Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2003;67(8):1775-1776

What is cholesterol?

Cholesterol is a substance that is in all of us. Our bodies make cholesterol. It is also in meat and dairy foods. Plant foods do not have cholesterol. Most of the cholesterol in your body is made by your liver from saturated fat in the food you eat.

Why is a high cholesterol level unhealthy?

While some cholesterol is needed for good health, too much cholesterol in your blood can raise your risk of having a heart attack or stroke.

The extra cholesterol in your blood may be stored in your arteries (blood vessels) and cause them to narrow. This is called atherosclerosis. Large deposits of cholesterol can completely block an artery, so the blood cannot flow through.

If an artery that supplies blood to your heart becomes blocked, you can have a heart attack. If an artery that supplies blood to your brain becomes blocked, you can have a stroke.

When should I start having my cholesterol level checked?

Men 35 years and older and women 45 years and older should have their cholesterol levels checked periodically. Depending on what your cholesterol level is the first time and what other risk factors for heart disease you have (see the box below), you may need to have it checked often.

Risk Factors for Heart Disease

  • Already having had one heart attack

  • Being a man 45 years or older

  • Having a father or brother who had heart disease before 55 years of age

  • Being a woman 55 years or older, or being a woman younger than 40 years going through menopause

  • Having a mother or sister who had heart disease before 65 years of age

  • Smoking cigarettes

  • Having high blood pressure or diabetes

  • Being very overweight

  • Being inactive

Are there different kinds of cholesterol?

Cholesterol travels through the blood in different packages, called lipoproteins. Low-density lipoproteins (LDL) deliver cholesterol to the body. High-density lipoproteins (HDL) take cholesterol out of the bloodstream.

This explains why too much LDL cholesterol is bad for the body, while HDL cholesterol is good for you. The balance between these kinds of cholesterol tells you what your cholesterol level means (see the box below).

For example, if your cholesterol level is high because you have a high LDL level, you may have a higher risk of heart disease or stroke. If your total level is high only because of a high HDL level, you probably do not have a higher risk.

What can I do to improve my cholesterol level?

You can do a number of things to improve your cholesterol level. Eating healthy foods can help lower your LDL cholesterol level. You can lower your health risk by quitting smoking if you smoke, losing weight if you are overweight and exercising regularly.

Total Cholesterol Levels

  • Less than 200 is best.

  • Between 200 to 239 is borderline high.

  • 240 or more means you have a higher risk for heart disease.

LDL Cholesterol Levels

  • Less than 130 is best.

  • Between 130 to 159 is borderline high.

  • 160 or more means you have a higher risk for heart disease.

HDL Cholesterol Levels

  • Less than 40 means you have a higher risk for heart disease.

  • 60 or higher means you have less risk of heart disease. Between 200 to 239 is borderline high.

What sort of foods are healthy choices?

Lowering your cholesterol level by eating healthy, low-fat foods is easier than you might think. You do not have to give up your favorite foods. Just eat them less often. And try to substitute healthier choices some of the time.

What about medicine to lower cholesterol?

Depending on your risk factors, if healthy eating and exercise do not get your cholesterol levels low enough after about 6 to 12 months, your doctor may suggest medicine to lower your cholesterol level.

Several kinds of medicines are used to lower high cholesterol levels:

  • Bile acid absorbers, such as Questran

  • Lipoprotein synthesis inhibitors, such as Nicobid

  • Coenzyme A reductase inhibitors, such as Mevacor

  • Fibric acid derivatives, such as Lopid

Your doctor will decide which kind of cholesterol medicine is right for you.

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