What It Is and What to Do About It

Has your doctor told you that you have “borderline” high cholesterol? That means your cholesterol level is above normal but not quite in the “high” range.

You have borderline high cholesterol if your total cholesterol is between 200 and 239 milligrams per deciliter (mg/dL).

Your doctor will also consider other things, like how much of your total cholesterol is LDL (“bad”) cholesterol and how much of it is HDL (“good”) cholesterol.

Making simple changes in your lifestyle is often enough to bring borderline cholesterol levels down to the normal range. Some people may also need to take medicine for it. And keep in mind that other things, like diabetes, high blood pressure, and smoking, also affect your heart health; it’s not just about cholesterol.

If you have borderline cholesterol, your doctor will decide whether you need treatment by looking at these and other risk factors for heart disease. They may ask you to get an imaging test of your heart called a coronary artery calcium (CAC) scan. This test reveals whether dangerous plaque has built up in your heart’s arteries.

You won’t know you have borderline cholesterol unless you get a cholesterol blood test. You should do that every 5 years.

The average American has a total cholesterol level of 200, which is in the borderline range.

You can turn it around before you get high cholesterol. Start with these six steps.

Make Changes in the Kitchen

Use your diet to help lower your LDL cholesterol and raise your HDL cholesterol.

For the biggest impact, choose foods that are low in saturated fats and trans fats, and high in fiber, antioxidants, and omega-3 fatty acids. Whole grains, beans, apples, pears, oatmeal, salmon, walnuts, and olive oil are excellent heart-healthy choices.

Here are some more diet tips to help you lower your cholesterol:

Make meat lean. Cut back on red meats that are high in saturated fat and cholesterol, and choose only lean meats with very little visible fat. Examples of lean beef include London broil, eye of round, and filet mignon. Avoid processed meats like bacon and sausage, which are linked to higher odds of heart disease and diabetes.

Remove skin from poultry. That’s where much of the fat is.

Eat more seafood. It usually has less fat than other meat. The American Heart Association recommends eating two servings of fatty fish (like salmon, tuna, or mackerel) each week for heart health. Those fish are good sources of omega-3 fatty acids, which are good for you.

Limit saturated fat. These are found in whole-fat dairy products, mayonnaise, and hydrogenated or partially hydrogenated oils or fats (such as stick margarine). These products may also contain trans fats, which can raise your cholesterol level.

Go liquid. For cooking, replace saturated fats that are solid at room temperature (such as butter and shortening) with liquid monounsaturated fats such as olive, canola, and flaxseed oils. There’s evidence that eating moderate amounts of monounsaturated fat — found in such foods as nuts, seeds, and avocados — may lower LDL cholesterol.

Add fiber with plant foods. Good sources include grapefruits, apples, beans and other legumes, barley, carrots, cabbage, and oatmeal.

Get two daily servings of plant sterol-rich foods. These foods, such as nuts, can help lower cholesterol. Plant sterols are also added to some soft margarines, granola bars, yogurts, and orange juice.

Read Food Labels

You need to know how much saturated fat, trans fat, and cholesterol are in your favorite foods. That can help you make better choices.

Too much saturated fat can drive up your cholesterol level. It’s found mostly in animal products. Cholesterol also is found in animal products. Your doctor or a dietitian can let you know what your daily limit should be.

Artificial trans fats can raise your LDL (“bad”) cholesterol. They’re in packaged foods, like some crackers, cookies, pastries, and microwave popcorn.

Check the nutrition label. And because products marked “0 grams” of trans fats per serving can have up to a gram of trans fats, check the ingredients label, too. Anything marked “partially hydrogenated” is trans fat.

Get Moving

Exercise helps you get your cholesterol down from the borderline range.

Aim for at least 30 minutes of moderate-intensity exercise, such as brisk walking, per day (150 minutes each week). You can also do a more intense workout for 75 minutes a week.

Taking a walk, riding your bike, playing a team sport, or taking a group fitness class will increase your heart rate while raising HDL (“good”) cholesterol. Push yourself, if you can, but keep in mind that moderate exercise is better than none at all.

Lose Extra Weight

You can have borderline high cholesterol and be at a healthy weight. But if you’re overweight, losing those extra pounds can help bring your cholesterol level back down.

Losing as little as 5% of your body weight can lower your cholesterol levels. One study found that adults who took part in a 12-week exercise program lowered their LDL by 18 points, and their total cholesterol dropped 26 points.

With a combination of weight loss and a healthy diet, it’s possible to lower LDL levels up to 30% — results that are similar to taking cholesterol-lowering drugs.

If you’re not sure whether your weight is in a healthy place, ask your doctor to check your body mass index (BMI). A normal BMI is 18 to 25. If your BMI is 25 or higher, ask your doctor for advice on the best types of physical activity for you.

Quit Smoking

If you smoke, kicking the habit can help raise your HDL (“good”) cholesterol up to 10%.

Have you tried to quit smoking before? For many people, it takes a couple of tries. Keep trying until it sticks. It’s worth it, for your whole body’s health.

Check to See What’s Working

During regular screening appointments, your doctor will check your cholesterol levels to see if the changes you’ve made have gotten you to your cholesterol goal.

If lifestyle changes aren’t enough to lower borderline high cholesterol, your doctor may talk to you about medication.

Cholesterol Tests: Understand Your Results

Your health care provider may send you for cholesterol tests, either as a part of a standard check-up or because they suspect you may be at risk for developing heart disease. But do you know what the cholesterol test results actually mean? Read on to learn how to interpret the numbers.

Why Do I Need a Cholesterol Test?

Cholesterol is a waxy, fat-like substance. Your liver makes all the cholesterol your body needs. But you take in more cholesterol from certain foods, such as those from animals. If you have too much cholesterol in your body, it can build up in the walls of your arteries (as “plaque”) and eventually harden. This process, called atherosclerosis, actually narrows the arteries, making it harder for blood to travel through the vessels. 

Unfortunately, high cholesterol doesn’t cause symptoms. In later stages of atherosclerosis, though, you may suffer angina — severe chest pain from lack of blood flow to the heart. If an artery gets totally blocked, a heart attack results. A routine blood cholesterol test is a far better way of finding out what your cholesterol level is.

What Does a Cholesterol Test Measure?

In addition to measuring the total cholesterol in your blood, the standard cholesterol test (called a “lipid panel”) measures three specific kinds of fat:

• Low-density lipoproteins (LDL). This is the “bad cholesterol,” the main cause of plaque build-up, which increases your risk for heart disease. In general, the lower the number, the better. But LDL cholesterol is only one part of a larger equation that measures a person’s overall risk of having a heart attack or stroke. For years, guidelines focused on specific target numbers for individuals to achieve to lower their risk. The most recent guidelines focus on a person’s overall risk and, based on that risk, recommend a certain percentage of LDL reduction as one part of a strategy for preventing serious heart and vascular problems.
• High-density lipoproteins (HDL). This is the “good cholesterol.” It transports bad cholesterol from the blood to the liver, where it is excreted by the body. Your HDL is another part of the equation that identifies the risk of a cardiovascular event. In general, the higher the number the better, although, as with LDL, the emphasis has shifted from specific target numbers to strategies for reducing the overall risk.
• Triglycerides. Another type of fat in the bloodstream, triglycerides are also linked to heart disease. They are stored in fat cells throughout the body.

What Do Cholesterol Test Numbers Mean?

If you have a lipoprotein profile, it’s important to look at all the numbers from the cholesterol test, not just the total cholesterol number. That’s because LDL and HDL levels are two primary indicators of potential heart disease. Use the information below to interpret your results (with the help of your doctor, of course). This will help you get a better idea about your risk for heart disease.

Total blood cholesterol level:

• High risk: 240 mg/dL and above
• Borderline high risk: 200-239 mg/dL
• Desirable: Less than 200 mg/dL

LDL cholesterol levels:

190 mg/dL and above represents a high risk for heart disease and is a strong indicator that the individual can benefit from intensive treatment, including lifestyle changes, diet, and statin therapy for reducing that risk.

For LDL levels that are equal to or less than 189 mg/dL, the guidelines recommend strategies for lowering LDL by 30% to 50% depending on what other risk factors you have that can affect the health of your heart and blood vessels.

HDL cholesterol:

• High risk: Less than 40 mg/dL for men and less than 50 mg/dL for women

Triglycerides:

• Very high risk: 500 mg/dL and above
• High risk: 200-499 mg/dL
• Borderline high risk: 150-199 mg/dL
• Normal: Less than 150 mg/dL

How Do I Prepare for My Cholesterol Test?

If your doctor recommends a “non-fasting” cholesterol test, the lab will look only at your total cholesterol (and sometimes your HDL) numbers. For that test, you merely need to show up at the lab and have some blood drawn. If your doctor suggests a “fasting” cholesterol test (also called a “lipid profile”), the lab will analyze your levels of LDL, HDL, triglycerides, and total cholesterol. For that test, you will need to fast nine to 12 hours before the blood test.

Sometimes a doctor will ask you to do a non-fasting cholesterol test first. Depending on the results, they may then send you back for the more complete lipid profile.

How Will My Doctor Use Results From My Cholesterol Test?

After reviewing your blood test, The doctor will also consider other risk factors you might have for heart disease, including:

• Your family history
• Age
• Weight
• Race
• Gender
• Diet
• Blood pressure and whether or not you’re being treated for high blood pressure
• Activity level
• Smoking status
• History of diabetes
• Evidence of elevated blood sugars

Then, your doctor will talk with you about your level of risk and the potential benefit to be derived by taking steps that include changes in your level of activity and diet as well as using medication to improve your cholesterol levels in order to reduce your overall risk.

How Often Should I Have A Cholesterol Test?

The National Cholesterol Education Program recommends adults age 20 years or older have a cholesterol test every five years. People who are at risk for heart attack or heart disease or who have a family history of either should be checked more often.

Cholesterol Tests: Understand Your Results

Your health care provider may send you for cholesterol tests, either as a part of a standard check-up or because they suspect you may be at risk for developing heart disease. But do you know what the cholesterol test results actually mean? Read on to learn how to interpret the numbers.

Why Do I Need a Cholesterol Test?

Cholesterol is a waxy, fat-like substance. Your liver makes all the cholesterol your body needs. But you take in more cholesterol from certain foods, such as those from animals. If you have too much cholesterol in your body, it can build up in the walls of your arteries (as “plaque”) and eventually harden. This process, called atherosclerosis, actually narrows the arteries, making it harder for blood to travel through the vessels. 

Unfortunately, high cholesterol doesn’t cause symptoms. In later stages of atherosclerosis, though, you may suffer angina — severe chest pain from lack of blood flow to the heart. If an artery gets totally blocked, a heart attack results. A routine blood cholesterol test is a far better way of finding out what your cholesterol level is.

What Does a Cholesterol Test Measure?

In addition to measuring the total cholesterol in your blood, the standard cholesterol test (called a “lipid panel”) measures three specific kinds of fat:

• Low-density lipoproteins (LDL). This is the “bad cholesterol,” the main cause of plaque build-up, which increases your risk for heart disease. In general, the lower the number, the better. But LDL cholesterol is only one part of a larger equation that measures a person’s overall risk of having a heart attack or stroke. For years, guidelines focused on specific target numbers for individuals to achieve to lower their risk. The most recent guidelines focus on a person’s overall risk and, based on that risk, recommend a certain percentage of LDL reduction as one part of a strategy for preventing serious heart and vascular problems.
• High-density lipoproteins (HDL). This is the “good cholesterol.” It transports bad cholesterol from the blood to the liver, where it is excreted by the body. Your HDL is another part of the equation that identifies the risk of a cardiovascular event. In general, the higher the number the better, although, as with LDL, the emphasis has shifted from specific target numbers to strategies for reducing the overall risk.
• Triglycerides. Another type of fat in the bloodstream, triglycerides are also linked to heart disease. They are stored in fat cells throughout the body.

What Do Cholesterol Test Numbers Mean?

If you have a lipoprotein profile, it’s important to look at all the numbers from the cholesterol test, not just the total cholesterol number. That’s because LDL and HDL levels are two primary indicators of potential heart disease. Use the information below to interpret your results (with the help of your doctor, of course). This will help you get a better idea about your risk for heart disease.

Total blood cholesterol level:

• High risk: 240 mg/dL and above
• Borderline high risk: 200-239 mg/dL
• Desirable: Less than 200 mg/dL

LDL cholesterol levels:

190 mg/dL and above represents a high risk for heart disease and is a strong indicator that the individual can benefit from intensive treatment, including lifestyle changes, diet, and statin therapy for reducing that risk.

For LDL levels that are equal to or less than 189 mg/dL, the guidelines recommend strategies for lowering LDL by 30% to 50% depending on what other risk factors you have that can affect the health of your heart and blood vessels.

HDL cholesterol:

• High risk: Less than 40 mg/dL for men and less than 50 mg/dL for women

Triglycerides:

• Very high risk: 500 mg/dL and above
• High risk: 200-499 mg/dL
• Borderline high risk: 150-199 mg/dL
• Normal: Less than 150 mg/dL

How Do I Prepare for My Cholesterol Test?

If your doctor recommends a “non-fasting” cholesterol test, the lab will look only at your total cholesterol (and sometimes your HDL) numbers. For that test, you merely need to show up at the lab and have some blood drawn. If your doctor suggests a “fasting” cholesterol test (also called a “lipid profile”), the lab will analyze your levels of LDL, HDL, triglycerides, and total cholesterol. For that test, you will need to fast nine to 12 hours before the blood test.

Sometimes a doctor will ask you to do a non-fasting cholesterol test first. Depending on the results, they may then send you back for the more complete lipid profile.

How Will My Doctor Use Results From My Cholesterol Test?

After reviewing your blood test, The doctor will also consider other risk factors you might have for heart disease, including:

• Your family history
• Age
• Weight
• Race
• Gender
• Diet
• Blood pressure and whether or not you’re being treated for high blood pressure
• Activity level
• Smoking status
• History of diabetes
• Evidence of elevated blood sugars

Then, your doctor will talk with you about your level of risk and the potential benefit to be derived by taking steps that include changes in your level of activity and diet as well as using medication to improve your cholesterol levels in order to reduce your overall risk.

How Often Should I Have A Cholesterol Test?

The National Cholesterol Education Program recommends adults age 20 years or older have a cholesterol test every five years. People who are at risk for heart attack or heart disease or who have a family history of either should be checked more often.

Cholesterol Tests: Understand Your Results

Your health care provider may send you for cholesterol tests, either as a part of a standard check-up or because they suspect you may be at risk for developing heart disease. But do you know what the cholesterol test results actually mean? Read on to learn how to interpret the numbers.

Why Do I Need a Cholesterol Test?

Cholesterol is a waxy, fat-like substance. Your liver makes all the cholesterol your body needs. But you take in more cholesterol from certain foods, such as those from animals. If you have too much cholesterol in your body, it can build up in the walls of your arteries (as “plaque”) and eventually harden. This process, called atherosclerosis, actually narrows the arteries, making it harder for blood to travel through the vessels. 

Unfortunately, high cholesterol doesn’t cause symptoms. In later stages of atherosclerosis, though, you may suffer angina — severe chest pain from lack of blood flow to the heart. If an artery gets totally blocked, a heart attack results. A routine blood cholesterol test is a far better way of finding out what your cholesterol level is.

What Does a Cholesterol Test Measure?

In addition to measuring the total cholesterol in your blood, the standard cholesterol test (called a “lipid panel”) measures three specific kinds of fat:

• Low-density lipoproteins (LDL). This is the “bad cholesterol,” the main cause of plaque build-up, which increases your risk for heart disease. In general, the lower the number, the better. But LDL cholesterol is only one part of a larger equation that measures a person’s overall risk of having a heart attack or stroke. For years, guidelines focused on specific target numbers for individuals to achieve to lower their risk. The most recent guidelines focus on a person’s overall risk and, based on that risk, recommend a certain percentage of LDL reduction as one part of a strategy for preventing serious heart and vascular problems.
• High-density lipoproteins (HDL). This is the “good cholesterol.” It transports bad cholesterol from the blood to the liver, where it is excreted by the body. Your HDL is another part of the equation that identifies the risk of a cardiovascular event. In general, the higher the number the better, although, as with LDL, the emphasis has shifted from specific target numbers to strategies for reducing the overall risk.
• Triglycerides. Another type of fat in the bloodstream, triglycerides are also linked to heart disease. They are stored in fat cells throughout the body.

What Do Cholesterol Test Numbers Mean?

If you have a lipoprotein profile, it’s important to look at all the numbers from the cholesterol test, not just the total cholesterol number. That’s because LDL and HDL levels are two primary indicators of potential heart disease. Use the information below to interpret your results (with the help of your doctor, of course). This will help you get a better idea about your risk for heart disease.

Total blood cholesterol level:

• High risk: 240 mg/dL and above
• Borderline high risk: 200-239 mg/dL
• Desirable: Less than 200 mg/dL

LDL cholesterol levels:

190 mg/dL and above represents a high risk for heart disease and is a strong indicator that the individual can benefit from intensive treatment, including lifestyle changes, diet, and statin therapy for reducing that risk.

For LDL levels that are equal to or less than 189 mg/dL, the guidelines recommend strategies for lowering LDL by 30% to 50% depending on what other risk factors you have that can affect the health of your heart and blood vessels.

HDL cholesterol:

• High risk: Less than 40 mg/dL for men and less than 50 mg/dL for women

Triglycerides:

• Very high risk: 500 mg/dL and above
• High risk: 200-499 mg/dL
• Borderline high risk: 150-199 mg/dL
• Normal: Less than 150 mg/dL

How Do I Prepare for My Cholesterol Test?

If your doctor recommends a “non-fasting” cholesterol test, the lab will look only at your total cholesterol (and sometimes your HDL) numbers. For that test, you merely need to show up at the lab and have some blood drawn. If your doctor suggests a “fasting” cholesterol test (also called a “lipid profile”), the lab will analyze your levels of LDL, HDL, triglycerides, and total cholesterol. For that test, you will need to fast nine to 12 hours before the blood test.

Sometimes a doctor will ask you to do a non-fasting cholesterol test first. Depending on the results, they may then send you back for the more complete lipid profile.

How Will My Doctor Use Results From My Cholesterol Test?

After reviewing your blood test, The doctor will also consider other risk factors you might have for heart disease, including:

• Your family history
• Age
• Weight
• Race
• Gender
• Diet
• Blood pressure and whether or not you’re being treated for high blood pressure
• Activity level
• Smoking status
• History of diabetes
• Evidence of elevated blood sugars

Then, your doctor will talk with you about your level of risk and the potential benefit to be derived by taking steps that include changes in your level of activity and diet as well as using medication to improve your cholesterol levels in order to reduce your overall risk.

How Often Should I Have A Cholesterol Test?

The National Cholesterol Education Program recommends adults age 20 years or older have a cholesterol test every five years. People who are at risk for heart attack or heart disease or who have a family history of either should be checked more often.

Everything You Should Know About Cholesterol

To understand how cholesterol affects your health, you must first know what cholesterol actually is.

Cholesterol is a waxy substance that your body requires to build cells and manufacture vitamins and other hormones, according to the American Heart Association (AHA).

Your body makes all the cholesterol it needs in your liver. But you can also get cholesterol in the foods you eat. Dietary sources of cholesterol are primarily animal products and include:

• Meat
• Full-fat dairy
• Poultry

These foods contain dietary cholesterol. However, they also tend to be high in saturated and trans fat and trigger the liver to make more cholesterol. Other foods, such as palm oil, palm kernel oil, and coconut oil, contain saturated fat that can increase so-called “bad” cholesterol.

For some people, these foods represent a major source for increasing blood cholesterol. Because the typical Western diet is loaded with these foods, rising cholesterol levels have led the way to an epidemic of health problems linked to high cholesterol, says Trejo Gutierrez, MD, a cardiologist with the Mayo Clinic in Jacksonville, Florida.

Though some experts dispute the direct link between high blood cholesterol levels and cardiovascular disease (CVD), major organizations like the National Heart, Lung, and Blood Institute (NHLBI) maintain that high blood cholesterol levels play a role in the development of conditions such as atherosclerosis, carotid artery disease, coronary artery disease, heart attack, stroke, peripheral artery disease, and sudden cardiac arrest.

Types of Cholesterol and How They Work in Your Body

Cholesterol is carried through the circulatory system on two lipoproteins: high-density lipoproteins (HDL), often referred to as “good” cholesterol, and low-density lipoproteins (LDL), also called “bad” cholesterol.

HDL has been labeled “good” cholesterol because it removes LDL cholesterol from the arteries and takes it to the liver, where it can be broken down and removed from the body, according to the AHA.

LDL is termed “bad” cholesterol because when there is too much of it circulating in the blood (more than the good HDL scavengers can scoop up and ferry away), it can eventually build up in the form of plaque on the walls of your arteries. This is called atherosclerosis. Over time, this narrows the arteries and raises the risk for heart attack, stroke, and peripheral artery disease, notes the AHA.

A high level of triglycerides — the most common type of fat in your body — can also lead to fatty buildups in your arteries and increase your risk of heart attack and stroke, if combined with high LDL or low HDL cholesterol levels, per the AHA.

Why Are Some People More Likely to Have High Cholesterol Than Others?

Understanding why some people have high cholesterol numbers and others don’t isn’t as simple as it might seem. For example, while overweight people are more likely to have high cholesterol, thin people can have it as well, notes the AHA.

Here are some factors that affect your cholesterol levels:

Heredity

A condition called familial hypercholesterolemia (FH) may make some people genetically prone to high levels of bad cholesterol. There are two types of FH: heterozygous, in which a person inherits the abnormal gene from one parent only; and homozygous, in which the person has two copies of the abdominal gene, one from each parent. Homozygous FH is both more rare and more dangerous. People with FH don’t recycle LDL cholesterol as effectively and end up with high levels of this type of cholesterol, making them more prone to atherosclerosis, often starting at far younger ages. About 1 in 200 adults have the FH genetic mutation, according to the AHA. If left untreated, these individuals have a 20 times higher risk of developing heart disease.

If you have a parent, sibling, or child who has FH or who had a heart attack early in life, it’s recommended that you get tested for the condition. (The majority of FH patients need cholesterol-lowering drugs such as a statin to keep their cholesterol numbers in a healthy range.)

Smoking

While smoking doesn’t directly cause high cholesterol, it is by itself a major proven risk for heart disease and stroke. That risk rises if you also have high LDL cholesterol levels. One reason is that smoking lowers your levels of HDL, helping to diminish or erase that form of cholesterol’s protective effect, according to the AHA.

Quitting smoking has immediate benefits on your heart health. A research review published in the journal Biomarker Research found that HDL levels increase almost immediately in people who quit smoking.

Diet

When it comes to what you eat, the best way to lower your cholesterol is to reduce your intake of saturated fat and trans fat, according to the AHA, which recommends limiting saturated fat to less than 6 percent of daily calories and minimizing the amount of trans fat you eat. This means cutting back on red meat, tropical oils, fried foods, and full-fat dairy.

Instead, opt for low-fat or fat-free dairy products, fruits, vegetables, whole grains, poultry, fish, nuts, and nontropical vegetable oils. Healthier cooking oils include canola, corn, olive, peanut, safflower, soybean, sunflower, vegetable oil, and other specialty oils, notes the AHA. As a general rule, says Dr. Gutierrez, “consume a diet that is based mostly on whole, plant-based foods and is low in saturated and animal fats.”

Getting Tested: What Do Blood Cholesterol Test Results Mean?

The AHA recommends that all Americans over age 20 get their cholesterol levels tested every four to six years. Your doctor may recommend getting your cholesterol tested more frequently in middle age because your overall risk for heart disease starts to rise.

Here’s what the test will reveal:

• Total Blood Cholesterol Think of this as your overall “score.” This number is the result of a calculation that adds up HDL and LDL levels, plus 20 percent of your triglyceride level, according to the AHA. Although stated guidelines point to a total cholesterol of below 200 milligrams per decililter (mg/dL) as “desirable” and anything over 239 mg/dL as “high,” this number is less meaningful than it might appear, says Barbara Roberts, MD, a clinical associate professor emerita of medicine at Brown University in Providence, Rhode Island, and former director of the Women’s Cardiac Center at The Miriam Hospital. She adds that what’s important is the ratio of good to bad cholesterol.
• HDL Cholesterol You want this number to be higher, as a high HDL level is linked with good heart health. An HDL level of 60 mg/dL or higher appears to be protective against heart disease, notes the Cleveland Clinic. In contrast, a level of less than 40 mg/dL appears to be nonprotective and may be harmful.
• LDL Cholesterol An LDL of less than 100 mg/dL is the holy grail; a number 129 mg/dL or lower is also good. A range of 130 to 159 mg/dL is borderline high, 160 to 189 mg/dL is high, and above 189 mg/dL is in the danger zone, per the Cleveland Clinic.
• Triglycerides Normal levels of triglycerides vary by age and sex, according to the AHA. Risk factors that can lead to high triglycerides include having diabetes, being overweight or obese, being sedentary, drinking alcohol in excess, and consuming a diet that is high in sugar, processed foods, and saturated fat. A normal level is below 150 mg/dL; if your level is approaching 200 mg/dL, that is borderline high; and anything over 200 mg/dL is high and leaves you at greater risk for cardiovascular disease, per the Cleveland Clinic. A triglyceride level of 500 mg/dL or higher is considered dangerously high.

Facts About Cholesterol-Lowering Medication

If you and your doctor feel it would be wise to lower your cholesterol levels, you may be prescribed a statin drug. Guidelines put out by the AHA and the American College of Cardiology in 2019 say that the decision to start statin therapy should be based on a calculation of your risk for cardiovascular disease over 10 years. (See the risk calculator here.)

Cholesterol numbers, says Gutierrez, are only part of the picture, “though the most current recommendations say that in the presence of diabetes you should start medication when LDL is higher than 70 mg/dL.”

He also points out that it’s important to first try making lifestyle changes, such as:

It’s also important to note that those lifestyle changes should not be abandoned just because you’re taking medication.

Statin drugs work in two ways, says Gutierrez. “They block the enzyme that helps you produce cholesterol in the liver, and they activate the receptors for LDL in your liver cells, so that more cholesterol is ‘captured’ from your blood.”

In addition to statin drugs, a new class of cholesterol-lowering drugs called PCSK9 inhibitors was approved by the U.S. Food and Drug Administration (FDA) in 2015 to treat people with familial hypercholesterolemia and other risk factors. PCSK9 inhibitors are monoclonal antibodies that work to inactivate a protein in the liver called proprotein convertase subtilisin-kexin type 9 (PCSK9), reducing the amount of LDL circulating in your body.

Cholesterol and Heart Disease: Understanding the Connection

For years, it had been believed that there’s more or less a straight line between cholesterol and heart disease — but recent research suggests that this relationship may be more complex.

A Minneapolis Heart Foundation study, published in April 2017 in the Journal of the American Heart Association, found that many people who have heart attacks don’t have high cholesterol. “The link between cholesterol and heart disease is weak,” says Dr. Roberts, who places a large portion of the blame for the persistence of that link on pharmaceutical advertising for statin drugs. “Statins do lower cholesterol levels,” she says, “but atherosclerosis still progresses” due to factors like age, poor diet, smoking, and so on.

In addition, a review of studies of cholesterol and cardiovascular disease published in August 2015 in the American Journal of Clinical Nutrition found that no rigorous connection could be drawn between dietary cholesterol intake and the risk of CVD.

In contrast, the results of long-term research, published in September 2017 in the journal Circulation, concluded that statin use in men with high LDL cholesterol who had no other risk factors for heart disease reduced their rates of coronary heart disease death, cardiovascular death, and all-cause mortality by 28 percent over 20 years.

Furthermore, a study of more than 400,000 people published in December 2019 in The Lancet found a strong link between non-HDL cholesterol and long-term risk of cardiovascular disease.

Still, when it comes to heart health, your biggest risk factor is age, says Roberts.

To keep your risk of high cholesterol as low as possible and your heart as healthy as you can for as long as you can, eat real (unprocessed) food, exercise regularly, don’t smoke, and keep your blood pressure under control.

Additional reporting by Ashley Welch.

LDL-C Levels can be a sign indicating FH

While cholesterol level monitoring is especially important for people with familial hypercholesterolemia, or FH, everyone should know what state their cholesterol is in. Cholesterol levels tell you a lot about the health of your cardiovascular system, since excess cholesterol can lead to the kind of plaque buildup that may eventually trigger a major cardiac event. However, if you get your cholesterol tested, it’s important to understand exactly what you’re looking at, because not all cholesterol is bad for you. Some cholesterol is actually a sign of positive health.

Getting Your Cholesterol Levels Tested

First, you need to know what testing for cholesterol level entails. The American Heart Association suggests that all adults age 20 or older should have what’s called a fasting lipoprotein profile every five years. This is a blood test that is done after a 9-12 hour fast without any food, liquids, or pills, producing four different measurements: total cholesterol, LDL cholesterol (the bad kind), HDL cholesterol (the good kind), and triglycerides. The test results will be reported as milligrams per deciliter of blood.

Understanding Your Cholesterol Test Results

While your doctor can help you take into account the risk factors that may shift these general guidelines slightly for your individual case, this is the basic rubric for what your cholesterol test results mean.

• Total Cholesterol:  This score is calculated by adding your HDL-C and LDL-C levels together, plus 20% of your triglyceride level. Ideally, your total cholesterol should be less than 200 mg/dL. If your total cholesterol level is in the range of 200-239 mg/dL, you have borderline high cholesterol. 240 mg/dL is considered high blood cholesterol and gives you twice the risk of heart disease as someone with normal cholesterol.

• LDL-C levels: LDL-C levels are the best gauge of risk of heart attack and stroke. Less than 100 mg/dL is optimal, while 100-129 mg/dL is near optimal. 130-150 mg/dL is borderline high, 160-189 mg/dL is high, and 190 mg/dL or above is extremely high.

• HDL-C levels: HDL-C is the type of cholesterol for which you want to see a high score. If your HDL levels are below 40 mg/dL for men or 50 mg/dL for women, this is a major risk factor for heart disease. 60 mg/dL or above is considered protective against heart disease.

• Triglycerides: Triglycerides are the most common type of fat in the body. Less than 100 mg/dL is optimal, less than 150 mg/dL is normal, 150-199 mg/dL is borderline high, 200-299 mg/dL is high, and 500 mg/dL or more is very high.

Cholesterol Numbers in Individuals with FH

LDL-C levels are the most important potential sign of FH that can be derived from a cholesterol test. Adults with LDL-C levels of 190 mg/dL or above and children with LDL scores of 160 mg/dL or above should consider further testing for FH, especially if they have a family history of heart disease, stroke or high cholesterol. For more information about FH or to find out how you can get involved, contact The FH Foundation today.

A Guide to Cholesterol Medication

Cholesterol medications help lower total cholesterol within the body.  Cholesterol is a natural waxy, fat-like substance that is carried through the bloodstream to different organs and tissues.  Although cholesterol is essential for human health, too much “bad” (low-density lipoproteins or LDL) cholesterol or not enough “good” (high-density lipoproteins or HDL) cholesterol can put you at risk for coronary heart disease, heart attack, or stroke.  This is because LDL can build up in the arteries, causing the artery to limit blood flow.  HDL is important because it clears the build-up of such damaging cholesterol.

Doctors used to advise us to avoid foods that are high in cholesterol, which include animal products, such as milk, eggs, and meat.  They now say that eating foods high in cholesterol does not cause a person’s cholesterol levels to increase.  However, red meat and whole milk are not healthy for other reasons.  On the other hand, eating fresh fruits and vegetables, nuts, and whole grains can help us reduce our cholesterol levels and has been shown to help prevent heart disease and cancer.

High levels of triglycerides, a type of fat (lipid) in your blood produced from unused calories, can also increase your risk of heart disease.

Cholesterol-lowering medications work by blocking the substance your body needs to make cholesterol.  Medications may also reduce triglycerides and help your body reabsorb cholesterol that has built up as plaque on your artery walls.  This prevents further blockage in your blood vessels and potential heart attacks.

An estimated 1 in 7 Americans has high blood cholesterol, resulting in 800,000 deaths each year.  Approximately 30 million Americans take cholesterol-lowering medication, making them the most prescribed medications in the U.S.  Although cholesterol-lowering medications can help a lot of people, as with any medication, there are risks to taking these drugs.  You should try to find other ways of lowering your cholesterol that might be a better option for you and your health.  If those other strategies are successful, you might not need these drugs or might be able to take a lower dose of these drugs.

The key to lower cholesterol and reduced risk of heart disease is through lifestyle changes. Lifestyle changes include exercising at least 30 minutes a day on most days of the week; eating a healthy diet low in fat, cholesterol, and salt; managing stress; and quitting smoking.  Even if you decide to take cholesterol-lowering medication or have been taking it for a while, these lifestyle behaviors are important for managing cholesterol.

You should also know that once you start taking cholesterol-lowering medication, you will usually need to continue taking the drug indefinitely.  Even if your cholesterol drops to the desired level while on medication, many people find that once they stop taking cholesterol-lowering drugs, their levels go back up unless they have changed their eating, exercising, smoking, or other habits.  The long-term effects of many of these drugs have not been adequately studied, so the risks and benefits over several decades of use are generally unknown.

What do your cholesterol levels tell you?

If you have high cholesterol, your doctor may recommend you take medication.  This chart explains what your cholesterol levels tell you:

The numbers alone won’t tell you or your doctor the entire story, however.  If the only risk factor you have is high cholesterol, you may not need medication.  Often high cholesterol can be lowered by exercise and a healthy diet.  High cholesterol is only one of a number of risk factors for heart attack and stroke.  Other risk factors include:

• Family history of high cholesterol or cardiovascular disease
• Inactive (sedentary) lifestyle
• High blood pressure
• Age—older than 55 if you’re a man, or older than 65 if you’re a woman
• Poor general health
• Having diabetes
• Overweight or obesity
• Smoking
• Narrowing of the arteries in your neck, arms, or legs (peripheral artery disease)

Overview of Cholesterol-Lowering Medications

Once your cholesterol level is considered along with other risk factors, you and your doctor may decide that taking medication is a good option.  There are many cholesterol-lowering medications on the market today, but which of these drugs is right for you?  Here is an overview of benefits, concerns, and possible side effects for common types, or classes, of cholesterol medication:[1]

*Livalo (pitavastatin) became available on the market in mid-2010. Livalo is new and does not have the long track record of some of the other statins, so you may want to avoid this drug until more is known about it.

What Does Research Say About Cholesterol-Lowering Medications?

There are so many medications to choose from, but knowing which one is best for your body and health can be confusing.  You will decide together with your doctor, but doctors are often not aware of all the latest research.  Below is a summary of some of the most important studies on cholesterol medication, with conclusions that may help steer you away from drugs with greater risks or drugs that may lower your cholesterol without reducing your chances of heart attack or stroke!

Vytorin: Zocor + Zetia

A study published in the New England Journal of Medicine in 2008 found that Vytorin was less effective at reducing risk of heart disease compared to taking Zocor alone.[2] Researchers found that while Vytorin was more effective at lowering cholesterol, it was not better at reducing plaque build up in the arteries compared to Zocor alone.  In fact, the arterial wall was thicker for patients taking Vytorin.  Two patients taking the combination pill died, compared to one taking Zocor, and three of the patients taking the combination pill had non-fatal heart attacks, compared to two taking Zocor.  These differences were not statistically significant, meaning they could happen by chance, but they suggest that Zocor alone is a better choice than Vytorin.  The final results of the two-year clinical trial indicated that patients taking Vytorin were at the same risk of heart disease as the patients who took Zocor alone.  Why take 2 drugs at once if the second one is not helpful and may be harmful? Conclusion: Vytorin (Zocor + Zetia) is not more effective than Zocor alone.

After the above study was published, doctors were advised that Zetia (one of the drugs in Vytorin) should only be used if all other medications have failed.  The listed side effects for Zetia include: stomach pain, tiredness, allergic reactions, and joint pain.  Rarely, patients also experience severe muscle problems with symptoms of muscle pain, tenderness, or weakness caused by muscle breakdown.[3]

A study published in the New England Journal of Medicine in November 2009 reported that patients taking Vytorin (a combination of Zocor + Zetia) were more likely to have heart attacks or die from heart disease than patients taking a combination of Zocor + Niaspan.  Niaspan is an extended release form of niacin (a type of vitamin B).[4] The patients taking Vytorin also had more plaque build up in their arteries compared to patients taking Zocor + Niaspan.  This is further evidence that Vytorin is not helpful and may be harmful compared to other medications.  Conclusion: Vytorin (Zocor + Zetia) may have more serious side effects than Zocor + Niaspan.

National Center for Health Research believes that the evidence indicates that patients should choose other cholesterol lowering drugs rather than Vytorin.

Zocor

In June 2011, the Food & Drug Administration (FDA) recommended limiting the use of high-dose (80 mg) simvastatin (Zocor, Vytorin, and generic) due to risk of muscle injury.[5] The recommendation came after a review of clinical trial data and data from the agency’s Adverse Event Reporting System, one of the FDA’s most important tools for tracking the safety of drugs that are already on the market.  The reviewers found a clear link between high-dose simvastatin and muscle pain.  Rare but potentially deadly muscle damage was also linked to high-dose simvastatin, particularly for older women and those who took simvastatin in addition to blood-pressure drugs, especially diltazem (Cardizem and generic).

People starting simvastatin treatment for high cholesterol, as well as those who’ve taken simvastatin for less than one year, should begin with or switch to a lower dose.  For those who’ve taken the 80 mg dose for 12 months or longer without any muscle problems, the FDA said continuation of the high dose is likely not a problem.

However, since the difference in cholesterol lowering between a dose of 80 mg and a dose of 40 mg is only about 6%, according to the FDA, medical consultants say even individuals who have taken the 80 mg dose for 12 months or more should consider switching to a lower dose.

The FDA also warned about taking simvastatin with certain other drugs.  Notably, it issued new limits for people taking simvastatin along with several heart medications, including:

• No more than 20 mg of simvastatin when taken with amlodipine (Norvasc and generic)
• No more than 10 mg of simvastatin when taken with diltiazem (Cardizem and generic or verapamil (Verelan and generic)
• No more than 20 mg of simvastatin when taken with amiodarone (Cardarone)
• No more than 20 mg of simvastatin when taken with ranolazine (Ranexa)

The agency also added several drugs to the current list of medications that should never be used with simvastatin.  The full list includes:

• Clarithromycin
• Cyclosporine
• Danazol
• Erythromycin
• Gemfibrozil
• HIV protease inhibitors
• Itraconazole
• Ketoconazole
• Posaconazole
• Nefazodone
• Telithromycin

In light of these findings, NRC reiterates its recommendation that patients find safer alternatives to Vytorin, and avoid high-dose simvastatin drugs.

Altoprev and Mevacor

The drugs Altoprev and Mevacor contain a type of statin called lovastatin.  Recent evidence has shown that lovastatin is very similar to simvastatin.  Accordingly, the FDA issued warnings in February 2012 that lovastatin should not be taken in with a number of other drugs, such as the common antibiotic, erythromycin, and HIV protease inhibitors.[6]

The full list of medications that should never be used with lovastatin includes:

• Itraconazole
• Ketoconazole
• Posaconazole
• Erythromycin
• Clarithromycin
• Telithromycin
• HIV protease inhibitors
• Boceprevir
• Telaprevir
• Nefazodone

Fish Oil Supplements

The American Heart Association (AHA) recommends taking fish oil capsules to prevent a second heart attack or stroke (this is also known as “secondary prevention”).  However, a January 2018 meta-analysis, published in the prestigious medical journal JAMA Cardiology, concluded that patients who have heart disease, including those who have had a prior heart attack or stroke do not benefit from fish oil supplements.[7] The analysis showed that taking the supplements do not decrease the chances of having a heart attack or stroke, dying from a heart attack or stroke, or dying from any other cause. The studies included almost 80,000 patients with coronary heart disease, stroke, or diabetes who were followed for about 4 years while taking fish oil supplements or a sugar pill (placebo).

When there are conflicting recommendations like this, it is not always possible to make sense of them.  However, experts believe that because most patients in the study were already taking many other kinds of heart medications, the researchers did not see an additional benefit from fish oil supplements. Therefore, it is possible that patients who are not being treated with other heart medications could benefit from taking fish oil. More research is underway.

Niacin

A study by the National Heart, Lung, and Blood Institute of the National Institutes of Health found that adding high dose, extended-release niacin to statin treatment in people with heart and vascular disease did not reduce the risk of cardiovascular events, including heart attacks and stroke.[8] Participants who took Zocor and extended-release niacin of up to 2,000 mg per day had increased “good” (HDL) cholesterol and lowered triglyceride levels compared to patients who took Zocor alone.  However, the combination treatment did not reduce fatal or non-fatal heart attacks, strokes, hospitalizations for acute coronary syndrome, or revascularization procedures to improve blood flow in the arteries of the heart and brain. Conclusion: Niacin + statin treatment might increase good (HDL) cholesterol and lower triglycerides compared to statin alone, but it does not reduce overall risk of serious health outcomes like heart attack or stroke.

Risk of Muscle Injury

Muscle injury due to statin use is a leading cause of statin intolerance and the most common reason people stop taking statin medication.  Studies estimate that 10 – 15% of statin users develop muscle side effects ranging from mild discomfort to more severe muscle symptoms.  Although severe muscle symptoms (myotoxicity) are very rare, most recent studies suggest that muscle pain (myalgias) and minor muscle damage may occur in a substantial number of patients treated with statins.[9]

A growing body of research on statin use suggests that the risk of muscle problems depends mostly on the dose.  For example, four large trials including 27,548 patients compared high-dose statin use (atorvastatin or simvastatin at 80 mg/day) to moderate-dose statin use (pravastatin at 40 mg/day, simvastatin at 20 mg/day, or atorvasatin at 10 mg/day).  High-dose use was linked to a reduced risk of cardiovascular events, such as heart attack, stroke, or death.  But, patients taking a high dose statin were 10 times more likely to have muscle problems than patients taking a moderate dose statin.[10] Conclusion: Patients on high-dose statin therapy (especially simvastatin) are at an increased risk of muscle-related side effects.

Risk of Diabetes

For people with a history of coronary heart disease, heart attack or acute coronary syndrome, an analysis of five clinical trial studies found a link between the onset of diabetes and high-dose statin intake, compared to moderate-dose intake.  The 2011 analysis defined high-dose statin therapy as 80 mg of statin medication, while moderate-dose therapy was defined as either 40 mg, 20 mg or 10 mg, depending on the study.  Across all five studies, patients who have suffered acute coronary syndrome (ACS) and patients who have stable coronary heart disease were more likely to develop diabetes if they were taking higher doses of statins.  Acute coronary syndrome is a medical term that includes any symptoms of an insufficient blood supply to the heart muscle. Conclusion: High-dose statins can increase the risk of diabetes.

Statin Use among Children

Several statins are approved by the FDA for use in children.  Some are approved for children over 8 years of age and others for children at least 10 years of age.  Approved statins include: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor and generic), pravastatin (Pravachol and generic), rosuvastatin (Crestor), and simvastatin (Zocor and generic).[11]

Statins are usually used to treat children with genetic conditions that cause hyperlipidemia, which is an excess of lipids like cholesterol and triglycerides in the blood.  Short term studies in children show some improvement in measures like LDL cholesterol, blood flow, and thickness of the artery walls.  However, statin research has not studied children for more than 2 years, so we don’t know the long-term risks of statins for children, or if treatment in childhood actually improves health over a longer period of time or into adulthood.[8][11] We also don’t know which of the statins work better in children.[8]

Genetic conditions in children can increase the risk of vascular disease in adulthood, but so can obesity and diabetes.  Around 17% (or 12.5 million) of Americans aged 2-19 years are obese.  This is almost three times higher than the rate of obesity in 1980.[13] Before a statin is prescribed, parents should make dietary and lifestyle changes for the whole family to improve health and vascular functioning.  More exercise and a “heart-healthy” diet can improve cholesterol, blood pressure, weight and other risk factors.[8] A “heart-healthy” diet is high in whole grains, fish, fruit, and vegetables and is low in salt and sugar-added products.

Many doctors question whether children should take statins, especially when it is used before trying to make positive diet and exercise changes.  Doctors point out that a healthy weight, healthy diet, and physical activity could be as effective as statins, in addition to reducing the risk of other diseases and eliminating the side effects of the drugs.[14] We don’t know if or how statin use by children might influence development of the brain or other organ systems.  Long-term drug therapy beginning at this young age could affect the central nervous system, immune function, hormones, metabolism or have other unexpected effects.[11] For those reasons, use by children should be avoided except under rare circumstances.

Conclusion

If you need to reduce your cholesterol, make sure you think about the risks and benefits of taking cholesterol medication.  It is a good idea to try to improve your cholesterol through a “heart-healthy” diet and regular physical activity.  If these efforts do not work and you need to start taking a prescription cholesterol drug, make sure you find one that is proven safer, more effective, and right for you.

If you are already taking a prescription cholesterol drug and are experiencing possible side-effects, talk with your doctor about your options.  There may be another drug that could work for you.  Also, be aware of the latest findings and conclusions about cholesterol medication, including those mentioned in this article!

All NCHR articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff. 

[1] Mayo Clinic, High Cholesterol

[2] Kastelein J, Akdim F, Stroes ESG, et al. Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia. The New England Journal of Medicine. 2008;358:1431-1443.

[3] FDA Patient Information Sheet: Ezetimibe (marketed as Zetia). July 2006. Retrieved at http://www.fda.gov/Cder/drug/InfoSheets/patient/ezetimibePIS.htm

[4] Taylor AJ, Villines TC, Stanek EJ, et al. Extended-release niacin or Ezetimibe and carotid intima-media thickness. The New England Journal of Medicine. 2009;361:2113-2122.

[5] FDA: Limit Use of 80 mg Simvastatin. Consumer Health Information. June 2011. Retrieved at http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM257911.pdf

[6] FDA. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering drugs. February 2012. http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm

[7] Abbasi J. Another Nail in the Coffin for Fish Oil Supplements. JAMA. 2018;319(18):1851–1852. doi:10.1001/jama.2018.2498 available online:https://jamanetwork.com/journals/jama/fullarticle/2679051?utm_source=silverchair&utm_medium=email&utm_campaign=article_alert&utm_term=mostread&utm_content=olf-widget_05142018

[8] National Heart, Lung, and Blood Institute. NIH stops clinical trial on combination cholesterol treatment. 26 May 2011. Retrieved at http://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2792

[9] Mammen AL, Amato AA, Statin myopathy: a review of recent progress. Current Opinion in Rheumatology. 2010;22:644-650.

[10] Silva M, Matthews ML, Jarvis C, et al. Meta-analysis of drug-induced adverse events associated with intensive-dose statin therapy. Clinical Therapeutics. 2007;29:253-260.

[11] O’Gorman CSM, O’Neill MB & Conwell LS (2011).  Considering statins for cholesterol-reduction in children if lifestyle and diet changes do not improve their health: a review of the risks and benefits.  Vascular Health and Risk Management, 7:1-14.

[12] Vuorio A, Kuoppala J, Kovanen PT, Humphries SE, Strandberg T, Tonstad S, & Gylling H (2011).  Statins for children with familial hypersholesterolemia.  Cochrane Database of Systematic Reviews, Issue 7.

[13] Centers for Disease Control and Prevention, Overweight and Obesity.  April 2011. Retrieved at: http://www.cdc.gov/obesity/childhood/data.html

[14] Ferranti S & Ludwig D (2008).  Storm over Statins—The Controversy Surrounding Pharmacologic Treatment of Children.  N Engl J Med, 359;13:1308-12.

90,000 Cholesterol under control! The main provisions of the hypocholesterol diet

Cholesterol is a soft fatty substance in the blood that plays an important role in the construction of cell membranes and the production of hormones.Cholesterol is important for the normal functioning of the immune, nervous, and digestive systems, but if there is more of it in the blood than is required for normal life, cholesterol is gradually deposited on the inner walls of the arteries. This forms an atherosclerotic “plaque” – a thick dense formation that narrows the vessel and reduces its elasticity. This process of plaque formation is called atherosclerosis. After some time, a blood clot may form at the site of the atherosclerotic plaque, which completely clogs the vessel, blocks the supply of vital organs.Blockage of the vessel supplying the heart leads to myocardial infarction; blockage of the vessel supplying the brain – to a stroke.

But you don’t die of high cholesterol?
From the very fact of high cholesterol – no, but the developing complications are fatal. The consequences of atherosclerosis are often ischemic heart disease and, as a complication, myocardial infarction, ischemic brain disease, strokes, acute thrombosis in the vessels feeding the digestive organs.If the arteries supplying the lower extremities are affected, gangrene may develop.

Are there really “good” and “bad” cholesterol? Cholesterol does not dissolve in the blood. For its transfer from cell to cell transporters are used – lipoproteins. High-density lipoprotein cholesterol (HDL) helps transport cholesterol from the arteries to the liver for elimination from the body. HDL cholesterol is called “good”: high levels of it protect against heart disease. The lower the HDL level, the higher the risk of cardiovascular disease. Low-density lipoprotein (LDL) cholesterol, by contrast, transports cholesterol from the liver to the cells of the body. It is the excess LDL cholesterol that can be deposited in the arteries and form atherosclerotic “plaques”. The lower the LDL level, the better.
There is another form of lipids that need to be monitored – 90,021 triglycerides. An excess of them in the blood is also highly undesirable.

Basic principles of the hypocholesterol diet:

– It is recommended to reduce the intake of foods rich in saturated fat and cholesterol (fatty meats, poultry with skin, whole dairy products, chocolate, baked goods with fat, egg yolks and the fats themselves – lard, butter, margarines).Animal meat is usually less fat than many sausage products.

-The proportion of animal fats should be no more than half of the daily fat requirement (25-30 g / day). The remaining half of the daily fat should be represented by vegetable oils (olive, soybean, sunflower, linseed, sesame, cedar) (25-30 g / day), containing polyunsaturated and monounsaturated fatty acids, which are also found in fatty fish (herring, sardines , mackerel, salmon, tuna, mackerel, halibut, etc.) and nuts. Regular consumption of sea fish at least 2 times a week, 1 time of fatty varieties is considered desirable. Preference should be given to fish of the northern seas, which contain large amounts of ω-3 PUFAs, which play an important role in the prevention of atherosclerosis and myocardial infarction.

-It is recommended to reduce the consumption of foods rich in cholesterol (egg yolks, brains, liver, kidneys, heart, butter, animal fats, as well as cheese, sour cream, sausages and sausages with a high fat content), no more than 200-300 mg of dietary cholesterol per day.It is advisable to limit the egg yolks to 2-4 pcs. in Week.

-Increase the consumption of foods rich in dietary fiber (at least
25-30 g) For example, consumption per day of 1 apple, 1 orange, 6 pcs. prunes and
1/2 cup cooked beans provides 20-30 grams of fiber or 400 grams of vegetables.
100 g of ready-made porridge and 15 g of nuts. Especially useful are the so-called soluble
dietary fiber – pectins, which bind some of the cholesterol in the intestine and
remove it from the body. Since daily nutrition is difficult to replenish
needs for vitamins, macro- and microelements, it is advisable to supplement food
diets with preparations of multivitamin-mineral complexes, but not in medicinal ones, but in
physiological doses.90,000 Cholesterol – VLDL (Very Low Density Lipoprotein Cholesterol, VLDL, VLDL Cholesterol)

Method of determination
Estimated

Study material
Blood serum

Synonyms : Very low density lipoprotein cholesterol;

Very Low Density Lipoprotein; VLDL; Very-low-density lipoproteins.

Brief characteristics of the analyte Cholesterol – VLDL

Marker of atherogenicity.

Very low density lipoproteins are a heterogeneous group of particles with a diameter of 30-80 nm (smaller than chylomicrons, but larger than other lipoproteins). It is the main vehicle for the transport of exogenous lipids in plasma. VLDL-induced hyperlipaemia, like chylomicrons, gives the plasma a cloudy appearance, which is noted as the presence of chylosis, but unlike chylomicron-induced lipemia, VLDL turbidity does not separate as a layer when plasma is stored for 12-18 hours at a temperature + 4 ° C.The heterogeneity of the size of VLDLP is determined by the difference in the content of both proteins and lipids in them. Larger particles contain relatively more non-polar triglycerides and less phospholipids and cholesterol than smaller ones.

The main place of VLDL synthesis is the liver; a small amount of them enters the plasma from the intestine. The main role of these particles is the transport of triglycerides from the liver to peripheral tissues. VLDL, in addition, serve as the main precursor of low density lipoprotein (LDL).The half-life of VLDL in plasma is 6-12 hours.

in the metabolism of triglycerides and VLDL plasma clearance of the important role played by tissue enzyme – lipoprotein lipase.

What is the purpose of determining the level of cholesterol – VLDL in the blood

Determination of VLDL in blood serum in combination with other lipids is used for additional assessment of cardiac risks. Increased VLDL cholesterol is associated with an increased risk of atherosclerotic changes.

Specificity of the analyte analyzed in the “Cholesterol – VLDL” test

Very low density lipoproteins are classified as highly atherogenic lipoproteins involved in the mechanism of atherosclerotic plaque formation: increased absorption of VLDL by macrophages causes a pronounced accumulation of cholesterol in them and the formation of foam cells.

It has been proven that the development of atherosclerosis is accelerated against the background of an increased concentration of VLDL in diabetes mellitus and kidney disease.

More details on laboratory assessment of lipid metabolism parameters can be found here.

Biochemical blood test – price in the MEGI Clinic Network

Measurement of blood lipid concentration: cholesterol, phospholipids, triglycerides

Total cholesterol convert to mmol / L, μmol / L, mg / dL, mg / 100ml, mg%, mg / L, μg / ml.Online calculator / converter from traditional units to SI

Cholesterol is a steroid with a secondary hydroxyl group at the C3 position. It is synthesized in many tissues, but mainly in the liver and intestinal wall. About three quarters of cholesterol is synthesized by the body itself, and a quarter comes from food.

Cholesterol is synthesized throughout the body and is an essential component of cell membranes and lipoproteins, it is also a precursor for the synthesis of steroid hormones and bile acids.

Cholesterol is transported by two classes of lipoproteins (low density lipoproteins and high density lipoproteins), each of which plays an opposite role in the pathogenesis of lipid disorders.

Cholesterol measurement is used for screening the risk of atherosclerosis, in the diagnosis and treatment of pathologies including high cholesterol and metabolic disorders of lipids and lipoproteins.

Performance from postprandial patient samples may be slightly lower than fasting patient samples.

REFERENCE INTERVALS

Recommended values ​​as recommended by the National Cholesterol Education Program Adult Treatment Panel III (NCEP)

Clinical interpretation as recommended by the European Atherosclerosis Society

cost of biochemical blood test in Dubna

Effect of lipid-lowering therapy with statins on the prognosis of patients with hormone-positive breast cancer in the BIG 1-98 study

With concomitant administration of statins
(drugs aimed at lowering blood cholesterol levels) and adjuvant hormonal
therapy reduces the risk of recurrence of hormone-positive breast cancer.

In research BIG 1-98 ( Signe
Borgquist et al., 2017), which was conducted from 1998 to 2003, included 8010 women
in menopause with early hormone-positive breast cancer (BC) [1-2].

Cholesterol and statin dependence were assessed at study enrollment and
every six months for 5.5 years. 789 patients with hormone-positive breast cancer took statins, of which
concurrently with letrozole monotherapy in 318 patients, with sequential therapy
tamoxifen / letrozole 189 patients with sequential letrozole / tamoxifen 176
patients and with monotherapy with tamoxifen 106 patients.

Serum cholesterol levels decreased while taking tamoxifen and returned to
baseline after completion of tamoxifen therapy, regardless of mono-regimen or alternation
with letrozole. Taking letrozole did not affect changes in cholesterol levels when administered in
mono-mode or sequential appointment (Table 3). The analysis revealed that the appointment
statins significantly increased progression-free time (RR 0.79, p = 01) and
duration of effect (RR = 0.74, p = 0.03).

Table 1 – Relationship between lipid-lowering therapy with statins (HPTS) during
hormone therapy and prognosis of patients with hormone-positive breast cancer in the study BIG 1-98

Statins were taken before hormone therapy in 637 breast cancer patients.In multivariate analysis
revealed (table. 2) that the use of statins in the anamnesis was associated with a statistically significant
increase in time to relapse (RR 0.82, p = 0.04)

Table 2 – Disease-free survival of patients with hormone-positive breast cancer who received
lipid-lowering therapy with statins before starting hormone therapy (study BIG 1-98)

Researchers have concluded that concomitant administration of statins with hormone therapy plays a role in
a definite role in the treatment of early hormone-positive breast cancer and it is necessary to continue further
study of this effect in clinical trials.