestyle changes with little success or need medication right away (cholesterol is extremely high) then there are a great deal of medications that your doctor can recommend. These medications work in a variety of ways. Some of the most commonly used medications stop the production of cholesterol by your own body, while others block the absorption of cholesterol from your diet.

To read about your specific cholesterol medication, see our medication link.

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