Cholesterol's Effect On Your Body

Too many Americans still have dangerously high LDL cholesterol levels, and about a quarter may not even know it. The effects of high cholesterol put those people at risk for a longer span of artery clogging disease and increases their risk of heart attack and stroke, a recent study says.

For their research, investigators used the U.S. National Health and Nutrition Examination Survey, which included about 24,000 people. They found that 1 in 17 U.S. adults still have LDL levels of 160 to 189 mg/dL and 1 in 48 adults have levels of 190 mg/dL or greater. Among those at the highest cholesterol levels, 1 in 4 are unaware and not being treated for high cholesterol. This was the case for an even higher proportion of people with levels of 160 to 189 mg/dL. The study findings were published in JAMA Cardiology

What Is Cholesterol?

Cholesterol is a waxy substance found in the blood and in cells throughout the body.  Your body makes 75 percent of its cholesterol, and the rest enters the body through the food you eat. 

"Cholesterol in itself isn't bad. In fact, it is essential for survival," explains David Kovacich, MD, a board-certified cardiologist with Franciscan Physician Network Indiana Heart Physicians in Indianapolis. "Your body requires cholesterol to make cell membranes, hormones, vitamin D and digestive fluids. Cholesterol also supports proper organ function."

But there is "good" and "bad" cholesterol, and those need to be balanced or our risk of heart attack increases.

What Are The Different Types Of Cholesterol?

There are two main types of cholesterol:

LDL Cholesterol

LDL cholesterol, or low-density lipoprotein, is the "bad," unhealthy cholesterol. It can slowly build up in arteries with calcium and inflammatory cells and create fatty deposits called plaques. LDL cholesterol is a risk factor for heart attack and stroke.

HDL Cholesterol

HDL cholesterol, or high-density lipoprotein, is the "good" kind of cholesterol. It carries excess cholesterol away from the arteries to the liver. HDL cholesterol protects against heart attack and stroke.

Generally the lower the LDL and the higher the HDL, the lower your risk of heart disease.

How Can Cholesterol Levels Hurt Your Body?

"Too much LDL cholesterol in the body can create problems," Dr. Kovacich said. "Over the course of time, elevated cholesterol levels can damage the arteries, contribute to heart disease and increase the risk of stroke. It's a good idea to monitor cholesterol levels during regular doctor’s visits and, if necessary, try to reduce high levels through diet, exercise and medication. Exercise by itself can raise the good cholesterol levels but cannot lower the bad cholesterol levels."

Excess LDL, especially in association with other risk factors, such as diabetes, high blood pressure and smoking, can lead to premature development of plaque in arteries throughout the body.

How Can You Tell If You Have Plaque From Cholesterol?

"Until recently, we had no way of detecting plaque until the build-up was pronounced," Dr. Kovacich said. "We can now detect plaque at early stages by using heart scans, which measure calcium deposits in the arteries."

Over years, the buildup of plaque in coronary arteries can interrupt the flow of oxygen-rich blood coming to the heart. This can cause symptoms called angina. In some, angina may be manifested by chest pain while in others it might be shortness of breath.  Women often have atypical symptoms and could suffer only from fatigue. Symptoms consistent with angina should lead to an urgent evaluation by your health care provider because ultimately, a clot could form on unstable plaque, leading to a heart attack or stroke.

If this cholesterol plaque breaks free, it can block the flow of blood, causing heart attack or stroke.

What Are Symptoms Of High Cholesterol?

High cholesterol has no symptoms, so your blood cholesterol levels should be checked regularly. This is done through a fasting blood test. Your physician can use this information, along with your other risk factors such as age, weight and smoking, to determine how your cholesterol levels may affect your risk of heart disease.

How Is High Cholesterol Diagnosed?

When a doctor checks your cholesterol level, he or she will usually do a blood test that's called a lipid panel, which includes measuring your total cholesterol and some of the other fats that are in the blood. This blood test requires a 14-hour fast to get an accurate reading of the blood fats.

Because the level of triglycerides is affected by many factors, including medications, use of oral contraceptives, alcohol and food intake, and recent exercise, you also should fast for at least 12 hours before testing for triglycerides.

Unfortunately, there's no sharp cutoff point between healthy and unhealthy levels, but ideally, your total cholesterol should be below 200 milligrams per deciliter. Anything between 200 and 239 mg/dL is considered borderline high, and a level of 240 mg/dL or above is high. Check with your doctor about what's right for you.

How Often Should Cholesterol Be Checked?

Starting at age 20, adults should have their lipid panels levels checked at least once every five years. Men 45 or older and women 55 or older should be checked more often.

If you already have high cholesterol or are at risk for heart disease, your doctor may want to measure your cholesterol more often.

How Do The Foods You Eat Impact Your Cholesterol?

When you eat too much fatty foods or drink too much alcohol, the liver produces more cholesterol and releases it in the blood stream. If too many calories are taken in, the liver changes them into triglycerides, storing them as fat.

This is why physicians recommend watching your saturated and trans fats in your diet, as well as the amounts of fast foods and processed foods.

Studies have not generally supported an association between dietary cholesterol and cardiovascular risk, according to a 2019 American Heart Association science advisory. However, many foods higher in cholesterol are also high in saturated fat. Eating too much saturated fat – along with too much sugar and sodium, and too little fiber – raises the risk of heart disease.

Are Dietary Cholesterol And Blood Cholesterol The Same Thing?

No, dietary cholesterol and blood cholesterol are not the same. Dietary cholesterol is found in food. Blood cholesterol – which includes HDL and LDL – is one of eight essential measures of heart health identified by the American Heart Association. A diet high in saturated fat can lead to high LDL cholesterol levels and further lead to plaque buildup in the walls of your arteries. This plaque restricts blood flow and can lead to a heart attack or stroke.

Dietary cholesterol comes from animal-based foods. High-fat meat, eggs, butter, processed meats and full-fat dairy products are major sources. Dietary cholesterol also can be found in baked goods made with eggs, butter or cream.

What Changes Can I Make To Reduce My Cholesterol?

Your doctor might recommend treating your cholesterol levels with medication is recommended at 190 mg/dL and may be considered if your cholesterol levels are 160 mg/dL to 189 mg/dL. But many non-medical options are available to help you reduce your cholesterol.

"The best defense against high cholesterol levels is following a healthy lifestyle, knowing your numbers and discussing them with your health care provider," Dr. Kovacich said. "Desired LDL levels are based on your risk of a cardiovascular event, so recommendations and intensity of therapy differ between patients."

Lifestyle changes to help reduce blood fats include:

• Stop smoking. Smoking and vaping have been shown to reduce your HDL cholesterol levels, especially among women. Learn about our tobacco cessation programs.
• Maintain a healthy weight. Even a 3 to 5 percent weight loss can be beneficial.
• Cut down on saturated and trans fats in your diet. Eat more fruits and vegetables, whole grains, beans and lentils and limit red meats, butter and other fatty foods. Also limit your intake of fast foods and processed foods.
• Exercise regularly. Regular workouts not only strengthen your heart but can also push your cholesterol levels in all the right directions. Your LDL cholesterol may drop, and your HDL cholesterol may rise. (LDL is primarily lowered by diet, and HDL is primarily increased by exercise, but we usually need to do both.)
• Eat foods low in added sugar or use sugar-free products. Foods high in sugar content should be used sparingly. They include jellies and jams, syrups, sodas, candies, some cereals, pies, cakes and most cookies.
• Limit alcohol consumption. Moderate alcohol consumption is defined as one drink a day for women and no more than two drinks a day for men. One drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

Lifestyle changes can make a difference in cholesterol levels, but many people need medications to bring cholesterol completely under control.If these measures are not effective, your physician may prescribe drug therapy to reduce your cholesterol levels.

How Can Medications Help Cholesterol Levels?

Doctors may recommend diet and lifestyle changes for mildly elevated cholesterol levels, but someone with levels of 190 mg/dL or higher should also take cholesterol-lowering medication, experts say. A family history of heart disease further heightens the risk. Drugs are especially important if you have other risk factors for heart disease, such as diabetes, or if you already have heart trouble.

Statins

The most effective cholesterol medications available today belong to a group of drugs called statins.  Statins are medications that reduce blood levels of “bad” LDL cholesterol that can accumulate into plaques that clog arteries. Statins can also reduce inflammation in patients, and might help lower blood pressure.

Statin pills like Lipitor (atorvastatin) and Zocor (simvastatin) are probably the best-known drugs for lowering cholesterol. Statins can dramatically lower cholesterol levels and have few side effects, although some patients complain of constipation, stomach pains, and cramps. In rare cases, a patient may develop significant muscle pain and weakness. (Report any unusual symptoms to your doctor; since some of these drugs interact with other medications, always mention any other drugs or herbs you're taking as well.) A recent study of heart patients found that one statin drug cut the relative risk of heart attacks by more than 60 percent.

Other Medications

Statins tend to be fairly harmless and helpful, but they aren’t for everyone.

People who should not take statins, or who at least should discuss it with their doctor, include:

• People with liver disease or poor liver function
• Women who are pregnant or trying to become pregnant
• People who have diseases that cause muscle breakdown
• Elderly patients

In addition to statins, there are other medications that can be taken by injection or orally.

Some other medications to treat cholesterol levels that may be prescribed instead of statins include:

• Ezetimibe. This drug lowers LDL cholesterol without any effect on the liver. However, it doesn’t control inflammation like statins, and it hasn’t been shown to reduce heart-related deaths as much as statins.
• Bempedoic acid. This medication is considered the “non-statin statin.” It’s often prescribed alongside a statin, but it can be used as an alternative for patients who can’t use statins.
• PCSK9 inhibitors. These are injectable drugs people take twice a month. They can cause a dramatic reduction in LDL cholesterol levels and reduce the risk of serious heart disease and heart-related death. However, they are much more expensive than statins.

Any of these alternative drugs will require the same level of monitoring and regular blood tests

It's important for even young adults to know their "numbers," so that high LDL cholesterol levels can be identified and treated early.

HealthDay News contributed information to this article.