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How Cholesterol Causes Heart Disease?
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Cholesterol is a waxy substance produced by the liver. It is essential
to every cell in the body. Cholesterol also enters the body through the
saturated fats we consume in certain foods.
There are two basic types
of cholesterol. One is considered "good" the other "bad."
The bad cholesterol is called Low Density Lipoprotein (LDL). A blood test
that reveals bad cholesterol below 130 milligrams per deciliter (mg/dL)
is considered good. The good cholesterol is the High Density Lipoprotein
(HDL). It works to cleanse the blood vessels of excess LDL cholesterol,
so a higher number, anything above 40 mg/dL is desirable. Overall or total
cholesterol should be below 200 mg/dL for optimal health.
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How Does Cholesterol Cause Heart Disease?
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When there is too much cholesterol (a fat-like substance) in your blood,
it builds up in the walls of your arteries. Over time, this buildup causes
"hardening of the arteries" so that arteries become narrowed and
blood flow to the heart is slowed down or blocked. The blood carries oxygen
to the heart, and if enough blood and oxygen cannot reach your heart, you
may suffer chest pain. If the blood supply to a portion of the heart is
completely cut off by a blockage, the result is a heart attack.
High
blood cholesterol itself does not cause symptoms, so many people are unaware
that their cholesterol level is too high. It is important to find out
what your cholesterol numbers are because lowering cholesterol levels
that are too high lessens the risk for developing heart disease and reduces
the chance of a heart attack or dying of heart disease, even if you already
have it. Cholesterol lowering is important for everyone--younger, middle
age, and older adults; women and men; and people with or without heart
disease.
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What Do Your Cholesterol Numbers Mean?
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Everyone age 20 and older should have their cholesterol measured at least
once every 5 years. It is best to have a blood test called a "lipoprotein
profile" to find out your cholesterol numbers. This blood test is done
after a 9- to 12-hour fast and gives information about your:
- Total cholesterol
- LDL (bad) cholesterol--the main source of cholesterol buildup and
blockage in the arteries
- HDL (good) cholesterol--helps keep cholesterol from building up in
the arteries
- Triglycerides--another form of fat in your blood
If it is not possible to get a lipoprotein profile done, knowing your
total cholesterol and HDL cholesterol can give you a general idea about
your cholesterol levels. If your total cholesterol is 200 mg/dL* or more
or if your HDL is less than 40 mg/dL, you will need to have a lipoprotein
profile done.HDL (good) cholesterol protects against heart disease, so
for HDL, higher numbers are better. A level less than 40 mg/dL is low
and is considered a major risk factor because it increases your risk for
developing heart disease. HDL levels of 60 mg/dL or more help to lower
your risk for heart disease.Triglycerides can also raise heart disease
risk. Levels that are borderline high (150-199 mg/dL) or high (200 mg/dL
or more) may need treatment in some people.
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What Affects Cholesterol Levels?
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A variety of things can affect cholesterol levels. These are things you
can do something about:
- Diet. Saturated fat and cholesterol in the food you eat make your
blood cholesterol level go up. Saturated fat is the main culprit, but
cholesterol in foods also matters. Reducing the amount of saturated
fat and cholesterol in your diet helps lower your blood cholesterol
level.
- Weight. Being overweight is a risk factor for heart disease. It also
tends to increase your cholesterol. Losing weight can help lower your
LDL and total cholesterol levels, as well as raise your HDL and lower
your triglyceride levels.
- Physical Activity. Not being physically active is a risk factor for
heart disease. Regular physical activity can help lower LDL (bad) cholesterol
and raise HDL (good) cholesterol levels. It also helps you lose weight.
You should try to be physically active for 30 minutes on most, if not
all, days.
Things you cannot do anything about also can affect cholesterol levels.
These include:
- Age and Gender. As women and men get older, their cholesterol levels
rise. Before the age of menopause, women have lower total cholesterol
levels than men of the same age. After the age of menopause, women's
LDL levels tend to rise.
- Heredity. Your genes partly determine how much cholesterol your body
makes. High blood cholesterol can run in families.
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What Is Your Risk of Developing Heart Disease or Having a Heart Attack?
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In general, the higher your LDL level and the more risk factors you have
(other than LDL), the greater your chances of developing heart disease or
having a heart attack. Some people are at high risk for a heart attack because
they already have heart disease. Other people are at high risk for developing
heart disease because they have diabetes (which is a strong risk factor)
or a combination of risk factors for heart disease. Follow these steps to
find out your risk for developing heart disease.
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Step 1: Check the table below to see how many of the listed risk factors
you have; these are the risk factors that affect your LDL goal.
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Major Risk Factors That Affect Your LDL Goal
- Cigarette smoking
- High blood pressure (140/90 mmHg or higher or on blood pressure medication)
- Low HDL cholesterol (less than 40 mg/dL)
- Family history of early heart disease (heart disease in father or
brother before age 55; heart disease in mother or sister before age
65)
- Age (men 45 years or older; women 55 years or older)
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Treating High Cholesterol
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The main goal of cholesterol-lowering treatment is to lower your LDL
level enough to reduce your risk of developing heart disease or having
a heart attack. The higher your risk, the lower your LDL goal will be.
To find your LDL goal, see the boxes below for your risk category. There
are two main ways to lower your cholesterol:
- Therapeutic Lifestyle Changes (TLC)--includes a cholesterol-lowering
diet (called the TLC diet), physical activity, and weight management.
TLC is for anyone whose LDL is above goal.
- Drug Treatment--if cholesterol-lowering drugs are needed, they are
used together with TLC treatment to help lower your LDL.
If you are in...
- Category I, Highest Risk, your LDL goal is less than 100 mg/dL. you
will need to begin the TLC diet to reduce your high risk even if your
LDL is below 100 mg/dL. If your LDL is 100 or above, you will need to
start drug treatment at the same time as the TLC diet. If your LDL is
below 100 mg/dL, you may also need to start drug treatment together
with the TLC diet if your doctor finds our risk is very high, for example
if you had a recent heart attack or have both heart disease and diabetes.
- Category II, Next Highest Risk, your LDL goal is less than 130 mg/dL.
If your LDL is 130 mg/dL or above, you will need to begin treatment
with the TLC diet. If your LDL is 130 mg/dL or more after 3 months on
the TLC diet, you may need drug treatment along with the TLC diet. If
your LDL is less than 130 mg/dL, you will need to follow the heart healthy
diet for all Americans, which allows a little more saturated fat and
cholesterol than the TLC diet.
- Category III, Moderate Risk, your LDL goal is less than 130 mg/dL.
If your LDL is 130 mg/dL or above, you will need to begin the TLC diet.
If your LDL is 160 mg/dL or more after you have tried the TLC diet for
3 months, you may need drug treatment along with the TLC diet. If your
LDL is less than 130 mg/dL, you will need to follow the heart healthy
diet for all Americans.
- Category IV, Low-to-Moderate Risk, your LDL goal is less than 160
mg/dL. If your LDL is 160 mg/dL or above, you will need to begin the
TLC diet. If your LDL is still 160 mg/dL or more after 3 months on the
TLC diet, you may need drug treatment along with the TLC diet to lower
your LDL, especially if your LDL is 190 mg/dL or more. If your LDL is
less than 160 mg/dL, you will need to follow the heart healthy diet
for all Americans.
To reduce your risk for heart disease or keep it low, it is very important
to control any other risk factors you may have such as high blood pressure
and smoking.
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Drug Treatment
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Even if you begin drug treatment to lower your cholesterol, you will need
to continue your treatment with lifestyle changes. This will keep the dose
of medicine as low as possible, and lower your risk in other ways as well.
There are several types of drugs available for cholesterol lowering including
statins, bile acid sequestrants, nicotinic acid, fibric acids, and cholesterol
absorption inhibitors. Your doctor can help decide which type of drug is
best for you. The statin drugs are very effective in lowering LDL levels
and are safe for most people. Bile acid sequestrants also lower LDL and
can be used alone or in combination with statin drugs. Nicotinic acid lowers
LDL and triglycerides and raises HDL. Fibric acids lower LDL somewhat but
are used mainly to treat high triglyceride and low HDL levels. Cholesterol
absorption inhibitorrs lower LDL and can be used alone or in combination
with statin drugs.
Once your LDL goal has been reached, your doctor may
prescribe treatment for high triglycerides and/or a low HDL level, if
present. The treatment includes losing weight if needed, increasing physical
activity, quitting smoking, and possibly taking a drug. |
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