High Blood Cholesterol: What You Need to Know

What is blood cholesterol and why does it matter?

High blood cholesterol is a serious problem: it is a "risk factor" for heart disease. That means that having high blood cholesterol increases your chance, or risk, of getting heart disease. The higher your blood cholesterol, the greater your risk of getting heart disease. And heart disease is the number one killer of both men and women in the United States.

Two specific kinds of blood cholesterol are low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL-cholesterol, sometimes called "bad" cholesterol, causes the cholesterol to build up in the walls of your arteries. Thus, the more LDL you have in your blood, the greater your heart disease risk. In contrast, HDL-cholesterol, sometimes called "good" cholesterol, helps your body get rid of the cholesterol in your blood. Thus, if your levels of HDL are low, your risk of heart disease increases.

What do your cholesterol numbers mean?

Every adult, ages 20 and older, should have his or her blood cholesterol checked at least once every 5 years. Here's a quick look at the numbers and what they mean:

Cholesterol levels less than 200 mg/dL are considered desirable, while levels of 240 mg/dL or above are high and require more specific attention. Levels from 200-239 mg/dL also require attention especially if your HDL-cholesterol is low or if you have two or more other risk factors for heart disease. Look at the chart to see how many risk factors you have. Your doctor looks at all your risk factors to decide what you need to do to lower your blood cholesterol and reduce your risk of heart disease.

HDL-cholesterol:. Unlike total and LDL-cholesterol, the lower your HDL, the higher your risk for heart disease. An HDL level less than 40 mg/dL is considered low and increases your risk for heart disease. The higher your HDL, the better. An HDL level of 60 mg/dL or above is high.

LDL-cholesterol: Your doctor will likely check your LDL-cholesterol level if your:

• HDL-cholesterol is low,
• Total cholesterol is high, OR
• Total cholesterol is borderline-high, and you have two or more other risk factors for heart disease.

Your LDL level gives a better picture of your risk for heart disease than your total cholesterol. Here are the categories for LDL levels:

Lowering LDL is the main aim of treatment for a Lowering LDL is the main aim of treatment for a cholesterol problem. If your LDL level puts you at high-risk and you have fewer than two other risk factors for heart disease, then your treatment goal is an LDL level of less than 160 mg/dL. However, if you have two or more other risk factors for heart disease, your LDL goal should be less than 130 mg/dL. If you already have heart disease, your LDL should be even lower -- 100 mg/dL or less.

What affects your blood cholesterol levels?

Your blood cholesterol levels are affected by:

• What you eat: The saturated fat and cholesterol in the food you eat raise total and LDL-cholesterol levels.
• Overweight: Being overweight can make your LDL-cholesterol level go up and your HDL level go down.
• Physical activity/exercise: Increased physical activity helps to lower LDL- cholesterol and raise HDL-cholesterol levels.
• Heredity: Your body makes all the cholesterol it needs, and your genes influence how your body makes and handles cholesterol.
• Age and gender: Blood cholesterol levels in both men and women begin to go up at about age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a woman's LDL-cholesterol level goes up -- and so does her risk for heart disease.

What if you already have heart disease?

If you already have heart disease, you have a great deal to gain by lowering your cholesterol level. If you lower your blood cholesterol, you can possibly prevent future heart attacks, and maybe even slow down or reverse some of the cholesterol buildup in the arteries. Remember, your LDL should be 100 mg/dL or less.

Source: National Institutes of Health; National Heart, Lung, and Blood Institute; National Cholesterol Education Program (NCEP)

What can you do to lower your blood cholesterol level

Now that you know about blood cholesterol, get set to lower it. All healthy Americans, regardless of their blood cholesterol level, should eat in a heart-healthy way. This is true beginning with toddlers (about age 2) on up to their parents, grandparents, and even great-grandparents. The whole family should also be physically active. And if you have a high blood cholesterol level -- whether due to what you eat, heredity, or both -- it is even more important to eat healthfully and to be physically active. Adopting these behaviors also can help control high blood pressure as well as diabetes.

You'll find more help on heart-healthy eating and physical activity a little later in this resource. First, here are some general rules to lower blood cholesterol:

Choose foods that are low in saturated fat: All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else that you eat. It is found in the greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils like coconut, palm kernel, and palm oils. The best way to reduce your blood cholesterol level is to choose foods low in saturated fat. One way to do this is by choosing foods such as fruit, vegetables, and whole grain foods naturally low in fat and high in starch and fiber.

Choose foods that are low in total fat: Since many foods high in total fat are also high in saturated fat, eating foods low in total fat will help you eat less saturated fat. When you do eat fat, you should substitute unsaturated fat for saturated fat. Unsaturated fat is usually liquid at room temperature and can be either monounsaturated or polyunsaturated. Examples of foods high in monounsaturated fat are olive and canola oils, those high in polyunsaturated fat include safflower, sunflower, corn, and soybean oils. Any type of fat is a rich source of calories, so eating foods low in fat will also help you eat fewer calories. Eating fewer calories can help you lose weight -- and, if you are overweight, losing weight is an important part of lowering your blood cholesterol.

Choose foods high in starch and fiber: Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods -- breads, cereals, pasta, grains, fruits, and vegetables -- are low in saturated fat and cholesterol. They are also usually lower in calories than foods that are high in fat. Foods high in starch and fiber are also good sources of vitamins and minerals.

Diets low in saturated fat and cholesterol, and high in fruits, vegetables, and grain products -- like oat and barley bran and dry peas and beans -- may help to lower blood cholesterol.

Choose foods low in cholesterol: Dietary cholesterol also can raise your blood cholesterol level, although usually not as much as saturated fat. So, it is important to choose foods low in dietary cholesterol. Dietary cholesterol is found only in foods that come from animals. Many of these foods also are high in saturated fat. Foods from plant sources do not have cholesterol but can contain saturated fat.

Move it... Be more physically active: Moving it -- being physically active -- helps your blood cholesterol levels; it can raise HDL and may lower LDL. Being more active can also help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress.

Lose weight, if you are overweight: People who are overweight tend to have higher blood cholesterol levels than people of desirable weight. And overweight people with an "apple" shape -- bigger (pot) belly -- tend to have a higher risk for heart disease than those with a "pear" shape -- bigger hips and thighs.

Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. An eating pattern high in starch and fiber instead of fat is a good way to lose weight: many starchy foods have little fat and are lower in calories than high fat foods. If you are overweight, losing even a little weight can help to lower LDL-cholesterol and raise HDL-cholesterol. You don't need to reach your desired weight to see a change in your blood cholesterol levels.

To lower your blood cholesterol, remember to:

• Choose foods low in saturated fat and cholesterol;
• Be more physically active; and
• Lose weight, if you are overweight.

A word about sodium

If you have high blood pressure as well as high blood cholesterol (and many people do), your doctor may tell you to cut down on sodium or salt. As long as you are working on getting your blood cholesterol number down, this is a good time to work on your blood pressure, too. Try to limit your sodium intake to 2,400 milligrams a day. We'll give you tips on how to do this later.

What kind of success can you expect?

Generally your blood cholesterol level should begin to drop a few weeks after you start on a cholesterol-lowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your high blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more.

Source: National Institutes of Health; National Heart, Lung, and Blood Institute; National Cholesterol Education Program (NCEP)

What are triglycerides?

Triglycerides are fats carried in the blood from the food we eat. Most of the fats we eat, including butter, margarines and oils, are in triglyceride form. Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.

How are triglycerides different from cholesterol?

Triglycerides and cholesterol are both fatty substances known as lipids. But triglycerides are fats; cholesterol is not. Cholesterol is a waxy, odorless substance made by the liver that is an essential part of cell walls and nerves. Cholesterol also plays an important role in body functions such as digestion and hormone production. In addition to being produced by the body, cholesterol comes from animal foods that we eat.

Pure cholesterol cannot mix with or dissolve in the blood. Therefore, the liver packages cholesterol with triglycerides and proteins in carriers called lipoproteins to transport it to sites throughout the body.

When are triglyceride levels measured?

Triglyceride levels are usually measured whenever you have a blood test called a Lipid Profile. Your health care provider can check your cholesterol and triglyceride levels by taking a sample of blood, which is sent to a lab for testing. The Lipid Profile shows your triglyceride level, total cholesterol level, HDL cholesterol (high-density lipoprotein or "good" cholesterol) and LDL (low-density lipoprotein or "bad" cholesterol) levels.

Following a meal, blood triglyceride levels are normally high. For an accurate reading, blood samples for a triglyceride test should be taken after a 12-hour period of not eating or drinking.

Many other factors affect blood triglyceride levels including alcohol, diet, menstrual cycle, time of day and recent exercise.

What are the guidelines for triglyceride levels?

Guidelines for triglyceride levels in healthy adults are:

Is a high triglyceride level a health problem?

It is controversial is whether high triglyceride levels alone increase the risk of heart disease. But many people with high triglycerides also have high LDL and low HDL levels, which are known heart attack risk factors.

Other health problems related to high triglycerides include diabetes, hypothyroidism, high blood pressure, pancreatitis, obesity and chronic kidney, liver and circulatory disease.

How can triglycerides be lowered?

If you have high triglycerides, you may be able to reduce them without medication by following a low-fat, low cholesterol diet and reducing sugar, fat and alcohol intake.

Dietary modifications

To reduce fat and cholesterol in your diet, here are some suggestions:

• Eat fewer high-fat foods.
• Decrease the total amount of fat you eat to 30% or less of your total daily calories. (For a person eating 2000 calories a day, this would be 65 grams of fat or less allowed per day
• Substitute unsaturated fat for saturated fat. Unsaturated fat comes from plants and is liquid at room temperature. Saturated fat is solid at room temperature and its sources include animal fats and some tropical oils (including palm and coconut oil).
• Reduce saturated fat by eating smaller amounts of low fat dairy products, lean meats, fish or poultry.
• Limit cholesterol to 300 milligrams (mg) or less per day.

Here are some suggestions to reduce sugar and alcohol in your diet:

• Eat fewer calories if you are overweight.
• Exercise to use up excess calories and maintain or achieve a healthy body weight.
• Eat less sugar and fewer sugar-containing foods such as desserts, candy, sweetened carbonated beverages, lemonade, fruit drinks or large amounts of juices. Instead, substitute artificially sweetened beverages that are labeled sugar-free, or other non-alcoholic drinks.
• Follow your doctor's advice on alcohol. (Alcohol increases triglyceride levels for some individuals). Generally, we recommend decreasing alcohol intake. If you are including red wine as part of a heart-healthy regimen to lower your risk of heart disease and you have high triglycerides, you may need to decrease the amount of wine to 5 ounces per day or eliminate it entirely.

Medications

People who have high triglycerides and low HDL or high LDL levels may require medications as well as diet modifications. Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause an acute inflammation of the pancreas.

Is it possible to combine a triglyceride lowering diet with a heart-healthy style of eating?

Absolutely! Modifying a heart-healthy eating style to reduce alcohol and sugar intake is simple, and it's also smart. Like a heart-healthy diet, a reduced alcohol, reduced-sugar diet, coupled with physical activity and a healthy body weight, are good goals for everyone.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/28/2002