Cholesterol is a fat-like substance produced by your liver. It plays a vital role in the development of vitamin D, cell membranes, and certain hormones.

It travels from the liver through the blood to reach your body parts where it is required. The excess cholesterol from a body part is carried back to the liver, where it is metabolized and removed from your body.

However, cholesterol is fat-soluble and cannot dissolve in water. It thus travels in blood with the help of particles called lipoproteins.

There are two main types of lipoproteins in your body:

  • Low-density lipoprotein (LDL): They carry cholesterol from the liver to your body cells. As it promotes cholesterol build-up in your blood vessels, cholesterol bound to LDL is known as LDL-cholesterol (LDL-C) or bad cholesterol.
  • High-density lipoprotein (HDL): This lipoprotein promotes the removal of excess cholesterol by carrying it from your cells to the liver, where it is metabolized. Cholesterol bound to this lipoprotein is known as HDL-cholesterol (HDL-C) or good cholesterol. 

A balance between LDL-C and HDL-C is essential for the functioning of cells. However, if the LDL-C builds up in your vessel wall, it may narrow and stiffen your blood vessels, resulting in a condition known as atherosclerosis.

So, high LDL cholesterol can eventually damage your blood vessels, resulting in heart diseases and stroke.

What does High Cholesterol do to Our Body?

As mentioned above, high LDL-C levels and low HDL-C levels can damage the blood vessels over time, increasing the risk of complications. 

Here is how high cholesterol levels can affect your health:

  • Excess LDL-C can build up on the wall of your blood vessels, narrowing and hardening them. So, blood cannot flow easily through them. Your heart is responsible for pumping blood to other body parts. If blood vessels are not flexible or are narrow, your heart has to pump harder to pass blood through them. Gradually, the heart gets broader or weaker, resulting in heart diseases. Narrowed blood vessels also reduce the oxygen and nutrient supply to your heart, resulting in chest pain or angina. This is a warning that indicates compromised functioning of your heart, and you are at risk of getting a heart attack.
  • If this narrowing and stiffening affect the blood vessel of the brain, it can result in a stroke. It can also affect the nerve cells and damage a part of your brain, resulting in memory and other problems.
  • Your endocrinal glands need cholesterol to produce hormones such as estrogen and progesterone. Abnormal cholesterol levels can also influence the formation of these hormones.
  • Cholesterol is also vital for bile acid production, a fluid formed by your liver that helps to break down the food you eat and absorb nutrients from the intestines. However, high cholesterol levels can result in gallstone formation, an excruciating condition.
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Common Warning Signs

High cholesterol level is a silent condition and often does not have any symptoms. It can only be picked up with blood tests. In other cases, it is diagnosed during emergency events such as stroke or heart attack. 

So, it is best to get your cholesterol levels checked regularly. Various factors, including your age, health conditions, and habits, influence how frequently you need these tests.

  • Healthy adults between 20–65 years: Every 5 years
  • Females between 55–65 years: Every 1-2 years
  • Males between 45–65 years: Every 1-2 years
  • Children between 9–11 years with a family history of high cholesterol levels: Every 5 years
  • Adults above 65 years: Every year

Your doctor may advise you to get tested more frequently if you smoke or have health conditions such as diabetes and hypertension

Diagnosis

Your doctor will advise a type of blood test known as lipid profile or lipid panel to measure cholesterol levels.

You may have to fast for 12-14 hours before you give blood for testing cholesterol levels.

Here are the normal and abnormal cholesterol levels of adults and children.

Adults

Total cholesterol levels:

  • Normal: Less than 200 mg/dL
  • Borderline high: Total cholesterol level between 200 and 239 mg/dL
  • High: Total cholesterol level of 240 mg/dL and above

LDL cholesterol levels:

  • Normal: Less than 100 mg/dL
  • Borderline high: 130—159 mg/dL
  • High: 190 mg/dL or higher

HDL cholesterol levels:

  • Normal: 60 mg/dL or higher
  • Borderline low: 41— 59 mg/dL
  • Low: Less than 40 mg/dL

Children

Total cholesterol levels:

  • Normal: Less than 170 mg/dL
  • Borderline high: Total cholesterol level between 170 and 199 mg/dL
  • High: Total cholesterol level of 200 mg/dL and above
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LDL cholesterol levels:

  • Normal: Less than 110 mg/dL
  • Borderline high: 110—129 mg/dL
  • High: 130 mg/dL or higher

HDL cholesterol levels:

  • Normal: 45 mg/dL or higher
  • Borderline low: 40— 45 mg/dL
  • Low: Less than 40 mg/dL

Treatment and Medication

Lifestyle changes and precautions are the first line of treatment for high cholesterol. However, if these changes cannot control your LDL-C levels, your doctor may prescribe medicines to manage the condition.

Various factors, such as age, presence of risk factors, and side effects it can have, will help your doctor decide the suitable medicine for you.

Some commonly used class of drugs for high cholesterol levels are:

Statins

They are the most common choice of drug for managing high cholesterol levels. They block the chemical required by your liver to make cholesterol. As a result, your body uses the excess cholesterol present in plaques, reversing coronary artery disease. 

Some options include:

  • Atorvastatin
  • Fluvastatin
  • Pravastatin
  • Pitavastatin
  • Simvastatin
  • Rosuvastatin

Cholesterol Absorption Inhibitors

As learned before, your intestines absorb cholesterol and pass it into your blood. These medicines work by limiting the absorption of dietary cholesterol. A common example includes Ezetimibe. It is usually prescribed with a statin. 

Bile-Acid-Binding Resins

Your liver requires cholesterol to produce bile acid. These medicines lower cholesterol levels by binding to bile acids. So, your liver has to use the excess cholesterol to make bile acids, reducing its level in the blood. Some common examples include Colesevelam, Cholestyramine, and Colestipol.

PCSK9 Inhibitors

These injectable and newer drugs prompt your liver to absorb more LDL-C, lowering its level in the blood. They are commonly used in people with a history of coronary disease, are intolerant to statins or other cholesterol medications, or people with a genetic condition that causes very high LDL-C levels.

Side Effects of Medications

Tolerance to these medicines differs for everyone. Some common side-effects of statins are reversible confusion and memory loss, muscle damage and pain, and high blood sugar levels.

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Your doctor may advise liver function tests to monitor the effectiveness of these medicines on your liver.

Precautions and Lifestyle Changes

Some lifestyle modifications and precautions that can help manage pr prevent high cholesterol levels are:

Heart-Healthy Diet

What you eat affects your cholesterol levels. So, this is the best way to lower high cholesterol levels.

It is best to limit the intake of trans and saturated fats. The intake of saturated fat should be less than 6% of daily calories, according to the American Heart Association. 

Foods high in these unhealthy fats are:

  • Organ meats and red meats
  • Processed foods rich in palm oil, cocoa butter, or coconut oil
  • High-fat dairy products such as milk, full-fat cheese, butter, and ice-cream
  • Deep-fried foods such as onion rings, potato chips, and fried chicken
  • Baked food items such as muffins and cookies
  • Egg yolks

Healthy foods that you can consume:

  • Fatty fish such as mackerel, salmon, and herring
  • Nuts such as walnuts and almonds
  • Seeds such as flax seeds
  • Avocados
  • High-fiber foods such as vegetables, fruits, and whole grains

Generally, opt for broiled, roasted, baked, or grilled food instead of fried and junk foods.

Being Physically Active

A sedentary lifestyle is a risk factor for high LDL-C and low HDL-C levels. Physical activity has the exact opposite effect. 

Try and get 30 minutes of moderate-intensity exercises a day for at least five days or 150 minutes a week.

Some examples of exercise include swimming, running, walking, and jogging. 

You can also include strength training with exercise bands, weights, or body-weight resistance for two days a week.

Quitting smoking

Vaping and smoking lower your HDL-C levels. Besides, if you have abnormal cholesterol levels and still decide to smoke, it further increases the risk of coronary heart diseases. 

Smoking also increases the risk of other conditions that increase your risk for heart diseases, such as diabetes and hypertension.

By quitting, you can boost your HDL-C levels and lower the LDL-C levels.

Nonsmokers should try and avoid passive smoking whenever possible.

Losing weight

Being overweight or obese tends to increase LDL-C levels and lower HDL-C levels.

But the good news is that losing weight by 5%-10% can improve your cholesterol numbers.

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