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Cholesterol
Information
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Table of Contents
Additional Information
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What is Cholesterol?
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| Cholesterol is a naturally occurring substance that is both made by your body and derived from the food you eat. Total cholesterol is a measure of all cholesterol in your blood including HDL "good" cholesterol, LDL "bad" cholesterol and triglycerides. |
| HDL: HDL is considered your "good" cholesterol because it can pick up "bad" cholesterol and transport it to your liver, where your body can get rid of it. High levels of HDL can protect your arteries from cholesterol build-up (formed by LDL) and reduce your risk of heart disease. Experts agree that a total cholesterol level under 200 mg/dl is considered desirable. Experts agree that a low total cholesterol does not necessarily mean low risk and that low HDL actually increases your risk of CHD. |
| Your risk of heart disease increases as the level of HDL decreases. In fact, the NCEP, adult treatment guidelines now recommend testing for HDL as well as total cholesterol for accurate assessment of cardiac risk. Total cholesterol testing alone can be misleading. Approximately 40% of the U.S. population who are only tested for total cholesterol could misinterpret their results. 17% tested don't realize they could be at risk due to low HDL (<40 mg/dl) and 23% tested may over estimate their risk because their HDL level is high (>60 mg/dl), indicating added protection from
CHD. |
| LDL: Low density lipoproteins - LDL is the major cholesterol carrier in the blood. When a person has too much LDL cholesterol circulating in the blood, it can slowly build up within the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog the arteries. This condition is known as atherosclerosis. The formation of a clot in the region of this plaque can block the flow of blood to part of the heart muscle and cause a heart attack. If a clot blocks the flow of blood to part of the brain, the result is a stroke. A high level of LDL reflects an increased risk of heart disease. That is why LDL cholesterol is often called the "bad" cholesterol. |
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Medical professionals and journals have noted that elevated total cholesterol and LDL cholesterol are major risk factors for CHD, and the reductions of LDL cholesterol in high risk individuals leads to lower incidence of fatal and nonfatal cardiac events.
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Triglycerides: Triglycerides are the chemical form in which most fat exists in food as well as in the body. They are also present in blood plasma and, in association with cholesterol, form the plasma lipids. Triglycerides in plasma are derived from fats eaten in foods or made in the body from other energy sources like carbohydrates. Carbohydrates ingested in a meal and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals. Most of the body's stored fat is in the form of triglycerides. Another lipoprotein-very low density lipoprotein- VLDL has the job of carrying triglycerides in the blood. It is not clear whether high levels of triglycerides alone increase an individual's risk of heart disease. However, they may be an important clue that someone is at risk of heart disease for other reasons. Many people who have elevated triglycerides also have high LDL or low HDL.
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People with diabetes or kidney disease, two conditions that increase the risk of heart disease, are also prone to high triglycerides. Triglyceride levels are strongly influenced by diet. While cholesterol levels remain pretty constant over a month or so, and aren't terribly affected by meals, triglycerides respond quickly to a meal, particularly one with a lot of fat, sugar, or alcohol.
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Cholesterol Risk
Table
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Desirable
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Borderline High
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High
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Total Cholesterol
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Less than 200 mg/dL |
200-239 mg/dL |
>240 mg/dL |
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HDL *
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Greater than 45 mg/dL |
20 - 45 mg/dL |
<20 mg/dL |
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LDL**
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Less than 130 mg/dL |
130-159 mg/dL |
>160 mg/dL |
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Triglycerides
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Less than 150 mg/dL |
150-400 mg/dL |
>400 mg/dL |
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* Less than 40 mg/dL creates additional risk
**Less than 100 mg/dL optimally if you have had a previous heart attack or stroke
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Since 1984, 3 major studies have shown that cholesterol plays a significant role in Coronary Heart Disease (CHD) and that lowering cholesterol to acceptable levels significantly reduces the risk of developing CHD. The same study showed that small but significant increases in HDL are associated with additional reduction in CHD risk. Increasingly, the measurement of HDL is being used as an indicator of risk and may be a strong predictor of risk, especially in women and older individuals. Elevated triglycerides may also be a risk factor for CHD. When performed as part of a Lipid Profile, Total cholesterol, HDL and Triglycerides are used in the calculation of an estimated LDL value. The National Institute of Health has recommended aggressive efforts to identify and treat those at risk for CHD.
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| High blood cholesterol is a condition that greatly increases your chances of developing CHD, the main form of heart disease. That is because extra cholesterol in the blood collects in the inner walls of the arteries, allowing less blood to get to the heart. |
| The primary evidence to support cholesterol screening is the ability of cholesterol-lowering interventions to reduce the risk of CHD in patients with high cholesterol. These benefits are now well established for persons with preexisting arteriosclerotic vascular disease. In individual trials and overviews of studies enrolling persons with angina or prior to myocardial infarction, cholesterol-lowering treatments slowed the progression of atherosclerosis, reduced the incidence of CHD, and reduced overall mortality. |
| Recommendation: Periodic screening for high blood cholesterol is recommended for all men and women. The National Cholesterol Education Program Adult Treatment Panel II, convened by the National Heart, Lung and Blood Institute, recommends routine measurement of nonfasting total cholesterol and HDL in all adults age 20 or older. Screening young persons can provide other information to help stimulate lifestyle changes. Elevated cholesterol is an important risk factor for CHD in men and women in the U.S. and there is now good evidence that lowering cholesterol can reduce the risk of CHD. Measures that lower cholesterol and provide other health benefits (e.g. regular physical activity, reducing dietary fat, and maintaining a healthy weight) should be encouraged in all persons. Cholesterol screening can identify high-risk individuals who are most likely to benefit from individualized counseling. |
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