Encyclopedia / C / Cholesterol



High blood cholesterol is one of the four major risk factors for coronary heart disease (cigarette smoking, high blood pressure, and sedentary lifestyle are the other three).

High blood cholesterol occurs when there is too much cholesterol in your blood. Your cholesterol level is determined partly by your genetic makeup and the saturated fat and cholesterol in the foods you eat. Even if you didn't eat any cholesterol, your body would manufacture enough for its needs.

The risk of developing coronary heart disease increases as your blood cholesterol level rises. This is why it is so important that everyone over age 20 should have their blood cholesterol level measured every 5 years. Your doctor can measure your level with a blood sample taken from your finger or your arm and will confirm this result with a second test if your HDL is less than 40mg/dL or your Total Cholesterol is more than 200. A fasting blood test would then be used to test for Total Cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and Triglycerides.

The following breakdown can help you see how the results of your total blood cholesterol tests relate to your risk of developing coronary heart disease:

Total Cholesterol

Desirable: Less than 200 mg/dl

Borderline High: 200 to 239 mg/dl

High: 240 mg/dl and above

A blood cholesterol level of 240 mg/dl or greater is considered "high" blood cholesterol. But any level above 200 mg/dl, even in the "borderline-high" category, increases your risk for heart disease. If your blood cholesterol is 240 mg/dl or greater, you have more than twice the risk of someone whose cholesterol is 200 mg/dl, and you need medical attention and further testing.

Currently, more than 50 percent of all adult Americans have blood cholesterol levels of 200 mg/dl or greater, which places them at an increased risk for coronary heart disease. Approximately 25 percent of the adult population 20 years of age or older has blood cholesterol levels that are considered "high," that is, 240 mg/dl or greater.

LDL Cholesterol

Optimal: Under 100mg/dL

Near optimal: 100-129mg/dL

Borderline High: 130-159 mg/dL

High: 160-189 mg/dL

Very High: 190mg/dL and over

HDL Cholesterol (HDL is protective and higher numbers are better)

Low: A level of 40mg/dL is considered low, and puts you at risk for heart disease.

High: A level of 60mg/dL or higher helps you lower your risk for heart disease


Levels above 200mg/dL, and possibly even above 150, may increase heart disease risk.


Lowering cholesterol with medication

Drug treatment is used along with with dietary changes to lower cholesterol levels. Several types of medications are available for cholesterol lowering, including statins, bile acid sequestrants, niacin, and fibric acids. Your doctor can help decide which one is best for you.

Statins have proven to be very effective and well-tolerated in most patients and are regarded as the treatment of choice for lowering "bad" cholesterol levels. These include aorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin calcium (Crestor), and simvastatin (Zocor). The frequency of side effects with these medications is generally very low, but nausea, gas, constipation, and abdominal cramping may occur. Headache, muscle pain, and liver problems have been reported in some cases. Statins work in the liver to interrupt the formation of cholesterol from the circulating blood.

Ezetimibe (Zetia) is a newer drug that lowers LDL (“bad”) cholesterol by working in the digestive tract to reduce the absorption of cholesterol. It is sometimes prescribed along with a statin.

Bile acid sequestrants lower LDL levels and are used alone or in combination with statin drugs. This type of drug includes cholestyramine (Questran), colestipol (Colestid), and colesevelam (Welchol). Bile acid sequestrants can be unpalatable and cause gastrointestinal effects (such as bloating, gas, abdominal pain, and constipation).

Niacin (nicotinic acid), a B vitamin, lowers LDL and triglyceride levels, and is very effective in raising HDL cholesterol levels. Side effects include hot flashes, nausea, indigestion, gas, and high blood sugar. A newer medication, Advicor, combines niacin to boost "good" cholesterol and lovastatin to lower "bad" cholesterol.

Fibric acids are used mainly to treat high triglyceride and low HDL levels. Three are currently available in the United States: gemfibrozil (Lopid), fenofibrate (Tricor), and clofibrate (Atromid-S). Fibrates are generally well tolerated but occasionally cause nausea, bloating, gas, and the formation of gallstones. Fibrates are often used in conjunction with another drug, such as statins, to reduce LDL levels.


Can cholesterol levels change from day to day depending on your diet?

Is there a dietician or some other resource you can recommend to help me obtain information about an appropriate diet?

Do you recommend niacin or any other medications to help lower the cholesterol levels? If so, what are the side effects?

How often should cholesterol level checked?

How can I best begin and sustain a program of regular physical activity?

If your doctor says your cholesterol is too high, you should respond by taking action. Lowering your total cholesterol levels will reduce your chance of suffering a heart attack or stroke, or dying of heart disease. If you have had a heart attack, keeping your cholesterol under control is especially important.

Managing your diet and weight, and increasing your physical activity can help bring low-density lipoprotein (LDL) cholesterol down to normal levels.

Diet. Reducing the amount of saturated fat and cholesterol in your diet helps to lower your blood cholesterol level. The diet recommended by the NHLBI’s National Cholesterol Education Program (NCEP) is a low-saturated-fat, low-cholesterol meal plan that calls for less than 7 percent of calories from saturated fat and less than 200 milligrams of dietary cholesterol per day. Foods that are low in saturated fat include fat-free or 1 percent dairy products, lean meats, fish, skinless poultry, whole grain foods, and fruits and vegetables. Foods high in cholesterol should be limited, including liver and other organ meats, egg yolks, and full-fat dairy products. The NCEP diet recommends only enough calories to maintain a desirable weight and avoid weight gain.

The NCEP recommends eating 10-25 grams of dietary fiber per day, particularly soluble fiber. Certain fruits and vegetables such as oranges, pears, brussels sprouts and carrots, as well as oats, dried peas and beans do not contain dietary cholesterol. They also help your body excrete cholesterol before it is absorbed into the bloodstream. Eating one tablespoon per day of either plant stanols or sterols, which help prevent the absorption of cholesterol into the bloodstream. Sterols are found in vegetable oils, fruits, vegetables, nuts, seeds, cereals, beans and other plant sources. Stanols can be found in some of the same sources. Some food products, such as Benecol Spread, have been fortified with stanols or sterols and can help lower cholesterol.

Weight. Being overweight is a risk factor for heart disease and increases your cholesterol. Losing weight helps lower your "bad" cholesterol and total cholesterol levels.

Physical activity. Not being physically active is a risk factor for heart disease. Regular physical activity helps lower your "bad" cholesterol, raises your "good" cholesterol levels, and helps you lose weight. You should try to be physically active for 30 minutes a day, especially if you have high triglyceride and/or low HDL cholesterol levels and are overweight with a large waist measurement.