Cholesterol and High Cholesterol

In general, high LDL levels and low HDL levels are associated with a high risk for CVD; low levels of LDL and high levels of HDL are associated with lower risk. HDL is important because a high HDL level seems to offer protection from CVD even in cases where total cholesterol is high. This seems to be especially true for women.

LDL levels below 100 mg/dl (milligrams per deciliter) and total cholesterol levels below 200 mg/dl are desirable. The CVD risk associated with elevated cholesterol levels also depends on other factors. For example, a high LDL level would be of more concern for an individual who also smokes and has high blood pressure than for an individual without these additional risk factors, and it is especially a concern for diabetics.

Cholesterol levels:

Total cholesterol (mg/dl)

1. Less than 200 is Desirable
2. 200-239 is Borderline high
3. 240 or more is High

LDL cholesterol (mg/dl)*

1. Less than 100 is Oprimal
2. 100-129 is Near optimal/above optim
3. 130-159 is Borderline high
4. 160-189 is High
5. 190 or more is Very high

HDL cholesterol (mg/dl)

1. Less than 40 is Low (undesirable)
2. 60 or more is High (desirable)

Triglycerides (mg/dl)

1. Less than 150 is Normal
2. 150-199 is Borderline high
3. 200-499 is High
4. 500 or more is Very high
   

Goals for lowering blood cholesterol

Your primary goal should be to reduce LDL to healthy levels. Important dietary changes for reducing LDL levels include substituting unsaturated for saturated and trans fats and increasing fiber intake. Decreasing your intake of saturated and trans fats is particularly important because they promote the production and excretion of cholesterol by the liver. Exercising regularly and eating more fruits, vegetables, and whole grains also help. You can raise your HDL levels by exercising regularly losing weight if you are overweight, quitting smoking, and altering the amount and type of fat you consume.

Drug therapy for lowering cholesterol

Lowering high LDL-cholesterol with drug therapy should be carefully discussed with your physician. Generally, only after at least six months of dietary intervention are cholesterol-lowering drugs to be introduced for treatment but this guideline may not apply if a person has a significant family history for high cholesterol and has already been following careful dietary practices such as a low—fat and low—cholesterol diet.

Cholesterol lowering drugs are generally classified into four major groups:

1.      Bile acid sequestrants (e.g., cholestyramine and colestipol): These medications have a “strong safety and efficacy record.”

2.      Nicotinic acid: Effective in lowering total cholesterol and triglyceride levels and raising HDL cholesterol levels. This drug can cause flushing and itching of the skin in some people.

3.      Statins (e.g., lovostatin, pravastatin, and simvastatin): Highly effective in lowering LDL cholesterol.

4.      Fibric acids (e.g., gemfibrozil): Effective in lowering high triglycerides. In some patients they modestly lower LDL cholesterol and raise HDL cholesterol.

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