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The amount of cholesterol in your blood has a lot to do with your chances of getting heart disease; in fact, it’s one of the major risk factors for this illness. The higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack.

Cholesterol is a fat-like substance produced by your liver; it is necessary for building cell walls and in the production of hormones. Cholesterol is also found in some of the foods you eat. When you have too much cholesterol in your blood, it builds up in the walls of your arteries. Over time, this buildup causes “hardening of the arteries,” meaning that the arteries become narrow and that blood flow to the heart is slowed down or blocked.

Blood carries oxygen to your heart and other vital organs. If enough blood and oxygen cannot reach your heart, you may feel chest pain. If the blood supply to an area of the heart is completely blocked, the result is a heart attack.

High blood cholesterol does not cause symptoms, so many people are unaware that their cholesterol level is too high. That’s why it’s important to find out what your cholesterol level is. If your level is high, you can take steps to reduce it.

Keeping your cholesterol within healthy limits is important for you no matter what your age or gender, whether you have heart disease or not. Everyone age 20 and older should have a blood cholesterol test at least once every five years. The most accurate test is the “lipoprotein profile,” which is done after fasting.

A lipoprotein profile measures:

• Total cholesterol
• LDL (“bad”) cholesterol, which is the main source of cholesterol buildup and blockage in the arteries
• HDL (“good”) cholesterol, which helps keep LDL cholesterol from building up in the arteries
• Triglycerides, which are another form of fat in your blood If it’s not possible to get a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol level.

Understanding the cholesterol treatment guidelines

Current guidelines for treatment of high cholesterol come from the National Cholesterol Education Program III, overseen by the National Heart, Lung, and Blood Institute. The guidelines are used to determine a person’s risk of experiencing a heart attack within 10 years.

A person’s cholesterol level is one part of the equation for determining risk for heart disease. Other risks for heart disease include smoking, obesity, diabetes, high blood pressure, family history of heart disease, gender and age (over 45 for men and over 55 for women).

Treatment for high cholesterol depends on how many other risk factors are present.

Treatment

If you have high cholesterol, your goal is to reduce your LDL level enough to cut your risk of developing heart disease or having a heart attack. The higher your risk of these illnesses, the lower your LDL should be.

You can lower your LDL level through lifestyle changes such as a cholesterol-lowering diet, exercise and weight management. A low-saturated-fat, low-cholesterol diet has less than 7 percent of calories from saturated fat and less than 200 mg of cholesterol. If this diet doesn’t lower your LDL enough, you can add soluble fiber to your diet.

It’s important to control your weight in order to control your LDL, especially if your HDL level is low, your triglycerides are high or your waist circumference is too great (more than 40 inches if you’re a man or more than 35 inches if you’re a woman). To get enough exercise, aim for 30 minutes of moderate physical activity most, if not all, days. (In some people, there are genetic reasons that the LDL level can’t be lowered by these methods. In others, these methods just don’t work well. In both of these cases, medications may have to be added.)

To reduce your risk for heart disease, it’s also important to control your blood pressure and to stop smoking.

Your doctor may prescribe cholesterol-lowering medication in conjunction with lifestyle changes. Maintaining your lifestyle changes will keep your medication dose as low as possible and lower your risk of heart disease in other ways. There are several types of drugs available for lowering cholesterol, including statins, bile acid sequestrants, nicotinic acid and fibric acids. A drug category called cholesterol absorption inhibitors are drugs that block cholesterol absorption in the intestine.

How statins work

By blocking a liver enzyme that helps to make cholesterol, statins lower LDL cholesterol. They may also protect against heart disease by decreasing the formation of plaque in artery walls, preventing plaque from breaking open and by reducing clot formation. If you take one of these drugs, there’s a good chance it will lower your cholesterol by 20 to 30 percent within a few weeks. They’re taken once a day and they’re long-term, meaning once you’re prescribed a statin, there’s a good chance you’ll stay on it for the rest of your life.

Initially, your doctor may monitor you for liver and muscle toxicity, the most serious side effects of statins. But such side effects are uncommon, occurring in only 1 percent to 3 percent of patients.
The other potential side effects, which are rare, include constipation, headache or nausea.

Maintain a heart-healthy lifestyle

No matter which cholesterol-lowering medication you take, it’s important to remember that diet and exercise also lower cholesterol and are a valuable part of your treatment strategy. Don’t think you can just take a pill.