Health ranges, what is high, and tips

Cholesterol levels vary by age, weight, and sex. These levels typically increase with age, and people over 20 should check their cholesterol levels every 5 years.

The Centers for Disease Control and Prevention (CDC) estimate that nearly 94 million adults in the United States have high cholesterol. This increases a person’s risk of heart disease and stroke.

In this article, we explain how doctors measure cholesterol, and we describe the healthy levels at different stages of life. We also look at ways of lowering cholesterol and maintaining healthy levels.

Cholesterol is a waxy, fat-like substance, and there are two types: low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

If there is too much LDL, or “bad,” cholesterol in the bloodstream, it can build up in blood vessels, forming fatty deposits called plaques.These plaques can lead to other problems, including heart attacks and strokes.

Total and LDL cholesterol levels should be low. But having more HDL, or “good,” cholesterol in the blood may reduce the risk of a heart attack or stroke.

Doctors can measure HDL, LDL, and total cholesterol levels. The results may also show levels of all non-HDL fats that can raise the risk of heart disease.

Cholesterol levels tend to increase with age. Taking steps to reach or maintain healthy levels earlier in life may prevent them from becoming dangerously high over time. Years of unmanaged cholesterol levels can be challenging to treat.

The CDC recommends that people aged 20 or over check their cholesterol levels every 5 years, or more frequently if they have other cardiovascular disease risk factors.

Children are less likely to have high cholesterol, and doctors may only need to check their levels twice before they turn 18 years old.

However, kids with risk factors for high cholesterol should have their levels checked more frequently.

Typically, males tend to have higher levels throughout their lives than females. A male’s cholesterol levels increase with age, and a female’s cholesterol levels rise after menopause.

The table below shows healthy levels of cholesterol by age, according to the National Institutes of Health (NIH). Doctors measure cholesterol in milligrams per deciliter (mg/dl).

Aging aside, any changes in cholesterol levels usually stem from health conditions and lifestyle factors.

Below, we describe healthy and unhealthy ranges in more detail.

Cholesterol levels for adults

A doctor may classify a person’s levels as high or low, borderline, or healthy.

Total cholesterol

Total cholesterol levels under 200 mg/dl are healthy for adults.

Doctors treat readings of 200–239 mg/dl as borderline high, and readings of at least 240 mg/dl as high.

LDL cholesterol

Ideally, LDL cholesterol levels should be less than 100 mg/dl. Doctors may not express concern about levels of 100–129 mg/dl for people with no health issues, but they may suggest treatment at this stage for people with heart disease or its risk factors.

If a person’s reading is 130–159 mg/dl, it is borderline high, while readings of 160–189 mg/dl are high. A reading of at least 190 mg/dl is very high.

HDL cholesterol

Doctors recommend keeping HDL levels higher. People with a reading of less than 40 mg/dl may have a risk of heart disease.

If a person’s reading is 41–59 mg/dl, doctors consider this borderline low. Optimal HDL levels are 60 mg/dl or higher.

Cholesterol levels for children

According to the American Academy of Pediatrics, children should have total cholesterol readings of under 170 mg/dl.

The borderline high range is 170–199 mg/dl, and a reading of 200 mg/dl or over is high.

LDL cholesterol levels should be under 110 mg/dl. The borderline high range is 110–129 mg/dl, and any reading over 130 mg/dl is high.

Other factors that affect blood cholesterol

The CDC point outs that some health conditions and lifestyle factors can raise cholesterol levels. It says that type 2 diabetes, for example, raises LDL cholesterol levels, as does familial hypercholesterolemia.

The CDC also states that having a diet high in saturated fats and getting low levels of exercise may contribute to high cholesterol levels.

In addition, it acknowledges that having family members with high cholesterol increases a person’s risk.

The NIH recommends these strategies for lowering cholesterol levels:

• having a diet rich in heart-healthy foods, including plenty of fruits and vegetables, lean proteins, and whole grains
• becoming more physically active
• quitting smoking, if this applies
• having a moderate weight
• managing stress

The NIH recommends consulting a healthcare professional before starting a new exercise plan, but overall, it advises a person to get at least 30 minutes of exercise a day.

Having a healthy diet and getting plenty of exercise can also bring down high cholesterol levels in children.

Generally, the earlier a person starts making these changes, the better for their cholesterol levels, as cholesterol builds up over time.

High cholesterol at any age increases the risk of heart disease, heart attack, and stroke. These risks only increase over time.

Drug therapies to treat high cholesterol

When lifestyle changes alone cannot bring down high cholesterol, doctors may recommend medications. The CDC reports that the following drugs and supplements can help:

• Statins: These drugs keep the liver from producing cholesterol.
• Bile acid sequestrants: These drugs reduce the amount of fat that the body absorbs from food.
• Cholesterol absorption inhibitors: These drugs lower levels of fats called triglycerides in the blood and reduce the amount of cholesterol absorbed from food.
• Some vitamins and supplements: These, such as niacin, stop the liver from removing HDL and lower levels of triglycerides.
• Omega-3 fatty acids: These raise HDL levels and lower triglyceride levels.

Before the age of 18, a doctor should check a child’s cholesterol levels at least twice. If the child’s family has a history of heart disease, overweight, or certain other health conditions, doctors may recommend checking levels more often.

A healthcare professional should check cholesterol levels in adults aged 20 or older every 4–6 years.

The doctor may recommend treatment if:

• The results show high or borderline high levels of total and LDL cholesterol.
• The person is overweight.
• The person has a family history of heart disease.

Cholesterol levels increase with age, and having high cholesterol at any age increases the risk of heart attacks and strokes.

Reaching or maintaining healthy levels may involve lifestyle changes, and if these are not enough, prescription medication.

A doctor should check cholesterol levels in adults, starting at the age of 20, every 4–6 years.

HDL, LDL, Total Cholesterol, and Triglycerides

There are two major forms of cholesterol: Low-density lipoprotein or LDL, also known as “bad” cholesterol, and high-density lipoprotein or HDL, also called “good” cholesterol. LDL is the main source of artery-clogging plaque. HDL, on the other hand, clears cholesterol from your blood.

Besides LDL and HDL, there’s another kind of fat in your blood called triglycerides. Research shows that high levels of triglycerides, just like high levels of LDL, are linked to heart disease.

Your body needs cholesterol to build new cells, insulate nerves, and make hormones. Having too much, though, is a major risk for heart disease.

Ordinarily, your liver makes all the cholesterol your body needs. But you also get elevated cholesterol from food. You’ll find these in many processed foods like doughnuts, frozen pizza, cookies, and crackers. You can also get it from milk, eggs, meat, and other animal products. Over time, without your even being aware, this extra cholesterol collects inside your body and begins to do damage.

High cholesterol doesn’t have symptoms. So you can be unaware that your levels are getting too high. That’s why it’s important to find out what your cholesterol numbers are. If they’re too high, lowering them will lessen your risk for getting heart disease. And if you already have heart disease, lowering cholesterol can reduce your odds of a heart attack or of dying from heart disease.

If you’re older than 20, your doctor should measure your cholesterol levels at least once every 5 years. All that’s needed for this is a simple blood test called a lipid profile. The test will show you your:

• Total cholesterol level
• LDL level
• HDL level
• Triglycerides level

Children between ages 9 and 11 should be checked once for high cholesterol, too. Kids should have their cholesterol checked earlier — after age 2 but by age 10 — if they have any of these risk factors: 

• A mother or grandmother who had a stroke, heart attack, or blocked arteries before age 65 
• A father or grandfather who had a stroke, heart attack, or blocked arteries before age 55 
• Any parent or grandparent who has or had a total cholesterol level over 240
• Unknown family health history because of adoption
• High blood pressure, diabetes, obesity, and any other conditions linked to heart disease

Children should have a total cholesterol level below 170 and an LDL below 110. High cholesterol in kids is defined as a total cholesterol level of about 200. 

Your numbers will help you and your doctor know not only your risk for heart disease but also the best options for lowering it. For instance, an LDL level of 190 or above in adults is considered very high. The doctor will likely talk to you about taking medicine to lower it. And if your HDL level is 60 or above, your risk of heart disease goes down. The goal is a lower LDL and a higher HDL to prevent and manage heart disease.

But cholesterol numbers are only one part of a larger equation. The doctor will also look at your age, blood pressure, smoking history, and use of blood pressure medicines. All of these things plus whether you already have heart disease will give a picture of your chance of a major heart problem over the next 10 years. You and your doctor will use that information to create a plan to lower your risk. This could involve lowering your cholesterol level with diet and medicine.

Lots of things can raise — or lower — your cholesterol levels. They include:

Saturated fats and simple carbohydrates. Reducing the amount of saturated fat, simple carbohydrates, and cholesterol in your diet can help lower your blood cholesterol.

Trans fats. Avoid artificial trans fats, which can raise your cholesterol. Check labels on baked goods, snack foods, frozen pizza, margarine, coffee creamer, vegetable shortenings, and refrigerated dough (such as biscuits and cinnamon rolls). Keep in mind that items that say they have “0 g trans fat” can actually have a tiny bit of trans fat in each serving, which adds up. So check the ingredients list. “Partially hydrogenated” means it has trans fat in it.

Good fats. Unsaturated fats don’t raise cholesterol levels. You can find unsaturated fats in foods like nuts, fish, vegetable oil, olive oil, canola and sunflower oils, and avocados. Limit saturated fats, which you find in animal products, and don’t eat processed meats.

Sugar. Eating and drinking too much sugar raises your triglyceride levels. High levels of triglycerides make heart disease more likely. Check food and drink labels to see how much sugar has been added, apart from sugars that are naturally part of a food. The average woman should get no more than 5 teaspoons (or 80 calories) per day from added sugars, and men shouldn’t get more than 9 teaspoons per day (or 144) calories, according to the American Heart Association.

Fiber. Fiber helps lower your cholesterol level. You get it from plant foods, like whole grains, beans, peas, and many fruits and vegetables.

Weight. Being overweight is a risk factor for heart disease. It also can increase your cholesterol. Losing weight will help lower your LDL, total cholesterol levels, and triglyceride levels. At the same time, it can help you raise your HDL. The best way to do this is to make changes you can live with long-term, instead of going on a crash diet.

Exercise. Regular exercise can lower LDL cholesterol and raise HDL cholesterol. It’s also good for your blood pressure and strengthens your heart. Aim to get 2 hours and 30 minutes of moderate aerobic activity per week (like brisk walking), or 1 hour and 15 minutes of harder exercise (such as jogging) per week.

Age and gender. As you get older, your cholesterol rises. Before menopause, women tend to have lower total cholesterol than men. After menopause, though, women’s LDL levels tend to rise.

Heredity. High blood cholesterol can run in families.

Medical conditions. Sometimes, a medical condition may cause higher cholesterol levels. Examples include hypothyroidism (an underactive thyroid gland), liver disease, and kidney disease.

Medications. Some drugs, such as steroids and progestins, can increase the “bad” cholesterol and decrease the “good” cholesterol.

Smoking. Tobacco smoke can raise levels of blood fats (triglycerides) and make your “good” HDL cholesterol go down.

The National Heart, Lung, and Blood Institute created the TLC Program, short for Therapeutic Lifestyle Changes, for people who want to control their cholesterol. Even if you take medications to lower your cholesterol, you may want to consider the possible benefits of this program.

It has three parts: diet, exercise, and weight control. The goal: Reduce your risk of heart disease. This is not a fad diet. It’s considered a “balanced” plan, and the idea is to change your habits for the long run.

This plan focuses on foods that are low in natural cholesterol and saturated fat but high in the “good fats.” One class of these good fats is monounsaturated fats. You also get a lot of fiber in this diet.

When you follow the program, you shoot for 2 key numbers every day:

1. Less than 7% of your calories from saturated fat
2. Fewer than 200 milligrams of dietary cholesterol

You do this to lower your LDL level. You can always talk to your doctor or dietician in more detail about how to measure how much fat and dietary cholesterol you’re taking in.

The first step is to manage dietary fats

When you follow the TLC Program, all the fat you eat in one day should not go over 35% of total calories. Try to avoid saturated fats. They can be found in things like:

• Butter
• Egg yolks
• Fatty cuts of meat
• Lard
• Whole milk dairy products

Trans fats can also raise cholesterol. Avoid them when you can. They are found in products such as:

• Fried foods
• Shortening
• Stick margarine
• Sweets

Foods made with hydrogenated oil or partially hydrogenated oil should also be limited. When you’re grocery shopping, be sure you’re reading labels.

Good fats

Up to 20% of your calories can come from monounsaturated fats. They can help lower your LDL levels. Plus, these fats don’t lower your good, or HDL, cholesterol levels.

Some sources include:

• Avocados
• Olive, canola, and almond oils
• Peanut butter

About 10% of your calories can come from polyunsaturated fats. Use these in moderation. While they lower LDL levels, which you want to happen, they can also lower HDL levels, which is what you don’t want. Some choices:

• Fatty fish such as salmon, mackerel, herring, and trout
• Pumpkin and sunflower seeds
• Soybean, safflower, sunflower, cottonseed, and corn oils

Dietary cholesterol

Your body makes cholesterol, but you also get it from food. Animal products such as red meat, shellfish, and egg yolks, for example, all contain cholesterol. With the TLC Program, you must keep your intake of dietary cholesterol to less than 200 milligrams a day. Choose lean meat and reduced-fat dairy products as often as you can.

Protein

It’s important for growth and helps your body repair cells. Protein-rich foods should make up about 20% of your daily total calories. But here’s the catch. Many protein sources are also high in cholesterol and saturated fat.

You have options beyond lean meats and reduced-fat dairy. They include:

• Beans
• Lentils
• Seeds
• Soy products

The right carbs

Carbohydrates are an important part of good nutrition, but you need to choose the right kind. The program calls for about 50% to 60% of your calories to come from them. Aim for carbs that are complex, meaning they are not heavily processed and are high in fiber. That’s important, because the TLC diet calls for about 20 to 30 grams of fiber a day.

Some great choices:

• Beans
• Fruit
• Lentils
• Quinoa
• Vegetables
• Whole grains and whole wheat sources

That’s a whole lot of information about food to take in, but there are two more pillars to the program.

Exercise

Physical activity is also part of the plan. You should try to get at least 30 minutes of moderate exercise most, if not all, days of the week.

Brisk walking is a great place for many people to start. Some other suggestions:

• Bicycling
• Bowling
• Dancing
• Gardening

Of course, you should talk with your doctor before you start an exercise plan.

Weight

The third part of the TLC Program is about shedding unwanted pounds. Besides the cholesterol, extra fat can increase your chances for high blood pressure, diabetes, heart disease, and other issues. If you’ve improved your diet and exercise but are still struggling with weight, the program suggests checking with your doctor.

It also offers ideas to help with your goal of weight loss:

• Slow down while you eat; it takes the brain a while to get the message you’re full
• Eat more fruits and vegetables; they make you feel full
• Serve your food on smaller plates
• Eat three meals a day; don’t skip any

TLC Program how-tos

The TLC Program works best when you work directly with your doctor or dietician, who can also guide you to become more active, manage your weight, and reach your cholesterol goals. With this program, you start out meeting with your doctor every 6 weeks to track how well lifestyle changes are working for you.

Your doctor can also help you control other things that make heart disease more likely, including quitting smoking and controlling high blood pressure, for example.

For some people, lifestyle changes alone may not be enough. You may need medication, too. But with lifestyle changes such as the TLC Program, you may be able to take lower doses.

The goal of cholesterol treatment is to help you prevent a heart attack or stroke. So the drugs your doctor prescribes also depend on your chances for heart disease.

The higher your risk, the more important it is to get your levels down. Your doctor will look at all of your risk factors and decide which medications will help you the most.

Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid sequestrants
• Fibrates
• Cholesterol absorption inhibitors
• PCSK9 inhibitors

Cholesterol-lowering drugs work best when combined with a low-cholesterol diet and an exercise program.

Statins

Statins block the production of cholesterol in the liver. They lower LDL and triglycerides and can slightly raise HDL. These drugs are the first treatment for most people with high cholesterol. If you already have heart disease, statins reduce the chances of heart attacks. Side effects can include diabetes, liver damage, and, in a few people, muscle tenderness or weakness. If your doctor prescribes statins, you should ask them the percentage by which you should lower your cholesterol. Generally, it will be between 30% and 50%. Commonly used statins include:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol, Lescol XL)
• Lovastatin (Altocor, Altoprev, Mevacor)
• Pitavastatin (Livalo)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Niacin

Niacin is a B vitamin. It’s found in food, but you can get high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling, and headache. Aspirin can reduce many of these symptoms. Speak with your doctor first, though, before taking aspirin. Research suggests that even though niacin may improve your cholesterol numbers, it doesn’t appear to lower your risk of heart disease, especially if you’re already taking a statin.

Bile acid sequestrants

These drugs work inside the intestine, where they bind to bile and prevent your circulatory system from reabsorbing it. Bile is made largely from cholesterol, so these drugs work by reducing the body’s supply of cholesterol. That then lowers both total and LDL cholesterol. The most common side effects are constipation, gas, and upset stomach. Commonly used bile acid sequestrants include:

• Cholestyramine resin (Prevalite, Questran, and Questran Light Questran Light)
• Colesevelam (WelChol)
• Colestipol (Colestid)

Fibrates

Fibrates lower triglyceride levels and can increase HDL and lower LDL. Scientists think fibrates help your body break down triglyceride-rich particles and stop it from putting out certain blood fats. Commonly used fibrates include:

• Fenofibrate (Lofibra, Tricor)
• Gemfibrozil (Lopid)

Cholesterol absorption inhibitors

Ezetimibe (Zetia) lowers LDL by inhibiting the absorption of cholesterol in the intestines. Vytorin is a drug that combines ezetimibe and a statin. It can decrease total and LDL cholesterol and raise HDL levels.

PCSK9 inhibitors

You get this newer type of cholesterol-lowering drug as a shot. Doctors use it to treat people with a genetic form of high cholesterol called familial hypercholesterolemia.

Combination drugs

Some people with high cholesterol get the best results with combination drugs. These are pills that contain more than one medication. Commonly used combination drugs include:

• Advicor: Lovastatin and niacin (nicotinic acid)
• Caduet: Atorvastatin and amlodipine
• Liptruzet: Atorvastatin and ezetimibe
• Simcor: Simvastatin and niacin (nicotinic acid)
• Vytorin: Simvastatin and ezetimibe

Multiple medications

Sometimes, one cholesterol medicine just won’t cut it. Even if you live a healthy lifestyle and take your pills the way you should, you may need extra help getting your levels to a healthier range.

But that doesn’t mean you have to live with high cholesterol. Help can come in the form of a second or even a third medication. Your doctor might recommend adding a medication if:

• Your statin hasn’t helped. Statins are a mainstay of cholesterol treatment. But they don’t work well enough for everyone who takes them. If that’s the case for you, your doctor might recommend that you add another medicine to your treatment.
• You have side effects from statins. These drugs can cause muscle pain, liver damage, and other problems that make it hard for some people to take them. Doctors can prescribe a lower dose to ease side effects, but that means adding another medication to bring down cholesterol.
• You have a genetic form of high cholesterol. Familial hypercholesterolemia (FH) is a condition that causes very high levels of cholesterol — so high that one drug and lifestyle changes won’t do enough. People with FH usually take a statin and one or two other drugs.
• You can’t take a statin. The pills aren’t safe for people with liver disease or women who are pregnant or breastfeeding. Doctors will rely on other types of drugs to lower cholesterol.
• You have high triglycerides. Some drugs do a better job of bringing down these blood fats than others. Your doctor might add another drug that targets them.

The side effect you need to be most concerned about is muscle aches. They could be a sign of a life-threatening condition. If you have muscle aches, call your doctor immediately.

Other side effects of cholesterol-lowering drugs include:

• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Memory loss

Ask your doctor about the other drugs you’re taking, including herbals and vitamins, and their impact on cholesterol-lowering medications. You shouldn’t drink grapefruit juice while taking cholesterol-lowering drugs. It can make it harder for your liver to process these medications.

When you have too much cholesterol, it builds up in the walls of your arteries, causing them to harden — a process called atherosclerosis. It also narrows your arteries, which slows and even blocks the flow of blood. That’s where the problem starts. Your blood is supposed to carry oxygen to all parts of your body, including your heart muscle. Without enough oxygen, your body’s parts won’t work the way they’re supposed to. 

Complications of high cholesterol include: 

• High blood pressure. If clogged arteries make it hard for blood to move to and from your heart, the heart has to pump harder, and your blood pressure will go up. 
• Chest pain. If your heart muscle doesn’t get enough blood and oxygen, you’ll have chest pain. 
• Heart attack or stroke.  If a piece of plaque breaks off or forms a clot, it can cut off the blood supply to a portion of your heart, causing a heart attack or stroke. If you have heart disease risk factors (like smoking, diabetes, or high blood pressure), you’re especially at risk of this complication.
• Peripheral artery disease (PAD). A cholesterol buildup can block blood flow to the arteries in your legs and feet. PAD may also affect arteries in your kidneys.

Total cholesterol (Cholesterol) — Laboratory ProfLabDiagnostics

Total cholesterol (total cholesterol) is a fat-like substance that the body needs for normal functioning. Belongs to the group of polyhydric cyclic alcohols. It is found in the body in free and esterified forms (compound of cholesterol with fatty acids).

Most of the total cholesterol (approximately 80%) is synthesized directly by the body itself. The organs that are involved in this process are the liver, kidneys and adrenal glands, the glands of the reproductive system. Cholesterol also enters the body with food. The largest amount is found in meat and dairy products.

Cholesterol does not interact with water and does not dissolve in it. It circulates throughout the body in a protein coat. This bond is called a lipoprotein complex. The complex is divided into types: high, low and very low density lipoproteins.

Elevated serum cholesterol levels may indicate the presence of atherosclerosis. An increase in concentration indicates the risk of developing cardiovascular pathology. However, the level of cholesterol directly depends on the time of day, the age of the person, his diet. High cholesterol can indicate diabetes, malnutrition, hypercholesterolemia. Elevated cholesterol levels can be associated with diseases of the cardiovascular system, pancreas, and obesity. Cholesterol levels above normal can be associated with pregnancy, gout.

Cholesterol levels differ between men and women throughout life. As a rule, high cholesterol levels in men in childhood, adulthood, and in old age the concentration decreases. In women, the concentration of cholesterol grows slowly, and reaches its peak during menopause – the values ​​\u200b\u200bmay exceed the male norm. During pregnancy, cholesterol levels increase.

Low cholesterol levels may indicate disorders of the reproductive system, depression, dysfunction of the digestive system, the development of osteoporosis, diabetes. Reduced cholesterol levels may occur when taking certain medications (before taking the test, it is recommended to consult with your doctor).

A change in the concentration of total cholesterol indicates the presence of various diseases. To clarify the diagnosis, it is recommended to take an analysis for the determination of high-density lipoproteins and low-density lipoproteins.

Indications:

• preventive examination;
• cardiovascular risk assessment;
• dyslipidemia;
• lipid metabolism assessment;
• presence of atherosclerosis or suspected disease;
• monitoring the effectiveness of treatment.

See also – “Atherogenic Index”

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Where does cholesterol come from and does our body need it

Cholesterol is a natural chemical compound, an alcohol that dissolves well in fats. It is found in the cell membranes of many animal organisms, including humans. Basically, cholesterol is produced by the body itself (up to 80%, which is 1.5-2.5 g / day). The rest comes with food (up to 20%). The main synthesis and metabolism occurs in the liver. Meat is rich in food, especially pork, eggs (yolk), cheese, butter, offal (liver), caviar.

Newborn babies receive cholesterol from breast milk, as it is vital for them to receive enough fat and cholesterol. The development of the central and peripheral nervous system, the musculoskeletal system, the functioning of immunity and metabolism in general depend on this.

For adults, cholesterol (Cholesterol) is no less important. Its main task is to ensure the stability, strength and permeability of cell membranes, it belongs to their main structural elements. Without it, the normal functioning of erythrocytes, nerve cells (especially long processes – axons), liver, white matter cells of the brain is impossible. The second function of cholesterol, on which the vital activity of the whole organism depends, is participation in the production of biologically active substances, including ¹ :

• vitamin D – responsible for calcium and phosphorus metabolism,
• female and male sex hormones (estrogen, progesterone, testosterone) – regulate the functioning of the reproductive system,
• hormones of the adrenal cortex (aldosterone, cortisol) – regulate mineral metabolism, water-salt, affect the state of blood vessels.
• salts of bile or cholic acids – are involved in the digestion of fats, activate liver enzymes.

Dangers of low levels of cholesterol

1. Violation of the nervous system – impulse conduction along the fibers, reaction speed, etc.
2. Bone fragility and impaired mineral metabolism.
3. Early menopause or amenorrhea (cessation of menses) in women.
4. Impotence, depression and other disorders in men.
5. Inability to fully digest fats.

Types of cholesterol

In the body, cholesterol goes through a rather complex transformation pathway, which is provided by the cholesterol transport system. In the blood, cholesterol is in a bound state, its transport is carried out by proteins.
Cholesterol, which is found in food, is absorbed in the small intestine and transferred to the liver as part of low-density lipoprotein (LDL-C), which consists of cholesterol, triglycerides and fatty acids. The same form of proteins helps to transport cholesterol from the liver to other organs. There are special LDL-C receptors in the cells, connecting with which, cholesterol is able to penetrate inside. Excess cholesterol is removed from the cell with other proteins – high-density lipoproteins (HDL-C). With them, it goes back to the liver, and then with bile acids to the small intestine.
LDL-C and HDL-C got their name because of the peculiarities of the distribution of these protein compounds during serum centrifugation. The former usually end up in the upper layers, as they have a low density, and the latter settle, since they are denser. In total, there are 5 types of lipoproteins:

• Chylomicrons – with them, cholesterol is absorbed from the intestine.
• Very low density lipoproteins.
• Low density lipoproteins (LDL-C).
• High density lipoproteins (HDL-C).
• Very high density lipoproteins.

This is how a certain circulation of cholesterol occurs in the body and its economical use, which helps living organisms to survive even during periods of hunger and its uneven intake with food.
Even a slight excess of cholesterol in the diet can lead to significant disturbances in its metabolism and regulation system. In this case, cholesterol is able to accumulate in tissues, including the vascular wall, which contributes to the formation of atherosclerotic plaques, the development of atherosclerosis and, as a result, to cardiovascular disasters (myocardial infarction, stroke) ⁷ .

The risk of developing CVD complications is assessed not only by cholesterol levels, but also by other indicators (SCORE scale). These include: numbers of systolic and diastolic pressure, the presence of heart and vascular diseases, diabetes mellitus and other chronic diseases, lesions of target organs (heart, brain, kidneys), smoking, gender, age and others.
The higher a person’s risk for CVD, the lower their lipid levels are preferred. These values ​​also comply with the requirements of modern recommendations for the treatment and prevention of atherosclerosis, adopted in 2016 by the European Society of Cardiology. And the main indication for the appointment of lipid-lowering therapy is the level of LDL-C in blood plasma.
In addition, for an additional assessment of the state of lipid metabolism, the ratio of LDL-C and HDL-C, which characterizes the flow of cholesterol from the liver to tissues and back, is taken into account. Moreover, the imbalance of cholesterol can be associated not only with an excess amount of cholesterol in food, but also with other mechanisms: deficiency of HDL-C or increased formation of LDL-C in the liver, disorders in the receptor apparatus of cells or cholesterol transport, as well as with an increase in its synthesis in the liver for one reason or another.

Theory of atherosclerosis development

Taking into account the importance of atherosclerosis in the development of such serious complications of coronary heart disease as acute coronary syndrome and myocardial infarction, a lot of scientific works are devoted to the formation of atherosclerotic plaques.
Thus, the results of the Framingham study made it possible to create a complete concept of risk factors for atherosclerosis. It has been proven that high LDL-C and low HDL-C are the most powerful factors in both women and men, regardless of age.
With excessive lipid content, high blood pressure, insufficient physical activity, LDL-C and calcium are deposited in the inner wall of blood vessels (endothelium) ⁴ . Biologically active substances and cells gather around such deposits. As a result, a plaque is formed, gradually blocking the lumen of the vessel. The blood flow is limited, the blood supply to organs and tissues is disturbed.
Under stress and other unfavorable factors, when an additional vasospasm occurs, a complete cessation of blood flow to the organ is possible. The vessels of the heart and brain are most vulnerable.

“Good” and “bad” cholesterol – what’s the difference?

Not all cholesterol is equally harmful or beneficial. It is divided into the so-called “bad” and “good” in relation to the processes that they can start in the vascular wall.
HDL-C can easily penetrate the vessel wall, but also freely leave it, so they do not cause atherosclerotic plaque formation. In addition, they contribute to the removal of cholesterol from tissues. These lipoproteins are called anti-atherogenic and are considered “good”.
VLDL-C linger in the vascular wall only during oxidation, but the accumulation of LDL-C in the endothelium (inner shell) of the vessel usually causes atherosclerosis. These are atherogenic lipoproteins or “bad”. Cholesterol-lowering therapy is aimed at lowering their level in the first place.
An increase in the level of total cholesterol may indicate a violation of fat metabolism, the development of atherosclerosis, coronary artery disease, bile stasis, obesity, diabetes mellitus and other diseases ⁴ . But its significant decrease is also not an absolute indicator of health, since cholesterol is necessary for the body to function normally. A sufficient amount of HDL-C has also been shown to help prevent Alzheimer’s disease ¹ , normalize the functioning of the immune system and has anti-cancer properties. Therefore, it is impossible to completely exclude fat-containing foods from the diet.

How to maintain a healthy lipid balance

In order to keep LDL cholesterol levels low and HDL cholesterol levels high, specialists have developed a whole range of measures. The basis is non-drug methods of correction. These include:

1. Diet: Replace saturated fats found in butter, palm, coconut and other solid oils with healthy poly- and monounsaturated fats (olive, linseed oil, sea fish, etc.). It also reduces the amount of carbohydrates, especially simple ones. In their place should come complex carbohydrates from fruits, vegetables, whole grains. It is important to maintain a sufficient amount of fiber in the diet, which is able to adsorb (take over) fats from the intestines and remove them, and also contributes to the normal functioning of the gastrointestinal tract. If possible, alcohol is excluded, especially strong drinks. If you are overweight or obese, the total calorie content decreases.
2. Adequate exercise. General strengthening cardio loads are welcome. It can be brisk walking, swimming, yoga, Pilates, etc. In order to engage more intensively, you need to consult a cardiologist. In any case, the energy consumption must correspond to its intake.
3. Elimination of other risk factors: smoking cessation, control and normalization of blood pressure, correction of blood sugar, regular examinations by a cardiologist or therapist who can evaluate the results of studies and recommend appropriate methods for correcting lipid metabolism. If the risk for cardiovascular disease is determined to be low, then it is sufficient to undergo an examination once a year.

Medicinal methods

Medicinal methods for the correction of hyperlipidemia (high fat content) are prescribed by the doctor based on the results of the examination.

Groups of lipid-lowering drugs:

1. Statins or cholesterol synthesis inhibitors. Reduce the concentration of cholesterol due to the inhibition of enzymes that are involved in the process of its production in the liver. At the same time, the number of LDL-C receptors in the liver cells increases, which contributes to the removal of cholesterol from the tissues.
2. Inhibitors of absorption (suction) cholesterol in the intestine. Selectively reduce the absorption of cholesterol, which is part of LDL-C. Reduce LDL-C, increase HDL-C.
3. Bile acid sequestrants. Binds bile acids in the intestine and prevents their reabsorption into the bloodstream, thereby lowering LDL-C levels.
4. Fibrates are derivatives of fibric acid. Reduce the production of fatty acids, triglycerides and low density lipoproteins.
5. Omega-3 polyunsaturated fatty acids. Inhibit the synthesis of VLDL-C in liver cells.
6. Nicotinic acid in high doses. Reduces the amount of triglycerides and LDL-C in the blood plasma, increases the level of HDL-C.

In addition to reducing the level of atherogenic LDL-C, an important part of the correction of lipid metabolism for the prevention of cardiovascular diseases is to increase the concentration of HDL-C. According to modern international recommendations, the level of high-density lipoproteins should not be lower than 1 mmol/l in men and 1.2 mmol/l in women.
Reducing the influence of any of the factors in the development of atherosclerosis prevents the development of such serious complications as myocardial infarction, stroke and other cardiovascular events. Multicenter studies ASCOT-LLA and CARDS have proven the effectiveness of statins for the prevention of cardiovascular diseases, as well as for improving their prognosis.
The approach to the correction of lipid metabolism should be individual and complex, as well as accompanied by regular monitoring.