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Background |
Types of cholesterol |
Risk factors and causes |
Signs and symptoms |
Diagnosis and screening |
Complications |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
High cholesterol
High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthy high levels of cholesterol in the blood. It is also called dyslipidemia, hyperlipidemia, and lipid disorder.Too much cholesterol in the blood is a major risk for heart disease, which may lead to a heart attack, heart failure (cannot pump enough blood to the body), and death. High cholesterol levels are also a risk factor for stroke (lack of blood and oxygen to the brain), causing nerve damage.
Cholesterol is a soft, waxy, fat-like substance found within the bloodstream and cells of the body. Cholesterol synthesis is a naturally-occurring process that functions to produce membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as the male and female sex hormones (androgens and estrogens) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used in making vitamin D.
The body obtains cholesterol in two ways, producing the majority of it in the body, and consuming the rest in the diet in the form of animal products, such as meats, poultry, fish, eggs, butter, cheese and whole milk. Plant foods, like fruits, vegetables, and grains, do not contain cholesterol. Fat that occurs naturally contains varying amounts of saturated and unsaturated fat.
High cholesterol can cause the formation and accumulation of plaque deposits in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium, normal substances in the blood that become deposited on the artery walls if the blood does not flow properly. When plaque builds up in the arteries, it results in atherosclerosis (hardening of the arteries), or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries, which increase the risk for heart attack, stroke, and death, as well as circulation problems such as Raynaud's disease and high blood pressure.
The development of plaques and blockages in the arteries involves several steps. When the innermost lining of the arteries (endothelium) is damaged by oxidation, cholesterol particles, proteins and other substances deposit into the damaged wall and form plaques. More cholesterol and other substances incorporate into the plaque and the plaque grows, narrowing the artery. Over time, plaque deposits may grow large enough to interfere with blood flow through the artery (called a blockage). When the arteries supplying the heart with blood (coronary arteries) are blocked, chest pain (angina) may occur; when arteries in the legs are blocked, leg pain or cramping may occur; and when arteries supplying the brain with blood are blocked, stroke may occur.
The platelets collecting on the plaque deposit are forming a clot as they try to rush by and get caught because the lining of the artery is rough and the platelets are sticky. Then the clot can break off and travel through the body, getting lodged in vessels of the leg or brain and less commonly the lungs. If a plaque ruptures or tears, a blood clot (thrombus) may develop. If a blood clot completely blocks blood flow through a coronary artery, heart attack (myocardial infarction) occurs; if an artery supplying blood to the brain is completely blocked, stroke occurs.
Blood clots can break loose and travel through the bloodstream (called an embolus) and lodge in blood vessels in other parts of the body, including the lungs, heart, brain, and legs. A thromboembolus is when the blood clot lodges in vessels.
According to current estimates, 71.3 million people in America have one or more forms of heart disease. High cholesterol affects about 20% of adults over the age of 20 in the United States. The highest prevalence occurs in women between the ages of 65 and 74. The World Health Organization (WHO) reports that high cholesterol contributes to 56% of cases of coronary heart disease worldwide and causes about 4.4 million deaths each year.
Generally, people who live in countries where blood cholesterol levels are lower, such as Japan, have lower rates of heart disease. Countries with very high cholesterol levels, such as Finland, have very high rates of coronary heart disease. However, some populations with similar total cholesterol levels have very different heart disease rates, suggesting that other factors (such as diet, heredity, and smoking) also influence risk for coronary heart disease.
Evidence is accumulating that eating more carbohydrates, especially simpler, more refined carbohydrates such as white breads, sugar, and pasta, may increase levels of triglycerides in the blood, lower high density lipoprotein (HDL or "good" cholesterol), and may increase low density lipoprotein (LDL or "bad" cholesterol). Thus a low fat diet, which often means a higher carbohydrate intake, may actually be an unhealthy change.
Background
High cholesterol, or hypercholesterolemia, is a condition in which there are unhealthy high levels of cholesterol in the blood. It is also called dyslipidemia, hyperlipidemia, and lipid disorder.Too much cholesterol in the blood is a major risk for heart disease, which may lead to a heart attack, heart failure (cannot pump enough blood to the body), and death. High cholesterol levels are also a risk factor for stroke (lack of blood and oxygen to the brain), causing nerve damage.
Cholesterol is a soft, waxy, fat-like substance found within the bloodstream and cells of the body. Cholesterol synthesis is a naturally-occurring process that functions to produce membranes for all cells in the body, including those in the brain, nerves, muscles, skin, liver, intestines, and heart. Cholesterol is also converted into steroid hormones, such as the male and female sex hormones (androgens and estrogens) and the adrenal hormones (cortisol, corticosterone, and aldosterone). In the liver, cholesterol is the precursor to bile acids that aid in the digestion of food, especially fats. Cholesterol is also used in making vitamin D.
The body obtains cholesterol in two ways, producing the majority of it in the body, and consuming the rest in the diet in the form of animal products, such as meats, poultry, fish, eggs, butter, cheese and whole milk. Plant foods, like fruits, vegetables, and grains, do not contain cholesterol. Fat that occurs naturally contains varying amounts of saturated and unsaturated fat.
High cholesterol can cause the formation and accumulation of plaque deposits in the arteries. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium, normal substances in the blood that become deposited on the artery walls if the blood does not flow properly. When plaque builds up in the arteries, it results in atherosclerosis (hardening of the arteries), or coronary heart disease (CHD). Atherosclerosis can lead to plaque ruptures and blockages in the arteries, which increase the risk for heart attack, stroke, and death, as well as circulation problems such as Raynaud's disease and high blood pressure.
The development of plaques and blockages in the arteries involves several steps. When the innermost lining of the arteries (endothelium) is damaged by oxidation, cholesterol particles, proteins and other substances deposit into the damaged wall and form plaques. More cholesterol and other substances incorporate into the plaque and the plaque grows, narrowing the artery. Over time, plaque deposits may grow large enough to interfere with blood flow through the artery (called a blockage). When the arteries supplying the heart with blood (coronary arteries) are blocked, chest pain (angina) may occur; when arteries in the legs are blocked, leg pain or cramping may occur; and when arteries supplying the brain with blood are blocked, stroke may occur.
The platelets collecting on the plaque deposit are forming a clot as they try to rush by and get caught because the lining of the artery is rough and the platelets are sticky. Then the clot can break off and travel through the body, getting lodged in vessels of the leg or brain and less commonly the lungs. If a plaque ruptures or tears, a blood clot (thrombus) may develop. If a blood clot completely blocks blood flow through a coronary artery, heart attack (myocardial infarction) occurs; if an artery supplying blood to the brain is completely blocked, stroke occurs.
Blood clots can break loose and travel through the bloodstream (called an embolus) and lodge in blood vessels in other parts of the body, including the lungs, heart, brain, and legs. A thromboembolus is when the blood clot lodges in vessels.
According to current estimates, 71.3 million people in America have one or more forms of heart disease. High cholesterol affects about 20% of adults over the age of 20 in the United States. The highest prevalence occurs in women between the ages of 65 and 74. The World Health Organization (WHO) reports that high cholesterol contributes to 56% of cases of coronary heart disease worldwide and causes about 4.4 million deaths each year.
Generally, people who live in countries where blood cholesterol levels are lower, such as Japan, have lower rates of heart disease. Countries with very high cholesterol levels, such as Finland, have very high rates of coronary heart disease. However, some populations with similar total cholesterol levels have very different heart disease rates, suggesting that other factors (such as diet, heredity, and smoking) also influence risk for coronary heart disease.
Evidence is accumulating that eating more carbohydrates, especially simpler, more refined carbohydrates such as white breads, sugar, and pasta, may increase levels of triglycerides in the blood, lower high density lipoprotein (HDL or "good" cholesterol), and may increase low density lipoprotein (LDL or "bad" cholesterol). Thus a low fat diet, which often means a higher carbohydrate intake, may actually be an unhealthy change.
Types of cholesterol
Saturated fats: Saturated fats are solid at room temperature, Foods that contain a high proportion of saturated fat are butter, lard, coconut oil, cottonseed oil and palm oil, dairy products (such as cream and cheese), meat, skin, and some prepared foods. People with diets high in saturated fat are reported to have an increased incidence of atherosclerosis (hardening of the arteries) and coronary heart disease. Saturated fats are popular with manufacturers of processed foods because they are less vulnerable to rancidity and are generally more solid at room temperature than unsaturated fats.Unsaturated fats: Unsaturated fats are liquid at room temperature. Unsaturated fats include monounsaturated and polyunsaturated fats. Monounsaturated fat remains liquid at room temperature but may start to solidify in the refrigerator. Foods high in monounsaturated fat include olive, peanut and canola oils. Avocados and most nuts also have high amounts of monounsaturated fat. Polyunsaturated fat is usually liquid at room temperature and in the refrigerator. Foods high in polyunsaturated fats include vegetable oils, such as safflower, corn, sunflower, soy and cottonseed oils. The use of monounsaturated and polyunsaturated fats instead of saturated fat can help to lower blood cholesterol levels.
Trans fats: Trans fatty acids (trans fats) are a type of unsaturated fat. Trans fat is formed when liquid vegetable oils go through a chemical process called hydrogenation, in which hydrogen is added to make the oils more solid. Hydrogenated vegetable fats are utilized in food production because they allow longer shelf-life and give food desirable taste, shape and texture. Trans fat can be found in shortenings (Crisco®), margarine, cookies, crackers, snack foods, fried foods (including fried fast food), doughnuts, pastries, baked goods, and other foods processed with partially hydrogenated oils. Some trans fat is found naturally in small amounts in dairy products and some meats. The primary health risk associated with trans fat consumption is an increased risk of coronary heart disease (CHD). Effective Jan. 1, 2006, the U.S. Food and Drug Administration (FDA) requires food companies to list trans fat content separately on the nutrition facts panel of all packaged foods.
Lipoproteins: Cholesterol and other fats cannot dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins. There are two main types of lipoproteins, including low-density lipoprotein (LDL, or the "bad" cholesterol) and high-density lipoprotein (HDL, or the "good" cholesterol). Another type, very low density lipoprotein (VLDL) is converted to LDL in the bloodstream. Each form of lipoprotein contains a specific combination of cholesterol, protein, and triglyceride (a blood fat). VLDL cholesterol contains the highest amount of triglyceride.
Too much LDL cholesterol can block the arteries, increasing the risk of heart attack and stroke. LDL takes cholesterol into the bloodstream and HDL takes it back to the liver for storage. It is also believed that HDL removes excess cholesterol from plaque in arteries, thus slowing the buildup. Studies suggest that high levels of HDL cholesterol reduce the risk of heart attack.
Lipoprotein (a) (Lp(a)) cholesterol: Lp(a) is a lipoprotein (fat/protein molecule) found in the body that is a genetic variation of LDL cholesterol. A high level of Lp(a) is an important risk factor for developing fatty deposits in arteries. The way an increased Lp(a) contributes to disease is not understood, but Lp(a) may attract substances that increase inflammation, such as interleukins (Il-1, Il-6, TNF-alpha) and prostaglandins (PG2), leading to the buildup of fatty deposits.
Triglycerides: Triglycerides are the body's storage form for fat. Most triglycerides are found in adipose (fat) tissue. Some triglycerides circulate in the blood to provide fuel for muscles to work. Extra triglycerides are found in the blood after eating a meal when fat is being sent from the intestines to fat tissue for storage. People with high triglycerides often have high triglycerides, high LDL cholesterol, and low HDL cholesterol level. Many people with heart disease also have high triglyceride levels. People with diabetes or who are overweight are also likely to have high triglycerides.
Risk factors and causes
Diet: Saturated fat and cholesterol in foods makes total cholesterol and low density lipoprotein (LDL) levels rise. Cholesterol is consumed in the diet in the form of animal products, such as meats, poultry, fish, eggs, butter, cheese and whole milk. Plant foods, like fruits, vegetables, and grains, do not contain cholesterol. Fat that occurs naturally contains varying amounts of saturated and unsaturated fat.Weight: Being overweight may increase "bad" cholesterol levels and is a risk factor for heart disease. Losing weight may help lower LDL, triglyceride, and total cholesterol levels, as well as raise HDL. Individuals with a large waist measurement (more than 40 inches for men and more than 35 inches for women) are at high risk for heart disease.
Physical activity: A lack of physical activity is a risk factor for heart disease. Exercise helps strengthen the heart and blood vessels. Exercising regularly can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. Being physically active for at least 30 minutes on most, if not all, days may help with reducing the risk of developing high cholesterol and coronary heart disease.
Age and gender: Cholesterol levels rise with age, due to various factors including hormonal changes, diet, and general health. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise due to hormonal imbalances. As a rule, women have higher HDL cholesterol levels than men do. The female sex hormone estrogen tends to raise HDL cholesterol, which may help explain why pre-menopausal women are usually protected from developing heart disease. Estrogen production is highest during the childbearing years (20s to 40s). Women also tend to have higher triglyceride levels. As people get older and/or gain weight, their triglyceride and cholesterol levels tend to rise. Evidence reports that the atherosclerotic process (buildup of fatty plaque in arteries) begins in childhood and progresses slowly into adulthood. Then it often leads to coronary heart disease, the single leading cause of death in the United States. Eating patterns and genetics affect blood cholesterol levels in children and increase the risk of developing heart disease later in life.
Heredity: Genetics partially determine how much cholesterol is produced endogenously. High blood cholesterol can run in families. If a parent or sibling developed heart disease before age 55, high cholesterol levels place an individual at a greater than average risk of developing heart disease.
Smoking: Cigarette smoking damages the walls of blood vessels through a process called oxidation, making them prone to build up fatty deposits. Smoking may also lower levels of HDL cholesterol.
High blood pressure: Increased pressure on the blood vessel walls damages arteries, which can speed the accumulation of plaque.
Diabetes: High blood sugar contributes to high LDL cholesterol and low HDL cholesterol. High blood sugar can also damage the lining of the arteries, making it easier for plaque (protein, fat, and cholesterol) to deposit.
Others: Kidney disease (nephrotic syndrome), hypothyroidism (low thyroid levels), anorexia nervosa (eating disorder), and Zieve's syndrome (a condition that causes high cholesterol during withdrawal from long term alcohol abuse) can all contribute to high cholesterol.
Signs and symptoms
High cholesterol does not lead to specific symptoms unless it has been chronic (long-term). High cholesterol levels may lead to specific physical findings such as xanthoma (thickening of tendons due to accumulation of cholesterol), xanthelasma (yellowish patches around the eyelids), and arcus senilis (white discoloration of the outer edges of the cornea due to cholesterol deposits).A high level of blood cholesterol causes the arteries to narrow and can slow, or even block, blood flow to the heart. This reduced blood supply prevents the heart from receiving enough oxygen. Chronic (long-term) high cholesterol can lead to atherosclerosis (hardening of the arteries), angina (chest pain), heart attack, transient ischemic attacks (TIAs, or temporary lack of blood flow and oxygen to the brain), cerebrovascular accidents/strokes (lack of blood and oxygen in the brain), and peripheral artery disease (PAD).
Diagnosis and screening
Recommendations for cholesterol screening and treatment have been provided by the National Institutes of Health (NIH) and are summarized in the National Cholesterol Education Program (NCEP). The guidelines recommend that all adults have their cholesterol levels checked at least once every five years. Patients with coronary heart disease or other forms of atherosclerosis are at the highest risk for heart attack and stroke (lack of blood and oxygen to the brain). These patients may benefit the most from cholesterol-reduction therapy and should have a full lipid profile (lipid panel) performed annually. This includes measuring total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglycerides. Very low density lipoproteins (VLDL) and lipoprotein a (Lp(a)) levels can also be taken. For the most accurate measurements, there is no eating or drinking anything (other than water) for nine to 12 hours before the blood sample is taken.There is no formula to determine what cholesterol level is considered "safe" and what cholesterol level requires treatment for each individual. General recommendations are based on ongoing research regarding future risk for heart attack. In a person with established coronary heart disease, the risk for heart attack (or subsequent heart attack) and death is much higher, so even mildly elevated cholesterol levels must be treated aggressively.
Total cholesterol levels: The total blood cholesterol will fall into one of three categories, including desirable (less than 200mg/dL, or milligrams per deciliter), borderline high risk (200-239mg/dL), and high risk (240mg/dL and above).
If the total cholesterol is less than 200mg/dL, the risk of heart attack risk is relatively low, unless there are other risk factors, such as smoking, a previous heart attack, or high blood pressure.
If the total cholesterol level is from 200-239mg/dL, individuals are classified as borderline high risk. About one-third of American adults are in this group, whereas almost one-half of adults have total cholesterol levels below 200mg/dL. Not every person whose cholesterol level is in the 200-239 range is at increased risk.
If the total cholesterol level is 240mg/dl or more, an individual is at high risk of heart attack and stroke. In general, people who have a total cholesterol level of 240mg/dL have twice the risk of coronary heart disease as people whose cholesterol level is 200mg/dL. About 20% of the U.S. population has high blood cholesterol levels.
Lipoprotein levels: LDL or "bad" cholesterol is a major risk factor for developing atherosclerosis (hardening of the arteries) and coronary artery disease (CAD). LDL levels are reported in several categories. An LDL level below 100mg/dL is best for people at risk for heart disease. If an individual is at very high risk for heart disease, such as having a previous heart attack, and LDL level less than 70mg/dl is optimal. LDL levels can also be near optimal (100 - 129mg/dl), borderline high (130 - 159mg/dl), high (160 - 189mg/dl), and very high (190mg/dl and above). HDL ("good") cholesterol protects against heart disease, so for HDL, higher numbers are better. A level less than 40mg/dL is low and is considered a major risk factor for developing heart disease. HDL levels of 60mg/dL or more help to lower the risk for developing heart disease.
Triglyceride levels: High levels of triglycerides can increase heart disease risk. Levels that are borderline high (150 - 199mg/dL) or high (200mg/dL or more) may need treatment.
Children: Total cholesterol levels in children and adolescents (2-19 years old) are acceptable (less than 170mg/dl), borderline (170 - 199mg/dl, and high (200mg/dl and greater). LDL cholesterol levels for children include acceptable (less than 110mg/dl, borderline (110 - 129mg/dl), and high (130mg/dl or greater).
Complications
Possible complications of high cholesterol include atherosclerosis (hardening of the arteries), coronary artery disease (CAD) or coronary heart disease (CAD), stroke (lack of blood flow to the brain), heart attack, and death. As discussed, high cholesterol levels can lead to plaque deposits in blood vessels. Plaque is composed of cholesterol, other fatty substances, fibrous tissue, and calcium, normal substances in the blood that become deposited on the artery walls if the blood does not flow properly. Over time, plaque deposits may grow large enough to interfere with blood flow through the artery (called a blockage). When the arteries supplying the heart with blood (coronary arteries) are blocked, chest pain (angina) may occur; when arteries in the legs are blocked, leg pain or cramping may occur; and when arteries supplying the brain with blood are blocked, stroke may occur.Treatment
The main goal of cholesterol-lowering treatment is to lower low density lipoprotein (LDL) levels enough to reduce the risk of developing heart disease or having a heart attack. The higher the risk, the lower the LDL goal should be. There are two main ways to lower cholesterol, including therapeutic lifestyle changes (TLC) and drug therapy. TLC includes a cholesterol-lowering diet (called the TLC diet), physical activity, and weight management. TLC is for anyone whose LDL is above their target number and goal. Drug treatment with cholesterol-lowering drugs can be used together with TLC treatment to help lower LDL. Prevention of elevated cholesterol is started if the individual is at risk for high cholesterol levels or heart disease, or a previous heart attack or stroke has occurred.Category I, highest risk: In those with highest risk, the LDL goal is less than 100mg/dL. They will begin the TLC diet to reduce high risk even if the LDL is below 100mg/dL. If the LDL is 100 or above, drug treatment will be started at the same time as the TLC diet. If the LDL is below 100mg/dL, drug treatment may also be started together with the TLC diet if the doctor finds the risk is very high, for example if the individuals has had a recent heart attack or has both heart disease and diabetes.
Category II, next highest risk: The LDL goal is less than 130mg/dL. If the LDL is 130mg/dL or above, treatment with the TLC diet should be started. If the LDL is 130mg/dL or more after 3 months on the TLC diet, drug treatment is started along with the TLC diet. If the LDL is less than 130mg/dL, individuals should follow the heart healthy diet for all Americans, which allows a little more saturated fat and cholesterol than the TLC diet.
Category III, moderate risk: The LDL goal is less than 130mg/dL. If the LDL is 130mg/dL or above, the TLC diet is started. If the LDL is 160mg/dL or more after having tried the TLC diet for 3 months, drug treatment may be started along with the TLC diet. If the LDL is less than 130mg/dL, the heart healthy diet for all Americans (low saturated fat and cholesterol) is used.
Category IV, low-to-moderate risk: The LDL goal is less than 160mg/dL. If the LDL is 160mg/dL or above, the TLC diet is started. If the LDL is still 160mg/dL or more after three months on the TLC diet, drug treatment may be started along with the TLC diet to lower LDL, especially if the LDL is 190mg/dL or more. If the LDL is less than 160mg/dL, the heart healthy diet for all Americans is used.
Diet: Individuals with high risk associated with developing heart disease will be started on the therapeutic lifestyle changes (TLC) diet. The TLC diet is a low-saturated-fat, low-cholesterol eating plan that calls for less than 7% of calories to come from saturated fat (such as in animal products) and less than 200 milligrams of dietary cholesterol daily. The TLC diet recommends only enough calories to maintain a desirable weight and avoid weight gain. If the LDL is not lowered enough by reducing saturated fat and cholesterol intakes, the amount of soluble fiber, such as psyllium, oat bran, and beta-glucan, in the diet can be increased (found in cereals, breads, and supplements), thereby helping to raise HDL and lower LDL. Certain food products that contain plant sterols (a cholesterol lowering component in many plants) can also be added to the TLC diet to boost its LDL-lowering power. Examples include cholesterol-lowering margarines (containing Benecol®, a plant sterol) and sterol supplements in capsule and tablet form. Plant sterols are found naturally in fruits, vegetables, nuts, seeds, cereals, legumes (beans), and vegetable oils (particularly soybean oil).
Weight management: When the body mass index (BMI, or fat content) is greater than 25, an individual is considered overweight. BMI uses an equation based on height and weight to determine the level of obesity. Losing weight can help lower LDL and is especially important for those with a cluster of risk factors that includes high triglyceride and/or low HDL levels.
Physical activity: Regular physical activity (at least 30 minutes on most, if not all, days) is recommended for those that can tolerate exercise. Taking a brisk 30-minute walk, three to four times a week can positively impact cholesterol levels. Patients with chest pain and/or known or suspected heart disease should talk to their doctor before beginning any exercise program. Exercise can help raise HDL and lower LDL and is especially important for those with high triglyceride and/or low HDL levels who are overweight with a large waist measurement. Individuals with a large waist measurement (more than 40 inches for men and more than 35 inches for women) are at high risk for heart disease.
Medication therapy: There are several medications that may help lower cholesterol, including total cholesterol, lipoproteins, and triglycerides. Medications can reduce LDL cholesterol levels by 20-40%. They also can modestly increase HDL ("good") cholesterol levels, usually by about 5-10%. Available drugs include 5-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors), bile-acid-binding resins, cholesterol absorption inhibitors, fibrates, and niacin.
5-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (HMG-CoA reductase inhibitors, or statins): Statins have significantly advanced the treatment of high cholesterol. Statins block a substance (HMG-CoA reductase) that the liver needs to make cholesterol. This decreases cholesterol in liver cells (hepatocytes), which causes the liver to remove cholesterol from the blood, thereby lowering cholesterol levels. Statins may also help the body reabsorb cholesterol from accumulated deposits on artery walls, potentially reversing coronary artery disease. Commonly prescribed statins include atorvastatin (Lipitor®), fluvastatin (Lescol®), lovastatin (Mevacol®), pravastatin (Pravachol®), rosuvastatin calcium (Crestor®), and simvastatin (Zocor®). Statins may also be added to blood pressure lowering drugs for use in protection from coronary heart disease (Caduet® a combination of atorvastatin (Lipitor®) and amlodipine (Norvasc®). Results from statin treatment should be seen after several weeks, with a maximum effect in four to six weeks. After about six to eight weeks, a doctor will check the LDL cholesterol levels while the individual is on the statin. Serious side effects are rare, and include liver problems, and muscle soreness, pain, and weakness. If this happens, or if there is brown urine present, contact a doctor immediately. Although rare, muscle breakdown, known as rhabdomyolysis, can occur. This is a medical emergency and a doctor should be contacted immediately.
Bile-acid-binding resins (sequestrants): The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite®, Questran®), colesevelam (WelChol®), and colestipol (Colestid®) lower cholesterol indirectly by binding to bile acids (called sequestrant therapy). This causes the liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in the blood. Bile acid sequestrant powders must be mixed with water or fruit juice and must be taken once or twice (rarely, three times) daily with meals. Tablets must be taken with large amounts of fluids to avoid stomach and intestinal problems. Sequestrant therapy may produce a variety of symptoms, including constipation, bloating, nausea, and gas. Although sequestrants are not absorbed, they may interfere with the absorption of other medicines if taken at the same time. Other medications should be taken at least one hour before or four to six hours after taking the sequestrant.
Cholesterol absorption inhibitors: The small intestine absorbs the cholesterol from the diet and releases it into the bloodstream. The drug ezetimibe (Zetia®) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia® can cause headaches, nausea and fever, and muscle weakness. Zetia® by itself lowers LDL cholesterol levels similar to statins, but when combined with a statin, Zetia® works better to control elevated LDL levels. There is a combination of ezetimibe and simvastatin on the market (Vytorin®).
Fibrates: The medications fenofibrate (Lofibra®, Tricor®) and gemfibrozil (Lopid®) decrease triglycerides by reducing the liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from the blood. VLDL cholesterol contains mostly triglycerides. Some people taking fibrates may have side effects such as stomach or intestinal discomfort. Fibrates may increase the likelihood of developing gallstones and can increase the effect of medications that thin the blood. The dose of fibrates should be reduced if kidney function declines.
Niacin: Niacin, also known as nicotinic acid or vitamin B3, decreases triglycerides by limiting the liver's ability to produce low density lipoprotein (LDL) and VLDL cholesterol. There are two types of niacin: immediate release and extended (or slow) release. Niacin can reduce LDL cholesterol levels by 10-20%, reduce triglycerides by 20-50%, and raise HDL cholesterol by 15-35%. A common and troublesome side effect of immediate release niacin is flushing or hot flashes, which are the result of blood vessels opening wide. The causes of this flushing are not well known. Most people develop a tolerance to flushing, which can sometimes be decreased by taking the drug during or after meals or by the use of aspirin 30 minutes prior to taking niacin - a doctor will guide the individual. The extended-release form may cause less flushing than the other forms (Niaspan®). Individuals will be started on regular niacin therapy to see how well it is tolerated, then the individual can be started on the extended release products if needed. Blood pressure may also be reduced while taking niacin. Niacin can cause a variety of gastrointestinal symptoms, including nausea, indigestion, gas, vomiting, diarrhea, and the irritation of peptic ulcers.
Other: If there are other symptoms of coronary heart disease (CHD) besides high cholesterol, other medications may be used to decrease the risk of stroke (lack of blood and oxygen to the brain) and heart attack. These include platelet inhibitors ("thin" the blood) such as aspirin (81-325mg daily, may cause bleeding) or Plavix® (clogidogrel), beta blockers (decrease the heart rate and blood pressure, reducing the heart's demand for oxygen, may cause fatigue) such as metoprolol (Lopressor®, Toprol®), nitroglycerin (increases the oxygen available to the heart by dilating coronary arteries, may cause headache), calcium channel blockers (slow heart rate and dilate coronary blood vessels, may cause slow heart rate) such as amlodipine (Norvasc®) or diltiazem (Cardizem®), angiotensin inhibiting drugs or ACE inhibitors (dilate blood vessels and increase oxygen to the heart, may cause cough) such as lisinopril (Prinivil®, Zestril®) or ramipril (Altace®), and statins or HMG-CoA reductase inhibitors (help lower cholesterol levels, may cause liver problems or muscle pain) such as atorvastatin (Lipitor®) or lovastatin (Mevacor®). Interventional procedures may also be used to treat CHD, including balloon angioplasty (PTCA or percutaneous transluminal coronary angioplasty) and stent (a wire mesh that opens blocked blood vessels) placement. Coronary artery bypass graft (CABG) surgery may be required to restore normal blood flow to the heart. CABG is a serious surgery, with complications including infection, lowered immunity, memory loss, "fuzzy" thinking, and even death.
Integrative therapies
Strong scientific evidence:Beta glucan: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. Numerous trials have examined the effects of oral beta-glucan on cholesterol. Small reductions in total and LDL cholesterol ("bad" cholesterol) have been reported. Little to no significant changes have been noted to occur on triglyceride levels or HDL ("good" cholesterol) levels. The sum of existing positive evidence is suggestive and not definitive.
Beta-sitosterol: Beta-sitosterol is one of the most common dietary phytosterols (plant sterols) found and synthesized exclusively by plants such as in fruits, vegetables, soybeans, breads, peanuts and peanut products. Many studies in humans and animals have demonstrated that supplementation of beta-sitosterol into the diet decreases total serum cholesterol, as well as low-density lipoprotein (LDL) cholesterol.
Niacin: Niacin, also known as vitamin B3 or nicotinic acid, is a well-accepted treatment for high cholesterol. Multiple studies show that niacin (not niacinamide) has significant benefits on levels of high-density cholesterol (HDL or "good cholesterol"), with better results than prescription drugs such as "statins" like atorvastatin (Lipitor®). There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. Adding niacin to a second drug such as a statin may increase the effects on low-density lipoproteins. The use of niacin for the treatment of dyslipidemia associated with type 2 diabetes has been controversial because of the possibility of worsening glycemic control. Niacin is available as an over-the-counter (OTC) drug in a lower strength that the prescription medicine.
Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. There should be a balance of omega-6 and omega-3 fatty acids for health. There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements significantly reduce blood triglyceride levels. Fish oil supplements also appear to cause small improvements in high-density lipoprotein ("good cholesterol"); however, increases (worsening) in low-density lipoprotein levels (LDL/"bad cholesterol") are also observed. Several well-conducted randomized controlled trials report that in people with a history of heart attack, regular consumption of oily fish or fish oil/omega-3 supplements reduces the risk of non-fatal heart attack, fatal heart attack, sudden death, and all-cause mortality (death due to any cause). Most patients in these studies were also using conventional heart drugs, suggesting that the benefits of fish oils may add to the effects of other therapies. Preliminary studies also report reductions in angina (chest pain) associated with fish oil intake. Better research is necessary before a firm conclusion can be drawn. Caution is advised when taking omega-3 supplements, as an increase in bleeding is possible, especially if taken with medications for bleeding disorders.
Policosanol: Policosanol is a cholesterol-lowering natural mixture of higher aliphatic primary alcohols, isolated and purified from sugar cane wax. Policosanol has been used to treat hypercholesterolemia (high cholesterol levels), and numerous studies have analyzed the effects of policosanol on cholesterol levels, including a number of well-designed trials. There is a plausible, well-described mechanism supporting this use. Notably, most human studies have been conducted in Cuba, and many have been conducted by the same author(s). At this time, the evidence supporting the efficacy of this agent is compelling, although greater acceptance in the U.S. market may await conduct of a large, well-conducted randomized trial in the U.S. Caution is advised when taking policosanol, as adverse effects including drug interactions are possible. Policosanol supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives, including products such as Metamucil® and Serutan®. Psyllium is well studied as a cholesterol lowering agent with generally modest reductions seen in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol"). Effects have been observed following eight weeks of regular use. Psyllium does not appear to have significant effects on high-density lipoprotein ("good cholesterol") or triglyceride levels. Because only small reductions have been observed, people with high cholesterol should discuss the use of more potent agents with their healthcare provider. Effects have been observed in adults and children, although long-term safety in children is not established. Psyllium can decrease the absorption of many prescription and non-prescription medications and dietary supplements. Psyllium should be taken either one half hour before or two hours after taking prescription and non-prescription medications and dietary supplements.
Red yeast rice: Red yeast rice is the product of yeast (Monascus purpureus) grown on rice, and is served as a dietary staple in some Asian countries. It contains several compounds collectively known as Monacolins, substances known to inhibit cholesterol synthesis. One of these, "Monacolin K" is a potent inhibitor of HMG-CoA reductase, and is also known as lovastatin (Mevacor®). Preliminary evidence reports that taking red yeast rice by mouth may result in cardiovascular benefits and improve blood flow. Since the 1970s, human studies have reported that red yeast lowers blood levels of total cholesterol, low-density lipoprotein/LDL ("bad cholesterol"), and triglyceride levels. Adverse effects including drug interactions are possible when using red yeast rice supplements. Red yeast rice supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. Red yeast rice should not be used in people with liver problems or in heavy alcohol users due to the potential for an increase in liver damage.
Soy: Soy (Glycine max) is a member of the pea family and has been a dietary staple in Asian countries for at least 5,000 years. Numerous human studies report that adding soy protein to the diet can moderately decrease blood levels of total cholesterol and low-density lipoprotein ("bad" cholesterol). Small reductions in triglycerides may also occur, while high-density lipoprotein ("good" cholesterol) does not seem to be significantly altered. Dietary soy protein has not been proven to affect long-term cardiovascular outcomes such as heart attack or stroke. Soy products such as tofu are high in protein and are an acceptable source of dietary protein. Soy supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor. It is not known if soy products increase the risk of developing breast cancer, so healthcare professionals recommend not using soy if there is a history of breast cancer or risk factors, such as taking hormonal replacement therapy (including estrogen and progesterone).
Good scientific evidence:
Betaine: Betaine is found in most microorganisms, plants, and marine animals. Its main physiologic functions are to protect cells under stress and to function as a source of methyl groups needed for many biochemical pathways. Betaine is also found naturally in many foods and is most highly concentrated in beets, spinach, grain, and shellfish. Overall, betaine supplementation may produce significant reductions in homocysteine, a known risk factor of CAD. However, additional studies are needed.
Cordyceps: Cordyceps sinensis is a fungus found mainly in China, Nepal, and Tibet. Cordyceps supplements may lower total cholesterol and triglyceride levels, although these changes may not be permanent or long lasting. Longer studies with follow up are needed to determine the long-term effects of cordyceps on hyperlipidemia.
Garlic: Garlic (Allium sativum) is traditionally used for heart health. Multiple studies in humans have reported small reductions in total blood cholesterol and low-density lipoproteins ("bad cholesterol") over short periods of time (4 to 12 weeks). It is not clear if there are benefits after this amount of time. Effects on high-density lipoproteins ("good cholesterol") are not clear. This remains an area of controversy. Well-designed and longer studies are needed in this area. Caution is advised when taking garlic supplements, as adverse effects including an increase in bleeding are possible, especially if taking drugs for bleeding disorders such as warfarin (Coumadin®). Garlic supplements should not be used if pregnant or breastfeeding, unless otherwise directed by a doctor.
L-carnitine: L-carnitine, or acetyl-L-carnitine, is an amino acid found in the body. Evidence from clinical trials suggests that L-carnitine is effective in reducing symptoms of angina. Carnitine may not offer further benefit when patients continue conventional therapies. Additional study is needed to confirm these findings. L-carnitine is generally safe when used in the recommended dosage.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several human studies suggest that yoga is helpful in people with heart disease. However, it is not clear if yoga reduces the risk of heart attack or death, or if yoga is better than any other form of exercise therapy or lifestyle/dietary change. Therefore, yoga may be a useful addition to standard therapies (such as medications for blood pressure or cholesterol) in people at risk for heart attacks, but further research is necessary.
Unclear or conflicting scientific evidence:
Acupuncture: The practice of acupuncture, or the insertion of needles into the body at various energy points, originated in China 5,000 years ago. Some research has suggested that acupuncture might help reduce distress and symptoms of angina, but this has not been consistently shown in other studies.
L-arginine: L-arginine, or arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required. There is initial evidence from several studies that arginine taken by mouth or by injection improves exercise tolerance and blood flow in arteries of the heart. Benefits have been reported in some patients with coronary artery disease and angina. Studies also suggest that arginine supplementation after myocardial infarction (heart attack) may decrease heart damage. However, further research is needed to confirm these findings. L-arginine is generally safe in the recommended dosage.
Astragalus: Astragalus products are derived from the roots of Astragalus membranaceus or related species, which are native to China. In Chinese medicine, herbal mixtures containing astragalus have been used to treat heart diseases. There are several human case reports of reduced symptoms and improved heart function, although these are not well described. High quality human research is necessary before a conclusion can be drawn.
Astaxanthin: Astaxanthin is classified as a xanthophyll, which is a carotenoid (naturally occurring pigment or coloring), and can be found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. There is insufficient evidence to recommend for or against the use of astaxanthin for LDL oxidation prevention. More research is needed to make a firm recommendation. Caution is advised when taking astaxanthin, as adverse effects including an increase in bleeding and drug interactions are possible.
Bilberry: Bilberry (Vaccinium myrtillus), also known as the European blueberry, is widely used as an antioxidant for general health. Bilberry has been used traditionally to treat heart disease and atherosclerosis. There is some laboratory research in this area, but there is no clear information in humans. Caution is advised when taking bilberry supplements, as adverse effects including an increase in bleeding and drug interactions are possible.
Coenzyme Q10 (CoQ10): CoQ10 is a vitamin-like substance produced by the human body and is necessary for the basic functioning of cells. Preliminary small human studies suggest that CoQ10 may reduce angina and improve exercise tolerance in people with clogged heart arteries. Several studies also suggest that the function of the heart may be improved after major heart surgeries such as coronary artery bypass graft (CABG) or valve replacement when CoQ10 is given to patients before or during surgery. Better studies are needed. CoQ10 is considered safe in recommended dosages.
Ginseng: Asian ginseng, or Panax ginseng, has been used for more than 2,000 years in Chinese medicine for various health conditions. Several studies from China report that ginseng in combination with various other herbs may reduce symptoms of coronary artery disease. Ginseng may also lower blood pressure. Caution is advised when taking ginseng supplements, as adverse effects including drug interactions are possible.
Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant, but processed differently. There is evidence that regular intake of green tea may lower cholesterol levels and reduce the risk of heart attack or atherosclerosis (clogged arteries).
Hawthorn: Hawthorn (Crataegus sp.), a flowering shrub of the rose family, has an extensive history of use in cardiovascular disease dating back to the 1st Century. Increased blood flow to the heart and heart performance have been observed in animals when given hawthorn supplements, and one randomized clinical trial indicates that hawthorn may be effective in decreasing frequency or severity of anginal symptoms. Hawthorn has not been tested in the setting of concomitant drugs such as beta-blockers or ACE-inhibitors, which are often considered to be standard-of-care. At this time, there is insufficient evidence to recommend for or against hawthorn for coronary artery disease or angina.
Kudzu: Kudzu (Pueria lobota) is well known to people in the southeastern United States as an invasive weed, but it has been used in Chinese medicine for centuries. Kudzu has a long history of use in the treatment of cardiovascular disorders, including angina, acute myocardial infarction, and heart failure. A small number of poorly designed trials found kudzu to reduce the frequency of angina events in human subjects. Overall, the studies have been methodologically weak.
Kundalini yoga: Kundalini yoga is one of many traditions of yoga that share common roots in ancient Indian philosophy. It is comprehensive in that it combines physical poses with breath control exercises, chanting (mantras), meditations, prayer, visualizations, and guided relaxation. One case series report, but no formal clinical trials, suggests that breathing techniques used in Kundalini Yoga may help people with angina pectoris (chest pain) reduce symptoms and need for medication.
Prayer: Prayer has far reaching healing effects that are hard to study. Initial studies in patients with heart disease report variable effects on severity of illness, complications during hospitalization, procedure outcome, or death rates when intercessory prayer is used.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). Its purpose is the exploration of thoughts, feelings and behavior for the purpose of problem solving or achieving higher levels of functioning. Alexithymia, or the inability to express one's feelings, may influence the course of coronary heart disease (CHD). Educational sessions and group psychotherapy may decrease alexithymia and reduce cardiac events.
Quercetin: Quercetin is one of the almost 4,000 bioflavonoids (antioxidants) that occur in foods of plant origin, such as red wine, onions, green tea, apples, berries, and brassica vegetables (cabbage, broccoli, cauliflower, turnips). Several of the effects of flavonoids that have been observed in laboratory and animal studies suggest that they might be effective in reducing cardiovascular disease risk. Studies in humans using polyphenolic compounds from red grapes showed improvement in endothelial function in patients with coronary heart disease. Antioxidant and cholesterol-lowering effects are proposed.
Reishi: Reishi (Ganoderma lucidum) is a fungus (mushroom) that grows wild on decaying logs and tree stumps. Reishi has been used in traditional Chinese medicine for more than 4,000 years to treat liver disorders, high blood pressure, arthritis and other ailments. A reishi supplement was reported to improve the major symptoms of coronary heart disease (angina, palpitations, shortness of breath, elevated blood pressure, and high cholesterol) in patients. Long-term studies are needed to evaluate the efficacy and safety of reishi in coronary heart disease. Caution is advised when taking reishi supplements, as adverse effects, including an increase in bleeding, and drug interactions, are possible.
Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus.
Resveratrol: Resveratrol is found in over 70 plant species including nuts, grapes, pine trees, certain vines and red wine. Resveratrol is used as an antioxidant in various health conditions, including heart disease prevention. Laboratory animal studies suggest resveratrol helps restore blood flow to the heart. Well-designed clinical trials in humans using resveratrol are needed.
Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th century China. Tai chi techniques aim to address the body and mind as an interconnected system, and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility and strength. There is evidence that suggests tai chi decreases blood pressure and cholesterol as well as enhances quality of life in patients with chronic heart failure. Most studies have used elderly Chinese patients as their population. Additional research is needed before a firm conclusion can be drawn.
Vitamin B12: Vitamin B12 (or cyanocobalamin) is an essential water soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meats, and dairy products. Vitamin B12 is frequently used in combination with other B vitamins in a vitamin B complex formulation. Folic acid, pyridoxine (vitamin B6), and vitamin B12 supplementation can reduce total homocysteine levels (a known risk factor of CAD). However, this reduction does not seem to help with secondary prevention of death or cardiovascular events such as stroke or myocardial infarction in people with prior stroke. More evidence is needed to fully explain the association of total homocysteine levels with vascular risk and the potential use of vitamin supplementation.
Vitamin B6: Vitamin B6 or pyridoxine is found in cereal grains, legumes, vegetables (carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Mild deficiencies of this B vitamin are common. Vitamin B6 may help lower homocysteine levels. Also, decreased vitamin B6 concentrations are also associated with increased plasma levels of C-reactive protein (CRP). CRP is an indicator of inflammation that is associated with increased cardiovascular morbidity in epidemiologic studies.
Vitamin E: Vitamin E is a fat-soluble vitamin with antioxidant properties. Vitamin E has been suggested and evaluated in patients with angina, although possible benefits remain unclear. Vitamin E has been proposed to have a role in preventing or reversing atherosclerosis by inhibiting oxidation of low-density lipoprotein ("bad cholesterol"). Several population studies have suggested that a high dietary intake of vitamin E and high blood concentrations of alpha-tocopherol are associated with lower rates of heart disease. However, while the Cambridge Heart Antioxidant Study supported this hypothesis, the more recent prospective Heart Outcomes Prevention Evaluation (HOPE) study did not. This area remains controversial.
Others: Other integrative therapies that may have benefit in reducing the risk of developing or in treating high cholesterol levels include alfalfa (Medicago sativa L.), aortic acid, ashwagandha (Withania somnifera L), avocado (Persea americana), ayurveda, barley (Hordeum vulgare), berberine, carob (Ceratonia siliqua), chamomile (Matricaria recutita, Chamaemelum nobile), chondroitin sulfate, coleus (Coleus forskohlii), copper, creatine, danshen (Salvia miltiorrhiza), DHEA, dong quai (Angelica sinensis), elder (Sambucas nigra L.), fenugreek (Trigonella foenum-graecum), flaxseed and flaxseed oil (Linum usitatissimum), folate (folic acid), gamma oryzanol, globe artichoke (Cynara scolymus L.), goldenseal (Hydrastis canadensis L.), grapefruit (Citrus paradisi), guggul (Commifora mukul), gymnema (Gymnema sylvestre R. Br.), honey, horny goat weed (Epimedium grandiflorum), Lactobacillus acidophilus, lemongrass (Cymbopogon spp.), lycopene, macrobiotic diet, meditation, milk thistle (Silybum marianum), nopal (Opuntia spp.), ozone therapy, pantethine (pantethenic acid), physical therapy, pomegranate (Punica granatum), probiotics, pycnogenol (Pinus pinaster ssp. atlantica), Red Clover (Trifolium pratense), rhubarb (Rheum officinale, Rheum palmatum), safflower (Carthamus tinctorius), scotch broom (Cytisus scoparius Linn.), selenium, spirulina, squill (Urginea maritima, Scilla maritima), sweet almond (Prunus amygdulus dulcis), taurine, TENS (Transcutaneous Electrical Nerve Stimulation), Traditional Chinese medicine (TCM), tribulus (Tribulus terrestris), turmeric (Curcuma longa Linn.), Vitamin D, white horehound (Marrubium vulgare), wild yam (Dioscoreaceae villosa), and zinc.
Prevention
Dietary modification: Minimize cholesterol and fat intake, especially saturated fat, which raises cholesterol levels more than any other substance. Cholesterol and saturated fats are found primarily in foods derived from animals, such as meats and dairy products. Dietary guidelines for reducing cholesterol and fat consumption include eating lean fish, poultry, and meat (remove the skin from chicken and trim the fat from beef before cooking), avoiding commercially prepared and processed food (cakes, cookies, doughnuts) and breaded fried foods, increasing the intake of fruits, vegetables, breads, cereals, rice, legumes (beans, peas), using skim or 1% milk, and using cooking oils that are high in unsaturated fat (corn, olive, canola, safflower oils). Healthcare professionals recommend eating fish, including salmon, tuna, and herring, which are high in omega-3 fatty acids, and therefore proposed to have a heart-protective action. Eggs do contain cholesterol, but may be eaten without negative effects on cholesterol levels.Weight loss: Excess weight contributes to high cholesterol. Losing 5% of the total body weight can have a significant impact on lowering total cholesterol levels. Fad diets such as the Atkin's diet may not give a person the balance of nutrients needed for a healthy heart and body. Exercising and eating the right foods in moderation help to increase weight loss.
Smoking cessation: Quitting smoking can improve HDL cholesterol levels, decrease blood pressure, and reduce the risk of a heart attack. Within one year after stopping, the risk of heart disease is half that of a smoker. Within 15 years of stopping, the risk of heart disease is similar to that of someone who has never smoked.
Alcohol consumption: In some studies, moderate use of alcohol (particularly red wine) has been linked with increasing levels of HDL cholesterol. No more than two glasses of red wine (four ounces each) should be consumed daily for heart protection. Excessive drinking can have a negative impact on cholesterol levels, actually raising triglyceride levels and increasing blood pressure.
Cholesterol screenings: Everyone age 20 and older should have their cholesterol measured at least once every five years.
Author information
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
American Heart Association. www.americanheart.org
Boekholdt SM, Sandhu MS, Day NE, et al. Physical activity, C-reactive protein levels and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study. Eur J Cardiovasc Prev Rehabil. 2006;13(6):970-6. View Abstract
Duffey KJ, Gordon-Larsen P, Jacobs DR Jr, et al. Differential associations of fast food and restaurant food consumption with 3-y change in body mass index: the Coronary Artery Risk Development in Young Adults Study. Am J Clin Nutr. 2007;85(1):201-8. View Abstract
Harris WS, Assaad B, Poston WC. Tissue omega-6/omega-3 fatty acid ratio and risk for coronary artery disease. Am J Cardiol. 2006 Aug 21;98(4A):19i-26i. Epub 2006 May 30. View Abstract
National Heart, Lung, and Blood Institute. www.nhlbi.nih.gov
National Institutes of Health. www.nlm.nih.gov
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2007.
U.S. Food and Drug Administration. www.fda.gov
Related Terms
Androgen, angina, angina pectoris, angiogenesis, angiogram, arcus senilis, arteriogram, atherosclerosis, blood clot, C-reactive protein, cholesterol, computerized tomography angiography (CTA), coronary artery bypass graft surgery (CABG), coronary heart disease (CHD), cortisol, diabetes, dyslipidemia, embolus, endothelium, enhanced external counter pulsation (EECP), estrogen, high-density lipoprotein (HDL), homocysteine, hypercholesterolemia, hyperlipidemia, hyperlipoproteinemia, lipid disorder, lipid panel, lipid profile, lipoprotein, low-density lipoprotein (LDL), magnetic resonance imaging (MRI), myocardial infarction, obesity, percutaneous transluminal coronary angioplasty platelet (PTCA), peripheral artery disease (PAD), plaque, Raynaud's disease, saturated fats, silent ischemia, soluble fiber, sterol, stress test, thrombus, therapeutic lifestyle changes (TLC), transient ischemic attacks (TIAs), trans fats, triglyceride, unsaturated fats, very low density lipoprotein (VLDL), xanthelasma, xanthoma.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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