CHOLESTEROL
& YOUR HEALTH
Books on the topic
Cholesterol is a waxy fat that is present in all human beings. Two sources contribute to
the amount of cholesterol in the human body. First, the liver manufactures about 80
percent of it. Second, people consume it by eating animal products such as meat, eggs and
dairy products. Cholesterol is carried through the bloodstream by certain proteins (apolipoproteins).
When these proteins wrap around cholesterol and other types of fats (lipids)to
transport them through the bloodstream, the resulting "packages" are called lipoproteins.  There are four different types of lipoproteins that carry
cholesterol through the bloodstream:
High-density lipoproteins
(HDL), which are associated with “good” cholesterol.
Low-density lipoproteins
(LDL), which are associated with “bad” cholesterol.
Very-low-density lipoproteins
(VLDL), which are associated with "very bad" cholesterol.
Chylomicrons, which only carry a small percentage
of cholesterol. Chylomicrons are mostly rich in another type of fat (lipid) called triglycerides.
The National Cholesterol Education
Program classifies cholesterol levels as follows (all measurements are in
milligrams per deciliter):
Total cholesterol levels between 200 and 239 are
borderline-high.
Total cholesterol levels that are 240 or higher are high.
HDL levels should be 40 or above (the American College of
Cardiology recommends levels of 45 or above for women; see Cholesterol
and Women).
LDL levels should optimally be less than 100
(levels greater than 129 are considered borderline-high, and levels greater than 159 are
considered high).
High levels of LDL cholesterol have been associated with
hardened arteries (atherosclerosis (books)) and coronary artery disease. In contrast, high levels of HDL
cholesterol have been shown to reduce some of the harmful effects of LDL cholesterol. For
information on improving the ratio between HDL and LDL cholesterol, see Increasing HDL Cholesterol and Lowering
LDL Cholesterol. The HeartCenterOnline encyclopedia also offers a general
overview of Triglycerides.
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What is
cholesterol?
Cholesterol is a fat-like
substance (lipid). It is either produced in the liver
or consumed by eating animal products such as meat, eggs or dairy products. The body uses
cholesterol to assist in the manufacture of hormones (books) or vitamin D (books), to build cell walls and to produce bile, which breaks down
other fats. It is carried through the bloodstream by lipoproteins.
Lipoproteins are proteins that wrap around both cholesterol and other fatty materials and
transport them through the bloodstream.
Two types of lipoproteins carry most of the cholesterol in the bloodstream, and they
behave very differently from each other as they move through the body:
High-density lipoproteins
(HDL). “Good” cholesterol, HDLs move easily through the blood and are actually
beneficial to the body. They are stable and do not stick to artery
walls. They help to prevent heart disease by carrying
cholesterol away from the arteries and back to the
liver, where the process of their removal from the body begins. 
Low-density lipoproteins
(LDL). “Bad” cholesterol, LDLs contain more fat and less protein than HDLs. LDLs
are unstable; they tend to fall apart. Rather than being removed from the body by the
liver, they stick to artery walls and contribute to plaque
build-up. This can eventually lead to hardened arteries (atherosclerosis)
or coronary artery disease. Therefore, high levels of
LDLs are strongly associated with increased risk for heart disease.
Smaller amounts of cholesterol may travel in very low-density lipoproteins or another type of lipoprotein
called chylomicrons (which are rich in triglycerides).
Many people with high levels of "bad" cholesterol also have high triglyceride
levels because both types of fats have similar risk factors (e.g., obesity (books) and diabetes (books)).
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What causes high
cholesterol levels?
The cholesterol value in the human body can rise to abnormally high levels when someone
eats a diet high in saturated
fats or trans fats (see Fats & Oils)
— especially when that person is obese and/or
rarely exercises.
High cholesterol levels can also be caused by a number of different genetic (books)
conditions. The most widespread inherited cholesterol disorder is familial
hypercholesterolemia (FH). The cholesterol levels of people with this disorder may
reach as high as 550 milligrams per deciliter — almost four times the level
considered desirable for the average person. With cholesterol this high, people with FH
are at a high risk for an early heart attack,
regardless of the presence of other risk factors. If
FH is suspected, children as young as two years of age may be appropriate for a
cholesterol screening.
Another genetic condition associated with high cholesterol levels is familial
dysbetalipoproteinemia (or familial combined hyperlipoproteinemia) in which
both cholesterol and triglyceride levels are elevated.
What is the link
between high cholesterol and heart disease?
The medical term for an excessive amount of cholesterol in the blood (over 240) is hypercholesterolemia.
It is one of the greatest threats to someone’s health. Not only is it a major
contributor to the development of hardened arteries (atherosclerosis (books), but it can also lead to a
certain type of chest pain called angina, or even a heart attack.
Research studies have concluded that for every 1 percent reduction in blood cholesterol
level, the risk of coronary heart disease decreases by
as much as 3 percent.
Although the National Center for Health Statistics reported that Americans’ average
total cholesterol levels dropped considerably between 1978 and 1990, the American Heart Association reported that 98.1 million
American adults still have borderline-high cholesterol levels (200 to 239 milligrams per
deciliter). Therefore, the average American’s cholesterol count puts him or her at a
greater risk of heart disease or stroke.
What cholesterol levels
are considered high or low?
According to the most recent
guidelines from the National Heart, Lung and Blood Institute
(NHLBI), cholesterol levels are classified as follows:
| Total Cholesterol Level |
Category |
| Less than 200 mg/dL |
Desirable |
| 200 to 239 mg/dL |
Borderline high |
| 240 mg/dL and higher |
High |
| LDLCholesterol Level |
Category |
| Less than 100 mg/dL |
Optimal |
| 100 to 129 mg/dL |
Near optimal/above optimal |
| 130 to 159 mg/dL |
Borderline high |
| 160 to 189 mg/dL |
High |
| 190 mg/dL and higher |
Very high |
| HDL Cholesterol Level |
Category |
| Less than 40* mg/dL |
Low (increased risk) |
| 60 mg/dL and higher |
High (heart-protective) |
* The American College of Cardiology recommends that women maintain HDL cholesterol levels of at least
45. For more information see Cholesterol
and Women.
| Triglyceride Level |
Category |
| Less than 150 mg/dL |
Normal |
| 150 to 199 mg/dL |
Borderline high |
| 200 to 499 mg/dL |
High |
| 500 mg/dL and higher |
Very high |
Labs outside of the United States may use different units of measure for cholesterol
levels. To convert a cholesterol level from milligrams per deciliter (mg/dL) to
international units (IU), multiply the mg/dL cholesterol level by 0.0259 millimoles per
liter (mmol/L). For example, a cholesterol level of 200 mg/dL is equal to a cholesterol
level of 5.18 IU.
Hypercholesterolemia, or high cholesterol, is diagnosed by measuring total cholesterol
levels, as well as by separate HDL ("good") and LDL ("bad") levels. It
is important for people to make sure that their total cholesterol levels are not too much
greater than their HDL cholesterol level. According to the American Heart Association, the level of total cholesterol should not be more than five times the level of
good cholesterol. This may also be expressed as the ratio 5:1. Test results may include
this important ratio. Ratios such as 4:1 or 3:1 are more desirable, and ratios such as 6:1
or 7:1 are less desirable. Furthermore, experts generally recommend that the level of HDL
cholesterol should be at least 35 milligrams per deciliter, regardless of total
cholesterol level.
Low total cholesterol (below 160) is not directly harmful to the human body but could
indicate the presence of other medical conditions that may require attention. These
medical conditions include the following:
Hyperthyroidism (books). An overactive thyroid gland that
leads to an excess of thyroid hormone in the body.
Malnutrition. Inadequate nutrition that may be caused by
an unbalanced diet or a condition in which the body has difficulty digesting or absorbing
nutrients from food (malabsorption).
Pernicious anemia. A type of anemia
(red blood cell deficiency) caused by the lack of a substance in the body needed to absorb
vitamin B-12.
Sepsis. A serious bacterial infection that has
spread to the blood.
Who needs cholesterol screening and how often?
Regular cholesterol
screenings are important, particularly for men over the age of 35 and women
over the age of 45. Regular cholesterol screenings are also important for people who have
risk factors such as diabetes, obesity
or a family history of cardiovascular
disease. Screenings should be conducted once every five years until the age of
65, or more regularly if a problem is discovered. People over age 65 may be screened more
frequently.
Even children can benefit from having their cholesterol checked, because it is one way to
identify factors that may adversely affect their heart health as they grow. However, the
U.S. Preventative Services Task Force does not encourage the routine screening of all
young children because coronary heart disease tends to begin later in life. Furthermore,
starting young children on medication to treat high cholesterol may be more of a risk than
the early plaque build-up it is meant to prevent.
Cholesterol screening is fast and relatively painless. Blood is drawn from a vein or through a fingertip “prick test.” Regular
screenings are the first line of defense against developing high cholesterol levels. If
triglyceride levels are going to be measured, test participants will be asked to stop
eating or drinking for several hours prior to the screening.
This cholesterol screening is only an approximate indication of one’s cholesterol
level. Even under normal conditions, the test results may be higher or lower than a
person’s actual cholesterol levels by about 14 percent. Also, test results can vary
quite a bit even when repeated over a short period of time. Therefore, many physicians
will provide results as a cholesterol range (e.g., 150 to 160) rather than an exact
number.
For more information about a cholesterol screening, please click on the following link: Cholesterol Test.
Gender Differences in
Cholesterol
Women benefit from cholesterol-lowering activities as much as men do. However, they are
far less likely to seek or receive treatment for high cholesterol.
Studies have suggested that high LDL levels are not as
significant a risk factor for women as for men.
Researchers suggest that apolipoprotein B (apoB), a protein found in in low-density
lipoproteins, is the best cholesterol-related predictor of coronary
artery disease for women. As gender-specific research continues, women will
probably see an increased availability of information and protocols for monitoring their
cholesterol levels. For more information, please click on the following link: Cholesterol and Women. |
