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Cholesterol - Highlights

Description

An in-depth report on the diagnosis, treatment, and prevention of unhealthy cholesterol levels.

Alternative Names

Hypercholesterolemia; LDL; HDL; Triglycerides

Highlights:

Total Cholesterol Goals

A blood test is used to measure cholesterol levels. A person� ' s total cholesterol count includes measurements of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Standard total cholesterol goals for adults are:

Less than 200 mg/dL is desirable
Between 200 - 239 mg/dL is considered borderline
Over 240 mg/dL is considered high

Lifestyle Changes

The first step to improving cholesterol levels is through lifestyle changes (especially diet and exercise). Even when drug therapy is required, lifestyle changes are also necessary. These include:

Eat a heart-healthy diet with plenty of fiber-rich fruits and vegetables. Avoid saturated fats (found mostly in animal products) and trans-fatty acids (found in fast foods and commercially baked products). Instead, choose unsaturated fats (particularly omega-3 fatty acids found in fish oils and canola).
Exercise regularly. Studies have shown that regular aerobic exercise can help boost HDL (“good” cholesterol) levels.
Quit smoking.
No dietary supplements have been shown to improve cholesterol levels, and some can cause health risks. In 2007, the FDA issued a warning about red yeast rice products, many of which contain unauthorized use of prescription drugs.

Drug Therapy

A person� ' s LDL (“bad” cholesterol) level generally determines if drug therapy is required. Most cholesterol drugs are used to help lower LDL levels. Some drugs are also used to help raise HDL levels. Drugs used in cholesterol treatment include:

Statins
Nicotinic acid (niacin)
Bile-acid binding resins
Fibrates
Ezetimbe

Cholesterol Screening and Treatment for Children

In 2008, the American Academy of Pediatrics (AAP) recommended expanded screening and treatment of high cholesterol in children.

The AAP now recommends cholesterol screening for children with risk factors beginning as early as age 2 and no later than age 10.
The AAP also recommends statin drug treatment for children as young as age 8 who have high LDL levels.
The issue of prescribing statin drugs to children is being hotly debated. Lifestyle modifications (diet, exercise) are still the recommended first treatment approach for children.

Resources

www.nhlbi.nih.gov/about/ncep -- National Cholesterol Education Program
www.nhlbi.nih.gov -- National Heart, Lung, and Blood Institute
www.acc.org -- American College of Cardiology
www.americanheart.org -- American Heart Association
www.eatright.org -- American Dietetic Association

References

AHA; ACC; National Heart, Lung, and Blood Institute, Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006 May 16;47(10):2130-9.

Armitage J. The safety of statins in clinical practice. Lancet. 2007 Nov 24;370(9601):1781-90.

Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007 Sep 27;357(13):1301-10.

Briel M, Ferreira-Gonzalez I, You JJ, Karanicolas PJ, Akl EA, Wu P, et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis. BMJ. 2009 Feb 16;338:b92. doi: 10.1136/bmj.b92.

Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: The METEOR Trial. JAMA. 2007 Mar 25; [Epub ahead of print]

Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008 Jul;122(1):198-208.

Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe S. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Engl J Med. 2007 Oct 11;357(15):1477-86.

Gaziano M, Manson JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, Braunwald E, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Saunders; 2007;chap 45.

Hlatky MA. Expanding the orbit of primary prevention--moving beyond JUPITER. N Engl J Med. 2008 Nov 20;359(21):2280-2. Epub 2008 Nov 9.

Jolliffe CJ, Janssen I. Distribution of lipoproteins by age and gender in adolescents. Circulation. 2006 Sep 5;114(10):1056-62. Epub 2006 Aug 28.

Kodama S, Tanaka S, Saito K, Shu M, Sone Y, Onitake F, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007 May 28;167(10):999-1008.

McCrindle BW, Urbina EM, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP, et al. Drug therapy of high-risk lipid abnormalities in children and adolescents. A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing. Circulation. 2007 Mar 21; [Epub ahead of print]

Park MK. Dyslipidemia and Other Cardiovascular Risk Factors. In: Pediatric Cardiology for Practitioners, 5th ed. Mosby; 2008:chap 33.

Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195-207. Epub 2008 Nov 9.

Thavendiranathan P, Bagai A, Brookhart MA, Choudhry NK. Primary prevention of cardiovascular diseases with statin therapy: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Nov 27;166(21):2307-13.

US Preventive Services Task Force. Screening for lipid disorders in children: US Preventive Services Task Force recommendation statement. Pediatrics. 2007 Jul;120(1):e215-9.

Reviewed last on: 5/5/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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