Young Ju, Ph.D.

When it comes to cholesterol, tennis players have an advantage because of the exercise involved and tennis’ positive effects on stress and weight control.  However, hyperlipidemia, the medical term for high blood cholesterol, is a serious medical problem for many.  

Hyperlipidemia means lipids are too high (such as total cholesterol and triglycerides) in blood.  High blood cholesterol builds up fatty plaque in arteries; this process is called atherosclerosis, which could lead to a higher risk of heart attack and stroke.  Atherosclerosis is the main cause of cardiovascular disease (1, 2).

Cholesterol is a complicated and confusing topic. You may think you know all about cholesterol, so let’s test your knowledge.

Q1. Do we get cholesterol only from fatty foods?

No.  The liver produces enough cholesterol for our body needs. We also get cholesterol from foods such as meat and other animal and dairy products.  

Q2.  Is cholesterol the only culprit in atherosclerosis?

No. Triglycerides are also guilty.

Cholesterol is a waxy, fat-like substance. In general, your liver makes enough cholesterol for proper bodily functions. Proper levels of cholesterol produce hormones, vitamin D, and certain substances to digest foods. It also helps the function of neuronal cells in the nervous system.

Triglycerides are another type of fat in blood. Triglycerides are produced in the liver and intestine.  Triglycerides store unused calories and provide energy when needed.

Eating fatty food (especially high in saturated fat) can contribute both to increased blood cholesterol and triglycerides levels.  Excess amounts of cholesterol and triglycerides are stored in fat cells and circulated in the bloodstream resulting in plaque build-up in artery walls.  Having high triglycerides levels could also be a sign of a fatty liver condition.

 Q3. Is all cholesterol bad?

No.  Lipoproteins, aka cholesterol (because they carry cholesterol and triglycerides), include low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL). HDL is considered “good”. 

LDL and VLDL are “bad” cholesterol.

• LDLs carry mainly cholesterol from the liver to the tissues in the body and increase blood cholesterol levels. (Hypercholesterolemia is one type of hyperlipidemia and means too much LDLs in blood.)

• VLDLs carry mainly triglycerides and increase blood triglyceride levels.

HDL is considered “good” cholesterol.

• HDLs carry excess cholesterol back to the liver for removal and result in lower blood cholesterol levels.

Q4. If my cholesterol level is high, do I have any symptoms?

No. Usually, high cholesterol has no symptoms. A blood test is the only way to detect.

The National Heart, Lung, and Blood Institute (3) recommends getting cholesterol screenings every 1–2 years for men ages 45 to 65 and for women ages 55 to 65, and every year for people over 65.  People who have heart disease, diabetes, or a family history of high cholesterol, need to test more often.

Q5. What does a blood cholesterol test measure?

A blood test (also called a lipid panel or lipid profile) typically measures total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides levels. 

Desirable levels include:  

• Total Cholesterol:  < 200 mg/dL

• LDL-c:  < 100 mg/dL

• Triglycerides:  < 150 mg/dL

• HDL-c:   ≥ 60 mg/dL

For complete ranges, see this link: (4).

Q6. If my parents or siblings have high blood cholesterol or history of heart disease, am I at a higher risk of hypercholesterolemia?

Likely.  There are several factors that increase a risk of high cholesterol;  some factors you can change, and others you cannot.

• A family history of high cholesterol or familial hypercholesterolemia–an inherited genetic condition that causes very high LDL-c levels beginning at a young age.

• Race or ethnicity has overall characteristics:

• Higher total cholesterol levels in Caucasian Americans

• Higher LDL-c levels in Asian Americans, Indians, Filipinos, Japanese, and Vietnamese

• Lower HDL-c levels in Hispanic Americans

• Higher HDL-c levels in African Americans, but more likely to have other risk factors, such as high blood pressure, obesity, or diabetes

• Age may increase LDL-c levels.

• Gender:  Men are more likely to have higher total cholesterol levels than women; women’s risk goes up after menopause and during pregnancy.

• Obesity

• Certain medical conditions: chronic kidney disease, diabetes, HIV infection, hypothyroidism, lupus, multiple myeloma, polycystic ovary syndrome, and sleep apnea, etc.

• Medicines: some types of blood pressure lowering medications, some types of birth control, antivirals, anticonvulsants, and corticosteroids, etc.

Q7. Many people with high cholesterol are taking statins. Will they also work for me?

No one medication works for everyone. Statins work to block cholesterol production in the liver but may cause muscle pain for some.

The first lines of defense are lifestyle changes (modifiable risk factors mentioned under Q6). If lifestyle changes alone cannot manage desirable cholesterol levels, there are many types of cholesterol-lowering medications.  Based on a patient’s lipid profile, a physician will discuss available management/treatment plans, either a monotherapy or a combinational therapy. Other medications may limit absorption in the small intestine from diet, make more bile acids to aid digestion and help the liver absorb more LDL, or reduce production of VLDL or LDL and thus reduce triglycerides.  All medications have benefits and side effects.

Q8. Can I reverse high cholesterol?

Yes.  Making some lifestyle changes can lower cholesterol levels, and slow, stop, and/or reverse the build-up of plaque.  

Lifestyle modifications include:

• Eating a heart-healthy diet.

• Being physically active: Get regular aerobic exercise (at least 150 min/week).

• Limiting alcohol consumption.

• Maintaining a healthy weight.

• Managing stress.

• Quitting smoking and avoiding secondhand smoke.

• Getting enough good sleep.

• Managing conditions like high blood pressure and diabetes.

The American Heart Association has launched Check. Change. Control. CholesterolTM (5) to improve the identification and management of cholesterol.  By taking this questionnaire, you can learn your 10-year risk for heart disease or stroke and can then be guided for cholesterol management (if necessary).  As always, the references below provide additional information on this topic.

REFERENCES

1. CDC. High Cholesterol Facts https://www.cdc.gov/cholesterol/facts.htm#:~:text=High%20total%20cholesterol%20in%20the%20United%20States&text=Slightly%20more%20than%20half%20of,medicine%20are%20currently%20taking%20it.&text=Nearly%2094%20million%20U.S.%20adults,levels%20above%20200%20mg%2FdL

2. NIH. What is blood cholesterol? https://www.nhlbi.nih.gov/health/blood-cholesterol#:~:text=High%20levels%20of%20%E2%80%9Cbad%E2%80%9D%20LDL,your%20risk%20for%20health%20problems

3. NHLBI. Blood cholesterol diagnosis. https//www.nhlbi.nih.gov/health/blood-cholesterol/diagnosis#:~text=Screening%20may%20be%performed%20as,every%201%20to%202%20years  

4. Mayo Clinic. High cholesterol. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/diagnosis-treatment/drc-20350806

5. AMA. Check. Change. Control. Cholesterol. https://ccccalculator.ccctracker.com/

People with high cholesterol and at risk of high cholesterol should talk to their healthcare providers about cholesterol management strategies.   This information is provided for your reference and you use at your own risk; you should rely on your medical professional for medical advice.