High Cholesterol

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is high cholesterol?

The popular media portray cholesterol as a deadly villain, but you need a certain amount of it in your bloodstream to stay alive and well. This waxy, fatty compound is one of a group of lipids (blood-borne fats) essential to the manufacture of hormones, nerve fibers, and cell membranes. Only when you have too much of it does cholesterol become a problem. Your liver typically makes all the cholesterol you need. When you eat foods high in cholesterol or saturated fats, the liver responds by churning out even more. Over time, the excess is likely to build up in your arteries and harden into what’s called atherosclerotic plaque. Untreated, this condition (atherosclerosis) can lead to angina, heart attack, or stroke.

Ideally, your total cholesterol level should be below 200 mg/dL (milligrams per deciliter). Two major subtypes of cholesterol must also be considered: low density lipoprotein (LDL), the so-called “bad” cholesterol, and high density lipoprotein (HDL), or “good” cholesterol. (Lipoproteins are tiny globules of fat and protein that help transport fats to cells throughout your body.) Each type of lipoprotein has a different impact on your health. The higher your LDL, for instance, the greater your risk of heart disease. On the other hand, high levels of HDL actually reduce your cardiovascular risk, because HDL carries cholesterol back to the liver, where it is metabolized and eventually excreted.

Who is at risk for high cholesterol?

Your risk for high cholesterol increases with age, although estrogen helps until menopause. Other risk factors include diabetes, an underactive thyroid, or a family history. Even though high cholesterol has no real symptoms, it is a major cause of coronary heart disease.

Treatment for high cholesterol

The first step is to try to lower cholesterol with lifestyle measures. Dietary changes, along with regular exercise, can often bring high cholesterol levels down to an acceptable range. If these don’t do the trick—which is common for people genetically predisposed to high cholesterol—your doctor can prescribe safe and effective medications. There are natural remedies you can try as well.

Medications for high cholesterol

If you have made the appropriate lifestyle changes and your cholesterol is still too high, your doctor will probably prescribe medications to lower it.

The statin drugs are the safest, most effective, and most widely used cholesterol-lowering medications available. Formally known as HMG-CoA reductase inhibitors, statins interfere with the liver’s ability to synthesize cholesterol. Popular statins include lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), and atorvastatin (Lipitor). Regular and careful monitoring by your doctor is essential. Although these drugs have a very low incidence of side effects, they can cause liver damage or serious muscle pain and weakness. Some evidence suggests that statins may help reduce your risk of osteoporosis and Alzheimer’s disease.

Not everyone responds well to statin drugs. If you don’t, your doctor may prescribe nicotinic acid (niacin), which lowers LDL and raises HDL. Extended-release forms of niacin (Niacor, Nicolar, Slo-Niacin, Niaspan) reduce the risk of bothersome side effects such as flushing and burning sensations in the skin. Combinations of nicotinic acid and lovastatin (Nicostatin, Advicor) are now available. Because you’re getting smaller amounts of each component, the chances of side effects are considerably reduced.

Another possibility is the class of drugs known as bile-acid sequestrants. These drugs—including cholestyramine (Questran), colestipol (Colestid), and colesevelam (Cholestagel, Welchol)—bind with bile acids in your intestine, then are excreted in your stool. Because the liver manufactures bile acids from LDL cholesterol, these drugs stimulate it to make more, lowering your cholesterol in the process. Fibric acid derivatives, such as gemfibrozil (Lopid), fenofibrate (Tricor), and clofibrate (Atromid-S), are typically prescribed for people with unacceptably high triglyceride levels. These drugs may modestly reduce LDL and total cholesterol levels, but are generally not used alone to lower cholesterol.

Lifestyle Changes

A few simple steps can cut cholesterol levels by 20% to 30%, or even more. First, dietary changes. Eat fewer high-fat, animal-derived foods, like red meat and whole-milk dairy products, which are high in cholesterol. Avoid processed foods that contain highly saturated vegetable oils (coconut oil, palm, and palm kernel oil). Even though these oils come from plant sources and don’t contain cholesterol, they stimulate your liver to manufacture it. Always be wary of foods that flaunt “low cholesterol” or “no cholesterol” on their labels. They can still have saturated fat.

Trans fatty acids—also known as TFAs or trans fats—are bad news too. Found mainly in margarines and commercial baked goods, TFAs occur when hydrogen is added to make any liquid vegetable oil solid or semisolid. Like saturated fats, trans fats increase LDL and reduce HDL. Shun products with the phrase “contains partially hydrogenated vegetable oil.” Use olive and canola oils instead. They’re good sources of monounsaturated fat, which is considerably healthier than saturated fat. You should also follow the so-called Mediterranean Diet. Seek out foods that are low fat and high in fiber (fruits, vegetables, whole grains); get your protein from fish, legumes, and soy. Harvard scientists suggest that high-risk patients can benefit from the diet, but cardiologists disagree about whether or not it lowers the risk of fatal heart attack.

In addition to dietary changes, you should lose extra pounds if you are more than 20% overweight. Be sure to exercise regularly: Burning at least 250 calories a day (the equivalent of 45 minutes of brisk walking or 25 minutes of jogging) can raise your HDL and significantly protect you against heart disease. For best results, combine aerobic activity with resistance training and strength training. You might also consider having a drink every day (a glass of wine, a beer, or a cocktail). A number of studies have shown that moderate alcohol consumption may boost HDL. Women should have no more than one drink a day. Exceeding that amount can increase your health risks. If you smoke, definitely quit.

Alternative Therapies for High Cholesterol

Studies show stress can boost lipid levels. Therefore, find an activity or technique to help you relax and manage your stress better.

Several nutritional supplements may have cholesterol-lowering effects, but evidence on their efficacy varies. Among the most effective are plant sterols and stanols and the Indian herb gugulipid, which block absorption of cholesterol in the intestine. Another supplement, inositol hexaniacinate, is a safe form of niacin less likely to cause skin flushing and liver problems. Policosanol, a derivative of sugar cane wax, reduces the liver’s ability to churn out cholesterol.

Questions for Your Doctor

• Why didn’t my strict diet plan make much of a dent in my cholesterol levels?
• Are there any tests to determine if my high cholesterol has damaged my health so far?
• Should I tell my children to get checked for high cholesterol?
• Could medicines I’m taking or other medical conditions I have be raising my cholesterol levels?

Living with High Cholesterol

If you have High Cholesterol, here are a couple of tips to help you take control:

• Eat more omega-3s. These fatty acids (found in olive and fish oils) are healthier than the more prevalent omega-6s (in corn, soybean, and cottonseed oils). To get a better balance, choose a salad dressing with olive oil. Cook with it, too. Look for mayonnaise made from canola oil.
• Ask about low-dose aspirin therapy. A daily low-dose aspirin may be a smart and inexpensive way to reduce your chance of heart attack. Don’t initiate such a regimen without talking with your doctor.