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High Cholesterol – Hypercholesterolemia Information

What is cholesterol? — Cholesterol is a substance that is found in the blood. Everyone has some. It is needed for good health. The problem is, people sometimes have too much cholesterol. Compared with people with normal cholesterol, people with high cholesterol have a higher risk of heart attacks, strokes, and other health problems. The higher your cholesterol, the higher your risk of these problems.

Are there different types of cholesterol? — Yes, there are a few different types. If you get a cholesterol test, you might hear your doctor or nurse talk about:

  • Total cholesterol
  • LDL cholesterol – Some people call this the "bad" cholesterol. That's because having high LDL levels raises your risk of heart attacks, strokes, and other health problems.
  • HDL cholesterol – Some people call this the "good" cholesterol. That's because people with high HDL levels tend to have a lower risk of heart attacks, strokes, and other health problems.
  • Non-HDL cholesterol – Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol.
  • Triglycerides – Triglycerides are not cholesterol. They are another type of fat. But they often get measured when cholesterol is measured. (Having high triglycerides also seems to increase the risk of heart attacks and strokes.)

What should my numbers be? — Ask your doctor or nurse what your numbers should be. Different people need different goals. (If you live outside the United States, see the table (table 1)). In general, people who do not already have heart disease should aim for:

  • Total cholesterol below 200
  • LDL cholesterol below 130 – or much lower, if they are at risk of heart attacks or strokes
  • HDL cholesterol above 60
  • Non-HDL cholesterol below 160 – or lower, if they are at risk of heart attacks or strokes
  • Triglycerides below 150

Keep in mind, though, that many people who cannot meet these goals still have a low risk of heart attacks and strokes.

What should I do if my doctor tells me I have high cholesterol? — Ask your doctor what your overall risk of heart attacks and strokes is. High cholesterol, by itself, is not always a reason to worry. Having high cholesterol is just one of many things that can increase your risk of heart attacks and strokes. Other factors that increase your risk include:

  • Cigarette smoking
  • High blood pressure
  • Having a parent, sister, or brother who got heart disease at a young age – Young, in this case, means younger than 55 for men and younger than 65 for women.
  • A diet that is not heart healthy – A "heart-healthy" diet includes lots of fruits and vegetables, fiber, and healthy fats (like those found in fish and certain oils). It also means limiting sugar and unhealthy fats.
  • Older age

If you are at high risk of heart attacks and strokes, having high cholesterol is a problem. On the other hand, if you are at low risk, having high cholesterol might not lead to treatment.

Should I take medicine to lower cholesterol? — Not everyone who has high cholesterol needs medicines. Your doctor or nurse will decide if you need them based on your age, family history, and other health concerns.

You should probably take a cholesterol-lowering medicine called a statin if you:

  • Already had a heart attack or stroke
  • Have known heart disease
  • Have diabetes
  • Have a condition called peripheral artery disease, which makes it painful to walk, and happens when the arteries in your legs get clogged with fatty deposits
  • Have an abdominal aortic aneurysm, which is a widening of the main artery in the belly

Most people with any of the conditions listed above should take a statin no matter what their cholesterol level is. If your doctor or nurse puts you on a statin, stay on it. The medicine might not make you feel any different. But it can help prevent heart attacks, strokes, and death.

Can I lower my cholesterol without medicines? — Yes, you can lower your cholesterol some by:

  • Avoiding red meat, butter, fried foods, cheese, and other foods that have a lot of saturated fat
  • Losing weight (if you are overweight)
  • Being more active

Even if these steps do little to change your cholesterol, they can improve your health in many ways.

Hypercholesterolemia

What is familial hypercholesterolemia? — Familial hypercholesterolemia is a disorder that causes too much cholesterol and fat to build up in the body. When the cholesterol and fat build up inside the arteries in the heart, they can cause heart attacks. As a result, people with this disorder can have heart attacks at a very young age – sometimes even as children.

Familial hypercholesterolemia, often called "FH," is passed on in families. There are 2 main forms of the condition:

  • Heterozygous FH – In this form, a child gets the FH gene from just one parent.
  • Homozygous FH – In this form, a child gets the FH gene from both parents. This form of FH is much more severe than the other. People with homozygous FH have very high levels of cholesterol. They have a very high risk of having heart attacks and dying young.

What are the symptoms of FH? — The most serious symptom of FH is a heart attack. But thanks to medicines, the rates of heart attacks in people with FH have dropped.

FH can also cause firm, fatty deposits to form under the skin. These deposits are called "xanthomas." They can form on different parts of the body, such as at the heel of the foot, around the knee or elbow, and around the eyes.

Is there a test for FH? — Yes. Routine blood tests to measure cholesterol can show whether a person's cholesterol levels are unusually high. If so, the doctor or nurse can look further for a possible cause and can then find out if FH is the problem.

Children should have routine cholesterol tests once around age 9 to 11 and again around age 17 to 21. Some children get tested younger if they have a parent with FH or if they show signs of FH, such as xanthomas.

How is FH treated? — FH is usually treated with medicines called statins, which lower cholesterol. Some people also get other medicines to lower cholesterol. Plus, people with the most severe forms of FH need other special treatments.

If you have FH, it's very important that you take your medicines every day as directed. If the medicines cause any problems, or if you cannot afford your medicines, talk to your doctor or nurse. He or she might have possible solutions for you to try. The medicines used to treat FH can keep you from having a heart attack and help you live longer.

Your doctor and other health care providers might also suggest that you make changes to your diet.

What if I want to get pregnant? — Make sure you talk to your doctor before you start trying to get pregnant. He or she will need to check the condition of your heart to make sure pregnancy is safe. Plus, you will need to stop taking your FH medicines for at least 3 months before you start trying to get pregnant. That's because the medicines used to treat FH, including statins, can harm a baby. You should not take your FH medicines while you are pregnant or breastfeeding.

Be aware that there is a good chance you will pass on your disorder to your baby. Before you start trying to get pregnant, you and your partner should meet with your doctor to learn about the possible risks to your baby.

What will my life be like? — If you stay on your medicines, eat right, and do all the things your doctor recommends, you will greatly reduce your chances of having a heart attack. Even so, be aware that you have a high risk of heart attacks and strokes, so you should learn to recognize their symptoms (figure 1 and figure 2).