Cholesterol

1. What Is Cholesterol?
• We may associate cholesterol
with fatty foods, but most of the
waxy substance is made by
our own bodies. The liver
produces 75% of the
cholesterol that circulates in
our blood. The other 25%
comes from food. At normal
levels, cholesterol actually
plays an important role in
helping cells do their jobs. But
cholesterol levels are
precariously high in more than
100 million Indians.

2. Symptoms of High Cholesterol
• High cholesterol does not
cause any symptoms. But it
does cause damage deep
within the body. Over time, too
much cholesterol may lead to
a buildup of plaque inside the
arteries. Known as
atherosclerosis, this condition
narrows the space available
for blood flow and can trigger
heart disease. The good news
is high cholesterol is simple to
detect, and there are many
ways to bring it down.

3. Cholesterol Testing
• People older than 20 should
have their cholesterol levels
checked at least once every
five years. This is done with a
simple blood test known as a
fasting lipoprotein profile. It
measures the different forms
of cholesterol that are
circulating in your blood after
you avoid eating for 9 to 12
hours. The results show your
levels of "bad" cholesterol,
"good" cholesterol, and
triglycerides.

4. "Bad" Cholesterol
• Most of the cholesterol in the
blood is carried by proteins
called low density lipoproteins
or LDL. This is known as the
bad cholesterol because it
combines with other
substances to clog the
arteries. A diet high in
saturated fats and trans fats
tends to raise the level of LDL
cholesterol. For most people,
an LDL score below 100 is
healthy, but people with heart
disease may need to aim even
lower.

5. "Good" Cholesterol
• Up to a third of blood
cholesterol is carried by high-
density lipoproteins or HDL.
This is called good cholesterol
because it helps remove bad
cholesterol, preventing it from
building up inside the arteries.
The higher the level of HDL
cholesterol, the better. People
with too little are more likely to
develop heart disease. Eating
healthy fats, such as olive oil,
may help boost HDL
cholesterol.

6. Triglycerides
• The body converts excess
calories, sugar, and alcohol
into triglycerides, a type of fat
that is carried in the blood and
stored in fat cells throughout
the body. People who are
overweight, inactive, smokers,
or heavy drinkers tend to have
high triglycerides, as do those
who eat a very high-carb diet.
A triglycerides score of 150 or
higher puts you at risk for
metabolic syndrome, which is
linked to heart disease and
diabetes.

7. Total Cholesterol
• Total cholesterol measures the
combination of LDL, HDL, and
VLDL (very low density
lipoprotein) in your
bloodstream. VLDL is a
precursor of LDL, the bad
cholesterol. A total cholesterol
score of under 200 is
considered healthy in most
cases. People who score in
the "high" range have an
increased risk of developing
heart disease compared to
those who score below 200.

8. Cholesterol Ratio
• To calculate your cholesterol
ratio, divide your total
cholesterol by your HDL
cholesterol. For example, a
total score of 200 divided by
an HDL score of 50 equals a
cholesterol ratio of 4 to 1.
Doctors recommend
maintaining a ratio of 4 to 1 or
lower. The smaller the ratio,
the better. While this figure is
useful in estimating heart
disease risk, it's not as
important in guiding treatment.
Doctors look at total
cholesterol, HDL cholesterol,
and LDL cholesterol to
determine treatment.

9. Cholesterol in Food
• Cholesterol-rich foods, like
eggs, shrimp, and lobster are
no longer completely
forbidden. Research shows
that the cholesterol we eat has
only a small effect on blood
cholesterol levels for most
people. A few people are
"responders," whose blood
levels spike up after eating
eggs. But for most, saturated
fat and trans fats are bigger
concerns. Daily cholesterol
limits are 300 mg for healthy
people and 200 mg for those
at higher risk. One egg has
186 mg of cholesterol.

10. Cholesterol and Family History
• Cholesterol comes from two
sources -- the body and food --
and either one can contribute
to high cholesterol. Some
people inherit genes that
trigger too much cholesterol
production. For others, diet is
the main culprit. Saturated fat
and cholesterol occur in
animal-based foods, including
meat, eggs, and dairy products
made with milk. In many
cases, high cholesterol stems
from a combination of diet and
genetics.

11. What Boosts Your Risk?
Several factors can make
you more likely to
develop high cholesterol:
• A diet high in saturated
fats and cholesterol
• A family history of high
cholesterol
• Being overweight or
obese
• Getting older

12. Cholesterol and Gender
• Until menopause, women
typically have lower total
cholesterol levels than men of
the same age. They also have
higher levels of HDL
cholesterol, the good kind.
One reason is estrogen: The
female sex hormone raises the
level of HDL cholesterol.
Estrogen production peaks
during the childbearing years
and drops off during
menopause. After age 55, a
woman's risk of developing
high cholesterol begins to
climb.

13. Cholesterol and Children
• There's evidence that
cholesterol can begin
clogging the arteries
during childhood, leading
to atherosclerosis and
heart disease later in life.
The American Heart
Association recommends
kids and teenagers with
high cholesterol take
steps to bring it down.
Ideally, total cholesterol
should be below 170 in
people ages 2 to 19.

14. Why High Cholesterol Matters
• High cholesterol is one of the
major risk factors for coronary
artery disease, heart attacks,
and strokes. It also appears to
boost the risk of Alzheimer's
disease. As we saw earlier,
high cholesterol leads to a
buildup of plaque that narrows
the arteries. This is dangerous
because it can restrict blood
flow. If the blood supply to a
part of the heart or brain is
completely cut off, the result is
a heart attack or stroke.

15. Cholesterol Buster: Eat More Fiber
• Diet changes offer a
powerful way to fight high
cholesterol. If you've ever
wondered why some
cereals claim to be heart-
healthy, it's the fiber. The
soluble fiber found in
many foods helps reduce
LDL, the bad cholesterol.
Good sources of soluble
fiber include whole-grain
breads and cereals,
oatmeal, fruits, dried
fruits, vegetables, and
legumes such as kidney
beans.

16. Cholesterol Buster: Know Your
Fats
• No more than 35% of your
daily calories should come
from fat. But not all fats are
equal. Saturated fats -- from
animal products and tropical
oils -- raise LDL cholesterol.
Trans fats carry a double-
whammy, boosting bad
cholesterol, while lowering the
good kind. These two bad fats
are found in many baked
goods, fried foods (doughnuts,
french fries, chips), stick
margarine, and cookies.
Unsaturated fats may lower
LDL when combined with other
healthy diet changes. They're
found in avocados, olive oil,
and peanut oil.

17. Cholesterol Buster: Smart Protein
• Meat and full-fat milk offer
plenty of protein, but they are
also major sources of
cholesterol. You may be able
to reduce LDL cholesterol by
switching to soy protein, such
as tofu, at some meals. Fish is
another great choice. It's rich
in omega-3 fatty acids, which
can improve cholesterol levels.
The American Heart
Association recommends
eating fish at least twice a
week.

18. Cholesterol Buster: Low-Carb Diet
• There's growing evidence
that low-carb diets may
be better than low-fat
diets for improving
cholesterol levels. In a
two-year study funded by
the National Institutes of
Health, people who
followed a low-carb plan
had significantly better
HDL (good cholesterol)
levels than those who
followed a low-fat plan.

19. Cholesterol Buster: Lose Weight
• If you're overweight, talk
to your doctor about
beginning a weight loss
program. Losing weight
can help you reduce your
levels of triglycerides,
LDL, and total
cholesterol. Shedding
even a few pounds can
also boost your good
cholesterol level -- it
tends to go up 1 point for
every 6 pounds you lose.

20. Cholesterol Buster: Quit Smoking
• Giving up tobacco is
tough, but here's one
more reason to try. When
you stop smoking, your
good cholesterol is likely
to improve by as much as
10%. You may be more
successful if you combine
several smoking
cessation strategies. Talk
to your doctor about
which options are best for
you.

21. Cholesterol Buster: Exercise
• If you're healthy but not very
active, starting an aerobic
exercise program could
increase your good cholesterol
by 5% in the first two months.
Regular exercise also lowers
bad cholesterol. Choose an
activity that boosts your heart
rate, such as running,
swimming, or walking briskly,
and aim for at least 30 minutes
on most days of the week. It
doesn't have to be 30
continuous minutes; two 15-
minute walks works just as
well.

22. Treatment: Medications
• If high cholesterol runs in your
family, diet and exercise may
not be enough to get your
numbers where you want
them. In that case, medication
can give your cholesterol
levels an extra nudge. Statins
are usually the first choice.
They block the production of
cholesterol in the liver. Other
options include cholesterol
absorption inhibitors, bile acid
resins, and fibrates. Your
doctor may recommend a
combination of these
medications.

23. Treatment: Supplements
• Certain dietary supplements
may also improve cholesterol
levels. These include flaxseed
oil, fish oil, and plant sterols,
such as beta-sitosterol.
Prescription niacin, a b-
complex vitamin, has been
found to raise good cholesterol
while reducing bad cholesterol.
Niacin found in ordinary
supplements should not be
used to lower cholesterol.

24. Herbal Remedies
Some studies suggest
garlic can knock a few
percentage points off total
cholesterol. But garlic
pills can have side effects
and may interact with
medications. Other herbs
that may reduce
cholesterol include:
• Fenugreek seeds
• Artichoke leaf extract
• Yarrow
• Holy basil

25. How Low Should You Go?
• Many people are able to lower
cholesterol levels through a
combination of medication and
lifestyle changes. But how low
is low enough? For people with
diabetes or a high risk of
developing heart disease, an
LDL score of less than 100 is
desirable. If you already have
heart disease or coronary
artery disease, some doctors
recommend reducing LDL to
70 or lower.

26. Can the Damage Be Undone?
• It takes years for high
cholesterol to clog the arteries
with plaque. But there is
evidence that atherosclerosis
can be reversed, at least to
some degree. Dean Ornish,
MD, has published several
studies showing that a low-fat
vegetarian diet, stress
management, and moderate
exercise can chip away at the
build-up inside the coronary
arteries. Other research
supports the idea that big
drops in cholesterol can
somewhat help open clogged
arteries.

27. Interpreting the numbers
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of
blood in the United States and some other countries. Canada and most European
countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these
general guidelines when you get your lipid panel (cholesterol test) results back to see if
your cholesterol falls in ideal levels.
• Total cholesterol
(U.S. and some other countries)
• Below 200 mg/dL Best
• 200-239 mg/dL Borderline high
• 240 mg/dL and above High
• Total cholesterol*
(Canada and most of Europe)
• Below 5.2 mmol/L Best
• 5.2-6.2 mmol/L Borderline high
• Above 6.2 mmol/L High
Information on this slide and the following slides are taken from Mayo Clinic
http://www.mayoclinic.com/health/high-blood-cholesterol/DS00178/DSECTION=tests-
and-diagnosis

28. • LDL cholesterol
(U.S. and some other countries)
• Below 70 Best for people at
high risk of heart disease
• Below 100 mg/dL Best for people
at risk for heart disease
• 100-129 mg/dL Near ideal
• 130-159 mg/dL3.4-4.1 mmol/L
Borderline high
• 160-189 mg/dL High
• 190 mg/dL and above Very high
• LDL cholesterol
(Canada and most of Europe)
• Below 1.8 mmol/L Best for people
at high risk of heart disease
• Below 2.6 mmol/L Best for people
at risk for heart disease
• 2.6-3.3 mmol/L Near ideal
• 3.4-4.1 mmol/L Borderline high
• 4.1-4.9 mmol/L High
• Above 4.9 mmol/L Very high

29. • HDL cholesterol
(U.S. and some other countries)
• Below 40 mg/dL (men)
Below 50 mg/dL (women) Poor
• 50-59 mg/dL Better
• 60 mg/dL and above Best
• HDL cholesterol
(Canada and most of Europe)
• Below 1 mmol/L (men)
Below 1.3 mmol/L (women) Poor
• 1.3-1.5 mmol/L Better
• Above 1.5 mmol/L Best

30. • Triglycerides
(U.S. and some other countries)
• Below 150 mg/dL Best
• 150-199 mg/dL Borderline high
• 200-499 mg/dL High
• 500 mg/dL and above Very high
• Triglycerides
(Canada and most of Europe)
• Below 1.7 mmol/L Best
• 1.7-2.2 mmol/L Borderline high
• 2.3-5.6 mmol/L High
• Above 5.6 mmol/L Very high
The American Heart Association (AHA) recommends that a triglyceride level of 100
mg/dL (1.3 mmol/L) or lower is considered "optimal." The AHA says this optimal level
would improve your heart health. However, the AHA doesn't recommend drug treatment
to reach this level. Instead, for those trying to lower their triglycerides to this level,
lifestyle changes such as diet, weight loss and physical activity are encouraged. That's
because triglycerides usually respond well to dietary and lifestyle changes.
*Canadian and European guidelines differ slightly from U.S. guidelines. These
conversions are based on U.S. guidelines

31. This information is from Quality Healthcare Medical
Center’s physical examination report reference section
• the table of risk
• Risk Male Female
• 1/2 avg 3.4 3.3
• avg risk 5.0 4.4
• 2 x avg 9.6 7.1
• 3 x avg 23.4 11.0
• How to get the risk
ratio :
• Total cholesterol
divided by HDL