Cholesterol,
a fatty substance produced in the body, is an essential component of
cell membranes and some hormones. The body makes enough
cholesterol for these necessary functions without our help. The
foods we eat provide additional cholesterol.
Blood levels of
cholesterol measure both the natural body-made, cholesterol and the
cholesterol absorbed through the food we eat. There is no
difference between the two and so they are measured as
one cumulative number.
Cholesterol
attaches to proteins in the blood to form large molecules called
lipoproteins.
-
HDL,
high-density lipoprotein, is the good guy. You want high HDL levels.
-
LDL,
low-density lipoprotein, is the harmful cholesterol.
Coronary
Artery Disease (CAD)
Atherosclerosis
results from cholesterol-rich fatty deposits building up on the heart
artery walls.
These plaque like deposits narrow the arteries and produce a
smaller opening for blood to flow through. This can greatly reduce the
blood flow to the heart.
Risk
Factors
-
Lower
than 35 mg/dl HDL cholesterol (beneficial cholesterol, not the harmful
LDL)
-
Smoking
-
A
diet high in fats
-
High
blood pressure (hypertension)
-
Diabetes
-
Female
over 55 or in premature menopause or a Male over 45
-
Family
history of diabetes or high cholesterol
-
Premature
CAD family history: found in family females under age 65 or males
under 55.
Symptoms
Usually no symptoms of
high cholesterol present themselves until atherosclerosis develops.
Once
atherosclerosis reduces the hearts blood flow, symptoms begin to appear.
In patients with inherited familial hypercholesterolemia: cholesterol
nodules may appear in the tendons, especially the lower leg Achilles
tendon, and on the eyelids. Patients may begin experiencing Angina (heart
related chest pain) and the possibility of having a stroke increases.
Diagnosis
A blood test can determine
your cholesterol levels. For most people with high cholesterol levels this
is a long-term battle. Eating a diet low in saturated fats may begin to
lower cholesterol levels within 4-6 weeks. Have a cholesterol level blood
test every five years (for adults over 20) to catch high levels before
atherosclerosis develops.
Treatment
Step
1 Diet: On the Step 1 diet less than 10 % of your daily calories come from saturated
fats. Daily cholesterol intake is kept to less than 300mg.
Step
2 Diet: On the Step 2 diet less than 7 % of your daily calories come from saturated
fats. Daily cholesterol intake is kept under 200mg. Diet 2 is used if
after three months Diet 1 was unsuccessful in lowering cholesterol levels.
Medications
consist of four different classes of cholesterol lowering drugs:
-
HMG-
CoA reductase inhibitors: (statins) block enzymes to stop cholesterol
production.
-
Bile
acid-binding resins: such as cholestyramine and colestipol
-
Fibrates:
such as gemfibrozil, clofibrate, and fenofibrate
-
Niacin
Prognosis
Diet
and medication effectiveness varies greatly from person to person. In
general, LDL (low density lipoproteins) can be lowered 8-10 % using Diet 1
and 13-17 % on Diet 2.
Bile
acid-binding resin medications may drop LDL levels 20-35 %. Niacin can
result in LDL drops of 25-35 %. HMG-CoA reductase inhibitors can produce
results of 25-50 % LDL reduction.
Prevention
Begin
a program of regular
exercise. This means at least three times per week. For those who are
overweight, losing extra pounds can greatly reduce your risk level and if
you smoke, please stop! Diabetics need to be especially carefully about
monitoring their blood sugar levels. Changing lifestyle habits can greatly
reduce your chances of developing Hypercholesterolemia. Eating a diet low
in saturated fat and high in whole grain bread and cereal products is a
great start. And if you must have dairy products, choose the low-fat
options. Cut back, or avoid altogether, fatty red meats. Give egg
substitute products a try and stop using whole eggs. Instead of using palm
or coconut oil, select corn and olive oils. Learn to love fresh fruits and
vegetables!
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