Hyperlipidemia (High Cholesterol)

High cholesterol is a major risk factor in the development of heart disease and peripheral vascular disease caused by plaque build-up in your blood vessels and arteries.

Cholesterol can enter into the wall of your blood vessels where it contributes to forming atherosclerotic plaques. When these plaques get large enough, they can prevent blood from reaching your heart muscle. If the plaque ruptures and a clot forms on it, no blood can get downstream to the heart muscle, causing a myocardial infarction (heart attack). Plaque also can reduce blood flow to your extremities (legs and arms), causing peripheral arterial disease (PAD). If plaque builds in the carotid arteries, located in the neck (carotid artery disease), it can restrict or block blood flow to the brain and is a risk factor for stroke.

Cholesterol in your blood comes from the foods you eat as well as your liver. Your liver makes most of the cholesterol your body needs. When your blood contains too much bad cholesterol your risk for atherosclerotic heart disease is increased significantly. 

Cholesterol terminology to know

• LDL (low-density lipoprotein) – the “bad” cholesterol. LDL leads to the build-up of plaque (hardened cholesterol) in the arteries. This condition is also called atherosclerosis. You want LDL to be a lower number. Your future risk of developing cardiovascular disease determines how low your LDL-cholesterol (LDL-C) should be.
• HDL (high-density lipoprotein) – the “good” cholesterol. HDL-cholesterol (HDL-C) helps move excess cholesterol from the blood to the liver. Having a higher HDL number is better. If it is less than 40 mg/dL for a man and 45 mg/dl for a woman you are at increased risk for heart disease.
• Triglycerides – are a type of fat which is produced in the liver. Triglycerides also can come from food. Excess triglycerides are stored in fat cells. Having high triglycerides greater than 150 mg/dL puts you at risk for heart disease.
• Total cholesterol – is a measurement of both LDL and HDL cholesterol. Total cholesterol should be less than 200 mg/dL.
• Non-HDL cholesterol – is a measurement of all the lipid particles in your blood that can cause plaque buildup. It is calculated by taking the total cholesterol and subtracting from it HDL-C. Non-HDL cholesterol goal is 30 mg/dl higher than the LDL-C goal.

Risk factors for high cholesterol

Some risk factors for high cholesterol are lifestyle-related, while others are not.

 Some lifestyle choices that contribute to high cholesterol:

• Eating too much fatty food – particularly foods with saturated fat. Saturated fat is found in fried foods, baked goods, some meats (fatty beef, pork, poultry with skin), dairy products including butter, whole and 2 percent milk, ice cream and cheese. Oils, including palm oil, palm kernel oil and coconut oil, also contain saturated fat.
• Not being physically active – Lack of physical activity lowers good cholesterol (HDL).
• Smoking – In addition to contributing to other serious conditions (lung disease, cancer), smoking lowers good cholesterol (HDL) and increases bad cholesterol (LDL).

Other factors that contribute to high cholesterol:

• Age – It’s important to know that as you age, (both men and women), your blood cholesterol levels will increase. After menopause, LDL (bad cholesterol) often increases in women.
• Family history – You may have inherited risk factors, including inherited cholesterol disorders and family history of heart disease.
• Weight – Being overweight contributes to higher cholesterol levels.

Recent research also has confirmed that some ethnicities (race, country of origin) may contribute to your risk for developing high cholesterol.

Diagnosing high cholesterol

Blood cholesterol is monitored through a simple blood test. Your primary care physician will recommend regular monitoring of cholesterol levels, starting at age 20.  Children who have a family history of high cholesterol (familial hypercholesterolemia, a genetic disorder) should be screened as recommended by their pediatrician. The American Academy of Pediatrics recommends that all children have a cholesterol screening between the ages of 9 and 11.

Treating high cholesterol

Your primary care provider will be the main person who helps you manage high cholesterol.

Treatment will include a combination of prescribed lifestyle changes and possibly medication to help reduce LDL and overall cholesterol.

Lifestyle changes to improve cholesterol levels

There are several things you can do to prevent high cholesterol or lower high cholesterol levels, including:

• Choose healthy foods – Focus on healthy choices for meals and snacks, especially foods that are rich in fiber like fresh fruit, non-starchy vegetables and whole-grains. Choose lean proteins, like chicken breast (no skin), and unsaturated fats, such as olive oil or corn oil.
• Add activity – Start where you are and gradually build your types of activities and endurance. If you don’t stand much during the day, start to stand more frequently. If you take walks, increase the distance or speed that you walk. Set goals to progressively increase your activity levels. A minimum goal should be 150 minutes of aerobic exercise per week.
• Lose weight – For many people, losing weight will help them improve cholesterol levels. You and your doctor can talk about what will help you lose weight (including healthier diet and adding activity), or how to help you if those lifestyle changes are not helping you lose weight.
• Stop smoking – By quitting tobacco use, you will help reduce your risk for many diseases. Learn more about the ways Lehigh Valley Health Network’s Tobacco Treatment Program can help you quit smoking.

Medications for high cholesterol include:

• Statins – block an enzyme in the liver that produces cholesterol
• Bile acid resins (sequestrants) – reduce LDL by binding to bile acids in the intestines (which contain cholesterol), and are then removed from the body in feces.
• Nicotinic acid (niacin) – reduces LDL and triglycerides, and increases HDL
• Fibrates – reduce triglycerides in the blood
• Cholesterol absorption inhibitors – reduce absorption of cholesterol by the small intestine
• PCSK9 inhibitors – an injectable monoclonal antibody that blocks an enzyme in the liver (PCSK9) which decreases LDL receptor levels. By blocking the enzyme that destroys LDL receptors, there are more LDL receptors available to remove cholesterol by the liver, allowing LDL levels in the blood to decrease.

Partnering with you to lower your cholesterol

You and your health care provider will work on a plan to lower your cholesterol levels.

If you have difficulty lowering your blood cholesterol after treatment, you may wish to consult with the Advanced Lipid Management and Cardiac Prevention Program at Lehigh Valley Heart and Vascular Institute.