Cholesterol is a fat in the blood that is associated with the acceleration of hardening of the arteries or atherosclerosis. This is a disease of the blood vessels that can result in damage to the organs supplied by blood vessels. These conditions that high cholesterol can result in include stroke, heart attack, blood vessel aneurysms and circulatory disturbances of the leg, among many other conditions. To a large extent, cholesterol is controlled by inherited factors, and by diet. A diet high in fat particularly saturated fat, can increase cholesterol levels.

In evaluation of a patient’s cholesterol we often look at various cholesterol subtypes in the blood. The two major types of cholesterol that we look at are HDL (high-density lipoprotein). A lipoprotein is the combination of a lipid (or fat) with a protein. This is the way cholesterol travels in the body.

HDL cholesterol is “moving in the right direction” away from blood vessels. It is good cholesterol. High levels of this have a favorable effect on the body and are a favorable risk factor in preventing vascular disease and heart disease.

LDL (low-density lipoprotein) is cholesterol “moving in the wrong direction” towards blood vessels. This is the main cholesterol fraction we look at when deciding when patients need to alter their diet, lifestyle and when medications are necessary.

The evaluation of cholesterol is individualized for each patient. There are several other risk factors for atherosclerosis that need to be considered in each patient and reviewed in total in evaluating the patient’s total risk of developing atherosclerosis.

Other risk factors for vascular disease include hypertension, smoking, diabetes, advancing age, male sex, postmenopausal women, and high blood levels of a chemical called homocystine.

Initial treatment of cholesterol involves diet and exercise. Diet low in fat, high in fiber and aerobic exercises have all been shown to have favorable effects on cholesterol.

If cholesterol problems are felt to require the addition of medication, there are numerous medications now that are once a day, safe, and very free of side effects. The decision to use them must be a careful decision made by a physician and the patient, and individualized for each patient. They should be monitored carefully to ensure that they are working properly and not causing any of the occasional side effects.

Authored by: Christopher P. Robben, M.D., F.A.C.P.

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