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Cholesterol |
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AHA Scientific Position
Cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream and in all your body's cells. It's an important part of a healthy body because it's used to form cell membranes, some hormones and is needed for other functions. But a high level of cholesterol in the blood ¡ª hypercholesterolemia ¡ª is a major risk factor for coronary heart disease, which leads to heart attack.
Cholesterol and other fats can't dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are several kinds, but the ones to focus on are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
What is LDL cholesterol?
Low-density lipoprotein is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis. A clot (thrombus) that forms near this plaque can block the blood flow to part of the heart muscle and cause a heart attack. If a clot blocks the blood flow to part of the brain, a stroke results. A high level of LDL cholesterol (160 mg/dL and above) reflects an increased risk of heart disease. If you have heart disease, your LDL cholesterol should be less than 100 mg/dL. That's why LDL cholesterol is called "bad" cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease.
What is HDL cholesterol?
About one-third to one-fourth of blood cholesterol is carried by HDL. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe HDL removes excess cholesterol from plaques and thus slows their growth. HDL cholesterol is known as "good" cholesterol because a high HDL level seems to protect against heart attack. The opposite is also true: a low HDL level (less than 40 mg/dL) indicates a greater risk. A low HDL cholesterol level also may raise stroke risk.
What is Lp(a) cholesterol?
Lp(a) is a genetic variation of plasma LDL. A high level of Lp(a) is an important risk factor for developing atherosclerosis prematurely. How an increased Lp(a) contributes to heart disease isn't clear. The lesions in artery walls contain substances that may interact with Lp(a), leading to the buildup of fatty deposits.
What about cholesterol and diet?
People get cholesterol in two ways. The body ¡ª mainly the liver ¡ª produces varying amounts, usually about 1,000 milligrams a day. Foods also can contain cholesterol. Foods from animals (especially egg yolks, meat, poultry, fish, seafood and whole-milk dairy products) contain it. Foods from plants (fruits, vegetables, grains, nuts and seeds) don't contain cholesterol.
Typically the body makes all the cholesterol it needs, so people don't need to consume it. Saturated fatty acids are the main culprit in raising blood cholesterol, which increases your risk of heart disease. Trans fats also raise blood cholesterol. But dietary cholesterol also plays a part. The average American man consumes about 337 milligrams of cholesterol a day; the average woman, 217 milligrams.
Some of the excess dietary cholesterol is removed from the body through the liver. Still, the American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit your daily intake to less than 200 milligrams. Still, everyone should remember that by keeping their dietary intake of saturated fats low, they can significantly lower their dietary cholesterol intake. Foods high in saturated fat generally contain substantial amounts of dietary cholesterol.
People with severe high blood cholesterol levels may need an even greater reduction. Since cholesterol is in all foods from animal sources, care must be taken to eat no more than six ounces of lean meat, fish and poultry per day and to use fat-free and low-fat dairy products. High-quality proteins from vegetable sources such as beans are good substitutes for animal sources of protein.
How does physical activity affect cholesterol?
Regular physical activity increases HDL cholesterol in some people. A higher HDL cholesterol is linked with a lower risk of heart disease. Physical activity can also help control weight, diabetes and high blood pressure. Aerobic physical activity raises your heart and breathing rates. Regular moderate to intense physical activity such as brisk walking, jogging and swimming also condition your heart and lungs.
Physical inactivity is a major risk factor for heart disease. Even moderate-intensity activities, if done daily, help reduce your risk. Examples are walking for pleasure, gardening, yard work, housework, dancing and prescribed home exercise.
How does tobacco smoke affect cholesterol?
Tobacco smoke is one of the six major risk factors of heart disease that you can change or treat. Smoking lowers HDL cholesterol levels and increases the tendency for blood to clot.
How does alcohol affect cholesterol?
In some studies, moderate use of alcohol is linked with higher HDL cholesterol levels. However, because of other risks, the benefit isn't great enough to recommend drinking alcohol if you don't do so already.
If you drink, do so in moderation. People who consume moderate amounts of alcohol (an average of one to two drinks per day for men and one drink per day for women) have a lower risk of heart disease than nondrinkers. However, increased consumption of alcohol brings other health dangers, such as alcoholism, high blood pressure, obesity, stroke, cancer, suicide, etc. Given these and other risks, the American Heart Association cautions people against increasing their alcohol intake or starting to drink if they don't already do so. Consult your doctor for advice on consuming alcohol in moderatio
Cholesterol can be both good and bad, so it's important to learn what cholesterol is, how it affects your health and how to manage your blood cholesterol levels.
Understanding the facts about cholesterol will help you take better care of your heart and live a healthier life, reducing your risk for heart attack and stroke.
To control your cholesterol, get a cholesterol screening, eat foods low in saturated fat and cholesterol, maintain a healthy weight, exercise regularly and follow all your healthcare professional's recommendations.
Side effects of cholesterol-lowering drugs
In a report published in the online issue of Circulation: Journal of the American Heart Association, (May 24, 2005), researchers said the cholesterol-lowering drug rosuvastatin (Crestor) was more likely to be associated with muscle damage (myopathy) compared to atorvastatin (Lipitor), simvastatin (Zorcor) and pravastatin (Pravachol). Adverse events were rare and occurred in the first weeks of therapy. The side effects generally go away when the patient stops taking the drug.
Researchers analyzed post-marketing data from the U.S. Food and Drug Administration (FDA) on cholesterol-lowering drugs known as statins. They measured the data by recording rates of adverse event reports (AERS) per million prescriptions. Data from the first year of rosuvastatin¡¯s marketing were compared with concurrent data from atorvastatin, simvastatin and pravastatin.
¡°Statins are among our best drugs for treating individuals who have elevated cholesterol,¡± said Alice K. Jacobs, M.D., president of the American Heart Association. ¡°The study should reassure the public that the drugs are safe. Overwhelmingly, the majority of individuals tolerate statins very well, and the absolute risk of side effects is low, including for rosuvastatin.¡±
For patients, the American Heart Association recommends:
Statins are one of the most effective drugs to reduce elevated low-density lipoprotein (LDL) or ¡°bad¡± cholesterol, which is associated with increased risk of cardiovascular disease.
The absolute risk of side effects from statins is low.
No medication should be discontinued without consulting a physician. Be aware of potential side effects and risks that can develop while taking the drug or after stopping the drug, and discuss them with a physician.
Report side effects to your doctor when they occur; do not wait for the next visit.
Higher doses of statins may be associated with a greater risk of side effects. Side effects tend to be dose-related and may disappear after reducing the dosage or, if necessary, withdrawing the medication.
Patients who are currently taking rosuvastatin or any other statin should continue to take their medication as prescribed and consult with their physician if you have any question about dosage or risk of side effects.
The only time patients should stop taking their statins is if they experience muscle pain or dark urine, and they should notify their physician immediately.
For physicians and other health care providers, the American Heart Association recommends:
The dose of statins should not exceed the level required to achieve current goals of therapy.
Be knowledgeable of the factors that may increase the risk of myopathy (muscle weakness).
Consider using combinations of cholesterol-lowering drugs at lower doses for patients at increased risk for myopathy.
Report adverse events to the FDA, to optimize the post-marketing surveillance system.
Select statins based on the degree of LDL-lowering required to achieve the patient¡¯s recommended goal, the potential for side effects, and the patient¡¯s preferences (e.g., compliance, costs, etc.)
The risks of specific statins should be weighed for each patient. In general, physicians should prescribe the lowest dose of statin to bring a patient¡¯s cholesterol to target levels.
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