MS and Cholesterol: The Basics

Patient Expert

High blood cholesterol affects over 65 million Americans and I am one of those people, as are each of my parents.   Often genetic, high cholesterol is a serious condition that increases one's risk for heart disease. The higher the cholesterol level, the greater the risk.

The scary thing with cholesterol is that it can be high and you may not even know it. Lowering cholesterol levels that are too high lessens your risk for developing heart disease and reduces the chance of having a heart attack or dying of heart disease.

September is designated National Cholesterol Education Month by the National Heart, Lung and Blood Institute (NHLBI).   It is a good time to learn about cholesterol and lipid profiles, to get your blood cholesterol checked, to take steps to lowering it if it is high, and to learn about food and lifestyle choices that can help you reach your personal cholesterol goals.

What is Cholesterol?

Cholesterol is a soft, waxy substance among the lipids (fats) found in the bloodstream and in all body cells. It is used to form cell membranes, produce hormones, and for other bodily functions.   Fats, including cholesterol, cannot dissolve in blood and are transported by lipoproteins.   Too much cholesterol in the blood (hypercholesterolemia) is a major risk factor for coronary heart disease.

The correct way to have your cholesterol tested is by having a "fasting" blood draw.   For 12 hours before you go to the doctor or lab, you must not eat.   You should drink water to stay hydrated, but food can make the test inaccurate.   In the United States, cholesterol levels are measured in milligrams per deciliter (mg/dL) of blood.   In Canada and the UK, they are measured in millimoles per litre (mmol/L).

In July my blood results were:

*   Total Cholesterol: 209 mg/dL (up from 205 mg/dL in February)

*   HDL (good) Cholesterol: 43 mg/dL (down from 44 mg/dL in February)

*   LDL (bad) Cholesterol: 150 mg/dL (up from 143 mg/dL in February)

*   Triglycerides: 81 mg/dL (down from 89 mg/dL in February)

Although I lost 24 pounds in the five months between these two blood draws, only triglycerides levels were improved.   You would think that the other measures would have improved as well.   But alas, they did not.   So my rheumatologist prescribed a statin medication which will (hopefully) help me to lower my cholesterol levels.   We are retesting and re-evaluting in October.

High-Density Lipoprotein (HDL) or "Good" Cholesterol

Where "good" cholesterol is concerned, higher is better.   HDL levels in the average man range 40-50 mg/dL (1.04-1.30 mmol/L). In the average woman, they range 50-60 mg/dL (1.30-1.55 mmol/L).   A low HDL level, which is less than 40 mg/dL (1.04 mmol/L) for men or less than 50 mg/dL (1.30 mmol/L) for women, increases the risk of cardiovascular disease.   Conversely, an HDL cholesterol of 60 mg/dL (1.55 mmol/L) or higher gives some protection against heart disease.   "¨"¨Increasing physical activity and losing weight can help to raise HDL levels.

Low-Density Lipoprotein (LDL) "Bad" Cholesterol

We want to get our "bad" cholesterol levels as low as possible.   The lower the level, the lower the risk of heart attack and stroke.   The American Heart Association states that LDL cholesterol is a better gauge of risk than total blood cholesterol.

*   less than 100 mg/dL is optimal ( < 2.59 mmol/L)

*   100-129 mg/dL is "near optimal" (2.59-3.34 mmol/L)

*   130-159 mg/dL is borderline high (3.37-4.12 mmol/L)

*   160-189 mg/dL is high (4.15-4.90 mmol/L)

*   above 190 mg/dL is very high ( >4.92 mmol/L)


Triglycerides are a form of fat.   People with high triglycerides often have high total serum cholesterol, including high "bad" cholesterol and low "good" cholesterol levels.

*   less than 150 mg/dL is "normal" ( < 3.89 mmol/L)

*   150-199 mg/dL is borderline high (3.89-5.16 mmol/L)

*   200-499 mg/dL is high (5.18-12.93 mmol/L)

*   above 500 mg/dL is very high ( >12.95 mmol/L)

Several possible causes of high triglyceride levels include being overweight/obese, physical inactivity, cigarette smoking, excess alcohol consumption and/or a diet very high in carbohydrates (60 percent or more of calories).   Although underlying diseases or genetic disorders can be the cause of high triglycerides, more often they are related to lifestyle.

Total Blood Cholesterol Level

When it comes to total cholesterol level, a level which is less than 200 mg/dL (< 5.18 mmol/L) is desirable.   A level of 200-239 mg/dL (5.18-6.19 mmol/L) presents a borderline-high risk for developing coronary heart disease.   A high risk level would be results of 240 mg/dL and over (> 6.22 mmol/L).   The American Heart Association says that "people who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (less than 200 mg/dL)."

Therapeutic Lifestyle Changes and Heart Healthy Recipes

Next week we'll talk more about lifestyle changes and a dietary approach to lowering cholesterol.   In the meantime, peruse these great resources offered by the National Heart, Lung, Blood Institute:

*   Your Guide to Lowering Your Cholesterol with Therapeutic Lifestyle Changes

*   Keep the Beatâ„¢: Recipes Web Pages

*   Keep the Beatâ„¢: Heart Healthy Dinners

*   Heart Healthy Home Cooking African American Style

*   Delicious Heart Healthy Latino Recipes

If you do have high cholesterol, work with your doctor and other health care providers to create an appropriate treatment plan for you.   Even if you need cholesterol-regulating medication to lower LDL cholesterol levels, it is smart to make lifestyle changes now, which include eating a heart-healthy diet, getting regular physical activity, losing weight, and avoiding tobacco smoke.

Since my LDL actually got worse as I lost weight, my doctor has prescribed a cholesterol-lowering drug.   I have added simvastatin (Zocor, Simvacor) to my daily drug regimen.   In the immediate days after starting the drug, I did notice that my blood pressure increased significantly; but it returned to normal after about three to four days.   Other than that I haven't noticed any particular side-effects.

We will retest my blood lipid levels in October.   Depending upon the results of my next blood lipid panel, I may be able to stop the medication or may need to continue for a little while longer.   However, since both my parents continue to take medication for their cholesterol, I anticipate that I too will need to continue.   Let's see what the blood test says first.


American Heart Association

Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (pdf)   National Cholesterol Education Program (NCEP)

High Blood Cholesterol: What You Need To Know (pdf)   by NHLBI