Most common heart-related conditions
- provided by America's leading cardiologists

Cholesterol

Eighty-percent of the cholesterol in your body is produced in your liver, and the remainder comes from foods like meats, eggs and dairy products. Saturated fats and transfats can raise the cholesterol level also. Understanding the different forms of cholesterol can help you make the right nutritional and treatment decisions to maintain a healthy heart. Select a program below to learn more about cholesterol and its effect on your heart.

• What are the Consequences of High Cholesterol?
• What Is Cholesterol and What Are the Types?
• How Can Cholesterol Management Help Prevent Heart Disease in Women?
• What Should Be the Target Value for My LDL-Cholesterol?
• How Safe are Cholesterol Medications?
• ASK YOUR DOCTOR: About Cholesterol

What are the Consequences of High Cholesterol?
Learn the basics of high cholesterol, and it's consequences on the cardiovascular system.

Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.

Webcast Transcript:

ANNOUNCER: Most people are aware that there are different types of cholesterol, but many don't know about the serious consequences surrounding high levels of LDL.

NANETTE KASS-WENGER, MD: High cholesterol—and here I would like to talk about high bad cholesterol, or LDL, low-density lipoprotein cholesterol—means that there is deposition of this fat in the arteries. In the arteries of the heart, in the arteries of the brain, all through the body, in the arteries of the kidney. And the consequences can be what we call atherosclerosis, meaning a narrowing and a deposition of cholesterol and all the fibrous tissue that goes in there.

SPENCER B. KING, III, MD: The consequences are that heart attack, stroke, peripheral vascular disease, blocked arteries in the legs and so forth, can occur. Cholesterol has multiple components. Some parts of cholesterol are more dangerous than others. Some parts of the cholesterol, the HDL, the high-density lipoprotein, is actually somewhat protective, and parts of that are even more protective.

On the other hand, the low-density lipoproteins are the ones that we really worry about. And when we talk about high cholesterol, we're really more worried about the high level of the LDL, the low-density lipoprotein. That is the one that is most dangerous for the progression of artery disease.

What Is Cholesterol and What Are the Types?
Cholesterol is necessary to keep the body functioning but too much of the "bad" cholesterol called LDL can cause more damage than good. Tune in to learn about the different types.

Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: When most people hear the word cholesterol they automatically think about "high cholesterol levels" and all the fatty foods associated with it.

Too much cholesterol in the bloodstream can cause damage to the blood vessels and heart and eating animal-derived foods such as meat, eggs and dairy products can increase your chances of developing high cholesterol. But not all cholesterol is bad for the body and not all cholesterol comes from your diet. As a matter of fact, the body naturally produces cholesterol and it needs "good" cholesterol to function so it's important to know the difference between the good and the bad types.

NANETTE K. WENGER, MD, FACC: Cholesterol is one of the blood fats, and we have heard so much about cholesterol lately, and likely one of the better divisions is the good cholesterol and the bad cholesterol.

SPENCER B. KING, MD, MACC: Cholesterol has many types. The two big components are called LDL (low-density lipoprotein) and HDL (high-density lipoprotein). And simplistically, we talk about the LDL being the bad cholesterol and the HDL being the good cholesterol.

That means that the bad cholesterol tends to accumulate in the arteries, tends to form plaques, tends to be the precursor to what eventually might end up being a heart attack.

The good cholesterol actually acts in part in reversing the cholesterol transport, takes cholesterol out of the plaque in the artery and may return it to the circulation, to the liver, to be excreted. So these are the two major categories, but within each one there are different particles, different cholesterols, different lipoproteins that carry the cholesterol, and they are differentially difficult players.

Some of the LDL cholesterol that is the bad cholesterol is worse than others. And it tends to be the small particle size that are very dense. You can think of the cholesterol particles as marbles, maybe, the small dense ones, and the larger, lighter ones might be ping-pong balls. And so the small marble ones are more dangerous.

On the other side, the HDL, the good cholesterol, there are some components of that that are better than others. So cholesterol is quite a complicated subject, and we're developing more and more therapies that aim not just at the total cholesterol, but in altering the good and the bad.

How Can Cholesterol Management Help Prevent Heart Disease in Women?
Heart disease is the number one killer of American women, but it can be prevented. One way is to control your cholesterol levels. Find out how.

Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: Did you know heart disease is the number one cause of death of American women? Did you know it can be prevented? Knowing the risk factors and taking action to prevent them can reduce your chances of developing heart disease. High cholesterol is one major risk factor, so keeping a watchful eye on your levels is important.

NANETTE K. WENGER, MD, FACC: The American Heart Association has put out a very exciting set of guidelines, and that is guidelines for cardiovascular prevention in women. And of course, you know that heart disease is the major health problem for American women, and we must institute prevention.

So what I tell all my women patients is that there are three numbers that they have to know, that their good cholesterol, the HDL cholesterol, should be more than 50; their bad cholesterol, the LDL cholesterol, should be lower than 100; and another blood factor, the triglycerides, should be below 150. So the three numbers you have to remember are 50, 100 and 150. And that’s pretty much general.

What Should Be the Target Value for My LDL-Cholesterol?
Low density lipoprotein or LDL is known as "bad" cholesterol because too much can clog arteries and cause life threatening consequences. Find out what your LDL levels should be.

Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.

Editorial Consultant:
Suzanne Hughes, MSN, RN

Webcast Transcript:

ANNOUNCER: Low density lipoprotein or LDL is known as "bad" cholesterol because too much can clog the arteries and cause life threatening consequences such as a heart attack or stroke.

But monitoring your levels and keeping them low can greatly reduce your risk of developing heart and other complications

And if you already have heart disease it’s especially important to keep your levels in check to prevent further damage to your heart.

SPENCER B. KING, MD, MACC: The target for LDL cholesterol has changed. When I was in medical school, the target for the total cholesterol was under 300. Now the target is under 200.

NANETTE K. WENGER, MD, FACC: Patients often ask, "What should my cholesterol be?" And really, the target value for your bad cholesterol, the LDL, depends on who you are and what your diseases are, because if you’re a high-risk patient, if you have documented coronary disease, if you've had a bypass, if you've had an angioplasty, if you have disease of your peripheral arteries, if you're a diabetic and remember, a diabetic is a high-risk patient. A diabetic woman has the same risk of having a heart attack as a woman who's already had a heart attack, or if you have chronic kidney disease, you're a high-risk patient, and your bad cholesterol, the LDL, should be at least lower than 100, and some of the newer recommendations are lower than 70.

SPENCER B. KING, MD, MACC: Patients tend to benefit with those lower LDL cholesterol numbers. Often it's asked, is there a cholesterol number that is too low? Some people feel that when you go below 40 for the LDL cholesterol that maybe that's a little excessive.

NANETTE K. WENGER, MD, FACC: Now, if you're at intermediate risk, if you have a number of risk factors for heart disease, high blood pressure, obesity, metabolic syndrome, physical inactivity, cigarette smoking, probably the goal for your cholesterol should be somewhere between 100 and 130 for the bad cholesterol, the LDL. And if you have just a few risk factors, perhaps 130 to 160 is reasonable. But more and more, the research studies are showing that lower is better.

How Safe are Cholesterol Medications?
It's important for those with high cholesterol to learn about the medications they may take to control it. Find out what the experts think about the most commonly used drugs.

Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine, Akron General Medical Center, Akron, Ohio
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua Heart Center, Piedmont Hospital, Atlanta, GA.
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia

Webcast Transcript:

ANNOUNCER: For those with high cholesterol, a common concern is about the safety of the medications used to lower it.

SUZANNE HUGHES, MSN, RN: The medications that lower cholesterol are in general very, very safe. The largest group of drugs that most people have heard the most about are called the statins, and the statins have been on the market now since September of 1987, and they overall have a great safety record.

Now, these drugs are metabolized by the liver, and so it's necessary for a person taking these medications to have regular blood tests, not only to measure how effective the medications are in optimizing the cholesterol profile, but also to make sure that there aren't any adverse effects on the liver.

ANNOUNCER: Besides the possibility of affecting the liver, there are other considerations to keep in mind.

SPENCER B. KING, III, MD: There are some other potentially dangerous things like muscle aches that may lead to complications, kind of a flu-like feeling that can develop. But in general, the cholesterol-lowering drugs are very safe.

Sometimes we worry about any side effect of a drug, but in doing that we must also look at what the drug is doing in a positive way, and the cholesterol-modifying drugs are one of our most important breakthroughs in medicine. So no one should avoid the use of these drugs if they're indicated simply because of fear of some of these side effects.

ANNOUNCER: In addition to statins, there are other medications that can lower cholesterol.

SUZANNE HUGHES, MSN, RN: Another one is fibrates that generally operate not to lower the LDL, like the statins do, but to normalize the triglyceride and the HDL cholesterol. These are also very safe, although when used in combination with a statin do require a little more careful followup.

And another class of medications is the niacin group. And there's a prescription medicine that's niacin that actually can very nicely raise the HDL cholesterol and lower triglycerides.

And then the last main class is the bile acid sequestrants, a group of medicines that actually can lower the LDL cholesterol, and they are not processed through the liver. They just act entirely on the gastrointestinal system.

NANETTE KASS-WENGER, MD There's a new medicine on the scene called ezetimibe, which prevents the absorption of cholesterol, and this has been added to a statin to provide further cholesterol lowering. ANNOUNCER: With all the information available, patients with high cholestrol have many treatment options to consider with their physican.

NANETTE KASS-WENGER, MD: The most important thing is the benefit. No drug is absolutely safe, just as crossing the street is not absolutely safe. And when you decide to take a drug, or when I recommend that you take a drug, it really is because the benefits of this drug far, far, far, far outweigh any potential adverse effects.

ASK YOUR DOCTOR: About Cholesterol

The following is a list of questions to ask your doctor about cholesterol, as well as tips for preparing for these conversations.

1. What is cholesterol?

Cholesterol is fatty substance in the blood that is necessary in the formation of cells and hormones. Cholesterol comes from the foods we eat, and is also produced in the liver.

2. How is cholesterol measured?

Cholesterol is measured by a simple blood test. This is usually done after fasting for at least 12 hours. The results generally consist of:

• Total cholesterol ­ should be well under 200.
• Triglycerides (another type of fat, related to cholesterol) ­ should be <150.
• HDL cholesterol "good" cholesterol- Considered a risk factor if <40 in men (<50 in women).
• LDL cholesterol "bad" cholesterol-should be <100.

3. Why does cholesterol matter?

Abnormal cholesterol levels increase your risk of developing blockages in your arteries. If the arteries providing blood to your heart become blocked, the result is a heart attack. If your cholesterol test shows an abnormal level of any of the above, your health care provider will advise lifestyle changes, including improving your eating habits and your exercise routine, or he or she may prescribe one or more medications. It has been proven in many research studies that improving your levels with diet changes, exercise or medicine makes a big difference in lowering your risk of heart problems. If you have heart problems already (heart attack, stent/balloon angioplasty, or bypass surgery) or you have diabetes, you will probably be prescribed medicines right away. In lower-risk people (younger, and/or with lower risk), lifestyle changes may be tried first. People who have hereditary cholesterol problems usually need medicine to help normalize them. If a person with abnormal cholesterol also has high blood pressure, diabetes or smokes cigarettes, the risk increases sharply.

The National Cholesterol Education Program Adult Treatment Panel reviews all of the current research on cholesterol and updates the recommendations regularly. The last full report was in May of 2001, with an update in July of 2004. Their recommendations are provided in the table below. And more detail can be found at: http://www.nhlbi.nih.gov/guidelines/cholesterol.

4. What are the key questions to ask my health care provider about my cholesterol?

• What is my cholesterol, HDL, LDL, and triglyceride level?
• How do I improve my overall blood lipid profile?
• Are statin drugs the best choice, if I need a medication?
• Are there diet guidelines to improve LDL? HDL?