Cholesterol

There is strong evidence that elevated cholesterol blood levels play a major role in the development of heart disease among younger and middle-aged people. A total cholesterol level of 200 to 239 is considered borderline high and levels of 240 mg/dL or higher are high. About 20 percent of Americans (39.4 million) have high cholesterol levels placing them at higher risk for heart disease. A slightly higher percentage of women than men have cholesterol levels of 240 mg/dL or higher.

Estimated Percentage of Americans Ages 20Ð74 With Blood Cholesterol of 240 mg/dL or Higher by Race and Sex United States: 1994


Source: NHANES III (1988Ð94), CDC/NCHS.

To learn more about the importance of lowering cholesterol whether you have heart disease or want to prevent it, click on the link "National Cholesterol Education Program" to visit the National Heart, Lung, and Blood Institutes at the National Institutes of Health.

Clinical trials suggest that for every 1 percent reduction in cholesterol level, there is a 2 to 5 percent reduction in heart disease incidence. At present, it remains controversial whether or not high cholesterol should be treated as aggressively in older adults as in younger people. Cholesterol does not seem to be as important a risk factor for heart disease in old age as in middle age.

Many studies find that the total cholesterol level for older adults is not a risk factor at all or that it is a very minor one. For example, Krumholz and colleagues found that cholesterol was not associated with the development of heart disease or mortality or morbidity in the 70 and older population. Corti and colleagues found that older women, but not men, with an elevated total cholesterol (over 240 mg/dl) were at modest risk for heart mortality. However, high levels of high density lypoproteins cholesterol continue to have a protective effect in old age. Those with high density lypoproteins levels below 35mg/dL had 2 1/2 times the risk of heart mortality of those with high density lypoproteins levels above 60 mg/dL.

Diagnosing High Cholesterol

Beginning at age 20, a fasting blood cholesterol test every 3 to 5 years is recommended to determine if your blood lipids are at a healthy level.

Your risk for heart disease increases if your cholesterol is 240 mg/dL or more. As the table below shows, you also want your HDL to be above 45 mg/dl and your LDL below 130 mg/dl.

Treating High Cholesterol

The best way to lower cholesterol is to adopt a low-fat or low-cholesterol diet, exercise regularly, and stop smoking. Dietary changes that may help lower your cholesterol levels include:

1. Limit your total fat to less than 30 percent of your total daily calories.
2. Reduce saturated fats (e.g., butter, cheese, meat, coconut) to less than one-third of your total fat intake.
3. Limit dietary cholesterol to 300 milligrams. Avoid dairy products made with whole milk and organ meats (e.g., liver, tongue).

  There are a number of cholesterol lowering drugs that may be used to reduce CVD risk. They include:

• Resins (e.g., Questran, Colestid) lower cholesterol indirectly by binding with bile acids that are made in your liver from cholesterol.
• Fibrates (e.g, Lopid, Tricor) are primarily triglyceride-lowering drugs that result in an increase in HDL cholesterol.
• Niacin is a vitamin that lowers triglycerides which causes an increase in HDL cholesterol. In addition, niacin can lower LDL cholesterol.
• Statins (e.g., Lescol, Mevacor, Zocor, Pravachol, Lipitor, Baycol) are becoming the most widely prescribed drugs to lower cholesterol because they are effective and have few side effects. Statins can reduce your LDL cholesterol by up to 40 percent. They work directly in your liver to block an enzyme that is needed to manufacture cholesterol. Statins may also help your body reabsorb cholesterol from plaques, slowly unplugging blood vessels. Statins are the only type of lipid-lowering drug that can your risk of death from cardiovascular disease they are also reduce your risk of having a second heart attack.