Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Cholesterol levels facts
- What is cholesterol?
- What are LDL and HDL cholesterol?
- What determines the level of LDL cholesterol in the blood?
- Does lowering LDL cholesterol prevent heart attacks and strokes?
- How can LDL cholesterol levels be lowered?
- What are "normal" cholesterol blood levels?
- What are the 2013 ACC/AHA Guidelines?
- Why is HDL the good cholesterol?
- What are LDL/HDL and total/HDL ratios?
- How can levels of HDL cholesterol be increased?
- What are triglycerides and VLDL?
- Do high triglyceride levels cause atherosclerosis?
- What causes elevated triglyceride levels?
- How can elevated blood triglyceride levels be treated?
- What medications are available to lower cholesterol, lipids, and triglycerides?
- Is lowering LDL cholesterol enough?
How can LDL cholesterol levels be lowered?
Therapeutic lifestyle changes to lower cholesterol
Therapeutic lifestyle changes to lower LDL cholesterol involve losing excess weight, exercising regularly, and following a diet that is low in saturated fat and cholesterol.
Medications to lower cholesterol
Medications are prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most effective and widely used medications to lower LDL cholesterol are called statins. Research has shown that only these statin drugs have a proven benefit to decrease the risk of heart attack and stroke. Other medications that have been prescribed to lower cholesterol profiles include fibrates such as gemfibrozil (Lopid), resins such as cholestyramine (Questran), and ezetimibe (Zetia).
What are "normal" cholesterol blood levels?
There are no established "normal" blood levels for total and LDL cholesterol. In most other blood tests in medicine, normal ranges can be set by taking measurements from large number of healthy subjects. The normal range of LDL cholesterol among "healthy" adults (adults with no known coronary heart disease) in the United States may be too high. The atherosclerosis process may be quietly progressing in many healthy children and adults with average LDL cholesterol blood levels, putting them at risk of developing coronary heart disease in the future.
What are the 2013 ACC/AHA Guidelines?
The American College of Cardiology and American Heart Association and have developed guidelines to help health care professionals counsel their patients on how to decrease the risk of suffering a heart attack or stroke. Since it takes years for cholesterol plaque to narrow arteries enough to cause blood flow problems, there is opportunity to intervene early to stop the progression of this narrowing.
In addition to controlling cholesterol, there needs to be lifelong attention to controlling high blood pressure and diabetes. The new guidelines stress the role of weight control, diet, and exercise. Additionally, smoking cessation is mandatory.
The previous goal of maintaining “normal” cholesterol levels has been replaced by an approach that suggests more patients may benefit from cholesterol-lowering statin medications, and not just those with high cholesterol levels. These four groups include:
- Patients with known cardiovascular disease
- Patients with type 2 diabetes, especially those older than 40 years of age
- Patients with LDL cholesterol levels (the “bad” cholesterol) higher than 190 mg/dL
- Patients with a 10-year risk of developing heart disease that is greater than 7.5%. An online calculator from the American Heart Association may be used to help predict this risk
The goal for statin therapy is to decrease the LDL blood levels in high risk patients by 50%. For those who have medium risk, the goal is a cholesterol reduction of 30% to 50%.
Tips to keep it under control.