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CHOLESTEROL REVIEW | Learn more about Cholesterol

What is cholesterol?

Cholesterol is the most common type of steroid in the body and a critically important molecule. Cholesterol is a fatty substance (a lipid) that is an important part of the outer lining (membrane) of cells in the body of animals. Cholesterol is also found in the blood circulation of humans. Cholesterol is carried in the bloodstream as lipoproteins. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. The cholesterol in a person's blood originates from two major sources; dietary intake and liver production. Dietary cholesterol comes mainly from meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol content, while foods of plant origin contain no cholesterol. After a meal, cholesterol is absorbed by the intestines into the blood circulation and is then packaged inside a protein coat. This cholesterol-protein coat complex is called a chylomicron. The liver is capable of removing cholesterol from the blood circulation as well as manufacturing cholesterol and secreting cholesterol into the blood circulation. After a meal, the liver removes chylomicrons from the blood circulation. In between meals, the liver manufactures and secretes cholesterol back into the blood circulation.

Most Prescribed Medications [Sorted by Popularity]

Statins®, Lipostatin®, Tricor®, Shuddha Guggulu®, Simvastatin®, Zocor®, Zetia®, Niacin®, Niacor®, Niaspan®, Slo-Niacin®, Red yeast rice [Monascus purpureus], Atorvastatin®, Lipitor®, Gemfibrozil®, Lasuna®, Lopid®, Pravastatin®, Pravachol®, Lovastatin®, Mevacor®, Crestor®, Altocor®, Vytorin®

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What are LDL and HDL Cholesterol [Hyperlipidemia]?

LDL cholesterol is called "bad" cholesterol, because elevated levels of LDL cholesterol are associated with an increased risk of coronary heart disease. LDL lipoprotein deposits cholesterol on the artery walls, causing the formation of a hard, thick substance called cholesterol plaque. Over time, cholesterol plaque causes thickening of the artery walls and narrowing of the arteries, a process called atherosclerosis.

HDL cholesterol is called the "good cholesterol" because HDL cholesterol particles prevent atherosclerosis by extracting cholesterol from the artery walls and disposing of them through the liver. Thus, high levels of LDL cholesterol and low levels of HDL cholesterol (high LDL/HDL ratios) are risk factors for atherosclerosis, while low levels of LDL cholesterol and high level of HDL cholesterol (low LDL/HDL ratios) are desirable.

”Good” HDL cholesterol protects the arteries from the atherosclerosis process. HDL cholesterol extracts cholesterol particles from the artery walls and transports them to the liver to be disposed through the bile. It also interferes with the accumulation of LDL cholesterol particles in the artery walls. The risk of atherosclerosis and heart attacks in both men and is bly related to HDL cholesterol levels. Low levels of HDL cholesterol are linked to a higher risk, whereas high HDL cholesterol levels are associated with a lower risk. For individuals with low HDL cholesterol levels, a high total or LDL cholesterol blood level further increases the incidence of atherosclerosis and heart attacks. Therefore, the combination of high levels of total and LDL cholesterol with low levels of HDL cholesterol is undesirable whereas the combination of low levels of total and LDL cholesterol and high levels of HDL cholesterol is favorable.

Very low and very high HDL cholesterol levels can run in families. Families with low HDL cholesterol levels have a higher incidence of heart attacks than the general population, while families with high HDL cholesterol levels tend to live longer with a lower frequency of heart attacks. Like LDL cholesterol, life style factors and other conditions influence HDL cholesterol levels. HDL cholesterol levels are lower in persons who smoke cigarettes, eat a lot of sweets, are overweight and inactive, and in patients with type II diabetes mellitus. HDL cholesterol is higher in people who are lean, exercise regularly, and do not smoke cigarettes. Estrogen increases a person's HDL cholesterol, which explains why women generally have higher HDL levels than men do.

Total cholesterol is the sum of LDL (low density) cholesterol, HDL (high density) cholesterol, VLDL (very low density) cholesterol, and IDL (intermediate density) cholesterol.

Level of LDL cholesterol in the blood

Diets that are high in saturated fats and cholesterol raise the levels of LDL cholesterol in the blood. Fats are classified as saturated or unsaturated (according to their chemical structure). Saturated fats are derived primarily from meat and dairy products and can raise blood cholesterol levels. Some vegetable oils made from coconut, palm, and cocoa are also high in saturated fats.

The liver not only manufactures and secretes LDL cholesterol into the blood; it also removes LDL cholesterol from the blood. A high number of active LDL receptors on the liver surfaces is associated with the rapid removal of LDL cholesterol from the blood and low blood LDL cholesterol levels. A deficiency of LDL receptors is associated with high LDL cholesterol blood levels. Both heredity and diet have a significant influence on a person's LDL, HDL and total cholesterol levels. For example, familial hypercholesterolemia (FH) is a common inherited disorder whose victims have a diminished number or nonexistent LDL receptors on the surface of liver cells. People with this disorder also tend to develop atherosclerosis and heart attacks during early adulthood.

Lowering LDL cholesterol level is currently the primary focus in preventing atherosclerosis and heart attacks. Most doctors now believe that the benefits of lowering LDL cholesterol include: Reducing or stopping the formation of new cholesterol plaques on the artery walls; Reducing existing cholesterol plaques on the artery walls; Widening narrowed arteries; Preventing the rupture of cholesterol plaques, which initiates blood clot formation; Decreasing the risk of heart attacks; and Decreasing the risk of strokes. The same measures that retard atherosclerosis in coronary arteries. Well, how can LDL cholesterol levels be lowered?

Therapeutic lifestyle changes to lower cholesterol - Lowering LDL cholesterol involves losing excess weight, exercising regularly, and following a diet that is low in saturated fat and cholesterol. For more, please read the TLC, Therapeutic Lifestyle Changes article.

Medications to lower cholesterol - Medications are prescribed when lifestyle changes cannot reduce the LDL cholesterol to desired levels. The most effective and widely used medications to lower LDL cholesterol are called statins. Most of the large controlled trials that demonstrated the heart attack and stroke prevention benefits of lowering LDL cholesterol used one of the statins. Other medications used in lowering LDL cholesterol and in altering cholesterol profiles include nicotinic acid (niacin), fibrates such as gemfibrozil (Lopid), resins such as cholestyramine (Questran), and ezetimibe, Zetia. (An in-depth discussion of these drugs is presented in this article starting at the heading: What are the statin drugs?).

Normal cholesterol blood level

In fact, there is no definite normal blood level for LDL cholesterol. In most other blood tests in medicine, normal ranges can be set by taking measurements from large number of healthy subjects. For example, normal fasting blood sugar levels can be established by performing blood tests among healthy subjects without diabetes mellitus. If a patient's fasting blood glucose falls within this normal range, he/she most likely does not have diabetes mellitus, whereas if the patient's fasting blood sugar tests higher than the normal range, he/she probably has diabetes mellitus and further tests can be performed to confirm the diagnosis. Medications, such as insulin or oral diabetes medications can be prescribed to lower abnormally high blood sugar levels. Unfortunately, the normal range of LDL cholesterol among healthy adults (adults with no known coronary heart disease) in the United States may be too high. The atherosclerosis process may be quietly progressing in many healthy adults with average LDL cholesterol blood levels, putting them at risk of developing coronary heart diseases in the future.

What is Low HDL Cholesterol best treatment?

In clinical trials involving lowering LDL cholesterol, scientists also studied the effect of HDL cholesterol on atherosclerosis and heart attack rates. They found that even small increases in HDL cholesterol could reduce the frequency of heart attacks. For each 1 mg/dl increase in HDL cholesterol, there is a 2 to 4% reduction in the risk of coronary heart disease. Although there are no formal NCEP (please see discussion above) target treatment levels of HDL cholesterol, an HDL level of <40 mg/dl is considered undesirable and measures should be taken to increase it.

Raising HDL Cholesterol levels

Regular aerobic exercise, loss of excess weight (fat), and cessation of smoking cigarettes will increase HDL cholesterol levels. Regular alcohol consumption (such as one drink a day) will also raise HDL cholesterol. Because of other adverse health consequences of excessive alcohol consumption, alcohol is not recommended as a standard treatment for low HDL cholesterol. In fact, the very first step in increasing HDL cholesterol levels (and decreasing LDL/HDL ratios) is therapeutic life style changes. When these modifications are insufficient, medications are used. In prescribing medications or medication combinations, doctors have to take into account medication side effects as well as the presence or absence of other abnormalities in cholesterol profiles. Medications that are effective in increasing HDL cholesterol include nicotinic acid (niacin), gemfibrozil (Lopid), estrogen, and to a much lesser extent, the statin drugs (discussed below). A newer medicine, fenofibrate (Tricor) has shown much promise in selectively increasing HDL levels and reducing serum triglycerides.

Food Sources

In foods, cholesterol is found in eggs, dairy products, meat, and poultry. Egg yolks and organ meats (liver, kidney, sweetbread, and brain) are high in cholesterol. Fish generally contains less cholesterol than other meats, but some shellfish are high in cholesterol. Foods of plant origin (vegetables, fruits, grains, cereals, nuts, and seeds) contain no cholesterol. Fat content is not a good measure of cholesterol content. For example, liver and other organ meats are low in fat, but very high in cholesterol.

General Recommendations

More than half of the adult population has blood cholesterol levels higher than the desirable range. High cholesterol levels often begin in childhood. Some children may be at higher risk due to a family history of high cholesterol. In general, you want your total cholesterol to be less than 200 milligrams per deciliter (mg/dl), because that level carries the least risk of heart disease. When the level is above 200 mg/dl, the risk for heart disease increases. You should also know your levels of high density lipoprotein (HDL, also known as the "good cholesterol") and low density lipoprotein (LDL, or "bad cholesterol"). Talk to your health care provider about what your cholesterol levels mean. To lower high cholesterol levels:

• Limit total fat intake to 25 - 35% of total daily calories. Less than 7% of daily calories should be from saturated fat, not more than 10% should be from polyunsaturated fat, and not more than 20% from monounsaturated fat.
• Eat less than 200 mg of dietary cholesterol per day.
• Get more fiber in your diet.
• Lose weight.
• Increase physical activity.

The recommendations for children's diets are similar to those of adults. It is very important that children get enough calories to support their growth and activity level, and that the child achieve and maintain a desirable body weight. The following two sample menus provide examples of an average American diet and a low-fat diet.

DAILY AMERICAN DIET

• Breakfast - 1 egg scrambled in 1 teaspoon of butter; 2 slices of white toast; 1 teaspoon of butter; 1/2 cup of apple juice;
• Snack - 1 cake donut;
• Lunch - 1 ham and cheese sandwich (2 ounces of meat, 1 ounce of cheese); white bread; 1 teaspoon of mayonnaise; 1-ounce bag potato chips; 12-ounce soft drink; 2 chocolate chip cookies;
• Snack - 8 wheat thins;
• Dinner - 3 ounces of broiled sirloin; 1 medium baked potato; 1 tablespoon of sour cream; 1 teaspoon of butter; 1/2 cup of peas, 1/2 teaspoon of butter

Totals: 2,000 Calories, 84 grams fat, 34 grams saturated fat, 425 milligrams cholesterol. The diet is 38% total fat, 15% saturated fat.

LOW FAT DIET

• Breakfast - 1 cup of toasted oat ring cereal; 1 cup of skim milk; 1 slice of whole-wheat bread; 1 banana;
• Snack - 1 cinnamon raisin bagel; 1/2 ounce light cream cheese;
• Lunch - turkey sandwich (3 ounces of turkey); rye bread; lettuce; 1 orange; 3 fig newtons; 1 cup skim milk;
• Snack - non fat yogurt with fruit;
• Dinner - 3 ounces of broiled chicken breast; 1 medium baked potato; 1 tablespoon of nonfat yogurt; 1/2 cup of broccoli; 1 dinner roll; 1 cup skim milk;

Totals: 2,000 Calories, 38g fat, 9.5g saturated fat, 91mg cholesterol. The diet is 17% fat, 4% saturated fat.

COMPARISON

For the same number of calories, a low-fat diet provides 190 mg of cholesterol, compared to 510 mg of cholesterol for an average American diet. Because fat is high in calories, the low-fat diet actually has more food than the typical American diet.

CHILDREN

The low-fat diet example is too low in fat for small children to promote good growth. In addition, it may be difficult for them to consume such a large volume of food. Children should have a diet that is closer to 30% of calories from fat. Lower-fat diets may be appropriate in some children. Ask your doctor what is best for your child.

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Cholesterol related topics

Cholesterol, Heart Attack Pathology (Photo Essay), Heart Attack Prevention Overview, Heart Attack Prevention - Aspirin, Beta Blockers, ACE Inhibitors, Heart Attack Prevention - Omega-3 Fatty Acids, Heart Attack Prevention - Vitamins and Exercise.

Cholesterol contents

• Learn more about Cholesterol
• Prescribed medications
• What are LDL and HDL cholesterol?
• Level of LDL cholesterol in the blood
• Normal cholesterol blood level
• What is Low HDL Cholesterol best treatment?
• Raising HDL Cholesterol levels
• Cholesterol related topics

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Asthma Facts

Maimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the Royal Princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy–chicken soup.

About 80% of children and 50% of adults with asthma also have allergies!