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Cholesterol¹ is a molecule in the human body that is essential for life. It is a fat-like, waxy compound used in multiple roles to keep your cells functioning normally.
Cholesterol keeps the outermost layer of your cells healthy. It is also used to produce vitamin D, steroid hormones (like the stress hormone cortisol), and sex hormones (such as testosterone and estrogen). The body can produce cholesterol but also absorbs it from food.
Cholesterol is a lipophilic molecule, meaning that it loves fats, and is transported through your body inside molecules called lipoproteins, which are often found alongside fats.
There are two main types of cholesterol found in your body alongside triglycerides. These different types of cholesterol can affect your health in different ways.
Your lipid profile is a measure of all of the different types of cholesterol within your body, including low-density lipoprotein (LDL), high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and chylomicrons, i.e., total cholesterol and triglycerides.
Low-density lipoprotein (known as LDL) is sometimes called “bad cholesterol.” It transports cholesterol from your liver to the rest of your body, This can lead to cholesterol collecting on the walls of your arteries, known as atherosclerosis, which narrows your blood vessels via plaque creation.
If these plaques get too big and rupture, they can block blood flow to the brain or heart and cause strokes or heart attacks. If the plaque clogging your arteries gets too thick, it could be difficult for blood and thus oxygen to reach your organs, leading to peripheral arterial disease, stroke, and heart attack.
High-density lipoprotein (HDL) is sometimes called “good cholesterol”. While LDL transports cholesterol from your liver to your arteries, HDL removes excess cholesterol from your cells and returns them to your liver, where it can be excreted from your body.
HDL helps balance the cholesterol metabolism in your body, making atherosclerosis less likely. Higher levels of HDL lower your risk of heart disease and stroke.
Triglycerides are a form of fat found in your blood. They help supply your body with energy and are normally stored in your fat cells. If you need energy between meals, triglycerides are released into your bloodstream.
Triglycerides are measured alongside your cholesterol levels. High levels of triglycerides can sometimes be due to medical conditions like diabetes, obesity, kidney disease, or diseases associated with insulin resistance.
Ideal cholesterol levels vary depending on your age and gender. You will see cholesterol measured in a variety of units.
Here, milligrams per deciliter (mg/dL) is used. In children, total cholesterol levels should be less than 170 mg/dL, with your LDL cholesterol making up less than 100 mg/dL and your HDL being at 45 mg/dL or higher.
In adults, ideal total cholesterol levels are below 200 mg/dL or 5.2 mmol/L in SI units. Levels between 200-239 mg/dL would be considered borderline high, with those above 240 mg/dL high.
Women's HDL levels should be at least 50 mg/dL, and men's HDL should be at least 40 mg/dL. This is because the sex hormone estrogen boosts your levels of HDL. During menopause, HDL levels will fall when estrogen production occurs.
You can have high cholesterol and not know you do. For this reason, it is important to get your cholesterol checked regularly.
High cholesterol can be determined by genetics. The amount of LDL your body makes and how fast it can get rid of it from your body is partially determined by your genes.
One genetic cause of high cholesterol is an inherited condition known as familial hypercholesterolemia (FH). FH causes you to have significantly elevated levels of LDL, which can cause an increased risk of early-onset atherosclerosis and heart attacks.
A study² before the statin era demonstrated that 30% of female first and second-degree relatives of a patient with FH would have a heart attack by age 60, and 50% of male first and second-degree relatives would have one by age 50.
From a genetic perspective, if you inherit one defective gene from a parent, known as heterozygous hypercholesterolemia (HeFH), you’ll have a milder disease than inheriting two faulty genes, one from each parent, thus homozygous disease.
This is known as homozygous familial hypercholesterolemia (HoFH). Individuals with HoFH will have a more severe form of the disease, which is less common than HeFH.
HeFH affects approximately 1 in 250 people, while HoFH affects 1 in 250,000. Signs of FH include:
LDL levels over 190 mg/dL
Tendinous xanthomas, for example, sometimes in the Achilles tendon
Family history of early heart disease or heart attacks
Bumps around your elbows, knees, and knuckles
Family member with known FH
If you believe you may have FH, speak to your doctor, as genetic testing for this condition is available. Finding and treating FH early on can reduce your risk of heart and artery diseases by 80%.
Studies³ have shown that lowering your LDL cholesterol levels can decrease the risk of heart attacks, strokes, and heart disease. You can lower your cholesterol levels through a variety of methods.
Statins can reduce your LDL levels by 30 to 60%. When you reduce your cholesterol, you can halt atherosclerosis and coronary artery disease in their tracks and occasionally even reverse some of the damage.
Lowering your cholesterol won’t prevent you from ever having a heart attack, as there are multiple causes for heart attacks, not just high cholesterol.
When treating high cholesterol, it won’t lower instantly or after a few days. It takes time, and there is no set timeline. Different bodies will react differently to treatment, and cholesterol will drop at differing rates per person.
If you are taking statins, you will typically see a change in LDL levels between 6 and 8 weeks after beginning treatment. However, improvements in outcomes (e.g., less cardiac risk, etc.) can be shown as early as six months.
If you are treating high cholesterol through diet and exercise, this timeline may be longer and can take between 6 and 12 months.
There are multiple options for reducing cholesterol levels, from lifestyle changes to prescription medications. Some of these methods are listed below.
Evidence⁴ has shown that diets high in saturated fats and trans fats can increase the level of cholesterol in the blood. You can also increase your cholesterol levels by consuming cholesterol.
There are a variety of diets to choose from if you are attempting to lower your cholesterol levels. Their effectiveness varies, with some able to reduce LDL levels in your blood by up to 37%. The main goal of these diets is to reduce the amount of fat and cholesterol you consume, decreasing the production of LDL within your body.
The Ornish diet is a vegetarian diet that completely excludes animal products and oils. Today, it is commonly referred to as a high-carb, low-fat diet. This diet can cause a reduction in LDL levels of up to 37%.
It may be a good option if you want to significantly reduce your cholesterol levels. However, it is an incredibly strict diet that some may find difficult to follow.
The Mediterranean diet is perhaps more widely known and easier to stick to. This diet got its name from a study that found countries that border the Mediterranean Sea were 2 to 3 times less likely to suffer from heart disease.
This diet consists of food high in dietary fiber and a substance called linoleic acid, which has been shown to help destroy LDL molecules. This diet consists of high levels of vegetables, fruits, and fish, moderate levels of cheese and yogurt, and low levels of non-fish meats.
Olive oil is heavily used in this diet. This diet is less effective at decreasing LDL levels than the Ornish diet, but it is more sustainable.
Exercise is another method to help keep cholesterol levels under control. Aerobic exercise, such as running and cycling, has been shown to increase HDL levels and decrease triglyceride and LDL levels.
Studies⁵ have shown that after 12 weeks of consistent aerobic exercise, HDL levels can increase by 4.6%, while triglyceride levels fall by 3.7% and LDL by 5%. The benefits of aerobic exercise increase the more you do it.
Sixty minutes of aerobic activity per day is all it takes to start seeing the cardiovascular benefits.
Maintaining a healthy weight can also help with the management of cholesterol levels. There is a correlation between weight loss and lower cholesterol levels, and a person suffering from obesity often has high LDL levels.
When you are overweight, your body will produce more triglycerides, which increases your cholesterol levels. People who are overweight can also suffer from insulin resistance, which will increase cholesterol levels in the bloodstream.
Reducing and maintaining a moderate body weight can help to prevent insulin resistance and lower the levels of triglycerides in your bloodstream.
Improving your diet and increasing exercise levels will benefit you in multiple ways. They will directly decrease your cholesterol levels, as previously stated, while also helping with weight loss.
Cholesterol-lowering medications are drugs that can help lower your cholesterol. These medications are prescription only and are often prescribed alongside a healthy diet and exercise. There are many different types of cholesterol-lowering medication which include:
Statins are the most well-known type of cholesterol-lowering drug. They work well for the majority of people. Statins decrease the production of cholesterol in your liver by blocking the enzyme used to make it.
Statins also reduce inflammation and the risk of blood clots and improve the function of the lining of your blood vessels.
Some of the statins you may be prescribed are atorvastatin (Lipitor), fluvastatin (Lescol XL), and lovastatin (Altoprev).
PCSK9 inhibitors are another class of medication that is used to lower cholesterol. It can be prescribed alongside statins and is typically used for people who have a high risk of heart disease and are struggling to reduce their cholesterol with statins or have contraindications to statins.
They are essential for people who suffer from heterozygous familial hypercholesterolemia. PCSK9 inhibitors work by blocking a protein that binds to receptors on your liver cells, making them more sensitive to LDL levels and thus creating more LDL.
The two approved PCSK9 inhibitors are alirocumab (Praluent) and evolocumab (Repatha). These medications are typically administered via injections and can be costly.
Cholesterol is an important molecule that your body needs to function properly. Unfortunately, if your cholesterol levels get too high (above 200 mg/dL), you can begin suffering adverse effects, such as atherosclerosis and an increased risk of heart attack and stroke.
High cholesterol levels can sometimes be due to genetic conditions but can also result from poor diet and low levels of exercise.
Ideally, you should get your cholesterol levels checked approximately every four years. But if you feel you are suffering from high cholesterol, you must see a medical professional. They can answer any questions you may have and help determine the best treatment for you.
There are different options for treatment, including changes to diet, increased levels of aerobic exercise, and prescription medications. Once you have started treating high cholesterol, you should see results in about six weeks.
Benefits from lower cholesterol and blood pressure targets | NIH: National Institute of Health
Physiology, cholesterol | NIH: National Library of Medicine
High cholesterol: Overview | NIH: National Library of Medicine
Familial hypercholesterolemia | National Organization for Rare Disorders
Familial hypercholesterolemia | Centers for Disease Control and Prevention
Obesity and dyslipidemia | National Library of Medicine