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High Cholesterol: Assessing Your Risk

High cholesterol level is one of the big risk factor for heart disease and heart attack. It's also a risk factor for stroke and peripheral artery disease. Assessing your risk is a first step in preventing these diseases. Have you been told that your cholesterol is too high? If so, you could be heading for a stroke or heart attack. This is especially true if you have other risk factors for heart disease.

Get smart about cholesterol and your heart disease risk. One of the first things to know is that having high cholesterol can start early in life and continue throughout your lifetime. It can increase your risk of developing these conditions over time. Talk with your healthcare provider about how to get started controlling your cholesterol and other things that can increase your risk.

Why is high cholesterol a problem?

Blood cholesterol is a fatty substance. The body uses it to make cell membranes and for hormone production. It travels through the bloodstream and is used by the tissues for normal function. But, when blood cholesterol is high, it forms plaque and causes inflammation. The plaque builds up in the walls of arteries that carry blood from the heart to the body. This narrows the opening for blood flow. Over time, the heart may not get enough oxygen. This can lead to coronary artery disease or a heart attack. It can lead to stroke if the plaque builds up in the arteries of the brain

3 steps to assessing your risk

Step 1. Find your risk factors for heart disease and stroke

How your cholesterol numbers affect your heart health depends on your other risk factors for heart attack and stroke. Check off each risk factor below that applies to you:

  • Age. Are you a man 45 years old or older or a woman 55 years old or older?

  • Blood pressure. Do you have high blood pressure? Do you take medicine to treat high blood pressure?

  • Cholesterol levels. Have you been told you have high cholesterol? Do you take medicine to control your cholesterol? Have your LDL-C ("bad") cholesterol and triglyceride levels stayed high over time even with a healthy diet and exercise?

  • Smoking. Do you smoke or use tobacco products such as electronic cigarettes or other products with nicotine? These products increase inflammation in the body and the arteries. Inflamed arteries tend to attract cholesterol deposits and are vulnerable to scarring and damage. Quitting smoking and other tobacco products can reduce this inflammation and reduce the risk for heart disease and stroke.

  • Diabetes. Do you have diabetes? Is your blood sugar level well-controlled? If you have diabetes, you may be able to lower your risk of heart disease or a stroke by keeping your LDL-C level lower than what is advised for people who don't have diabetes.

  • Exercise. Do you exercise very little or not very often? Experts advise 30 minutes of exercise at least 5 days a week. If you're not doing cardiovascular exercise as often as this, it may not be enough. You may be at higher risk for high cholesterol and heart disease.

  • Diet. Do you eat a diet that is high in saturated or trans fats, cholesterol, sugar, or alcohol? You may be at increased risk for heart disease if you don't eat enough fruits, vegetables, lean meats and eat sugars or drink alcohol sparingly.

All of the things listed above can increase risk for blockages in the arteries of your heart, neck, and legs. This can lead to heart disease, heart attack, stroke, and peripheral artery disease.

To help find your overall risk, your provider may use a risk calculator. It takes into account your cholesterol level and other risk factors. Ask your healthcare provider about your 10-year risk if you are older than 40 or your lifetime risk if you are age 20 to 39.

Depending on these results, your provider may talk with you about other conditions that can influence your risk and affect your treatment decisions. The following things can affect your risk:

  • A family have a history of heart problems before the age of 55 in male relatives or age 65 in female relatives

  • Primary high cholesterol

  • Metabolic syndrome

  • Chronic kidney disease or chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, or HIV/AIDs

  • Menopause before age 40

  • High blood pressure during pregnancy (preeclampsia)

  • Ethnicity (for example, being from South Asia)

  • Other blood lipid disorders

Your provider will want to help you understand your risk and options for treatment.

If your healthcare provider isn't sure about your risk and whether to start medicine, you and your provider may decide that you need more testing. This might include a coronary artery calcium (CAC) scan. This scan measures the amount of calcium in the coronary arteries. If you have calcium deposits in an artery, it means plaque is starting to build up. The results of the test are given as a calcium score. This can help guide the decision to start cholesterol medicines such as statins.

Step 2. Test your cholesterol

Healthcare provider drawing blood from man's arm.

High cholesterol has no symptoms. Getting your blood tested is the only way to know if your cholesterol level is high. Have your cholesterol tested every 4 to 6 years after the age of 20. Test more often if you have risk factors. Cholesterol testing most often needs no preparation. Your healthcare provider will tell you if you need to fast before the test. This means you don’t eat for a certain amount of time before the test is done. A blood sample is taken and sent to a lab. There, the amount of cholesterol and triglyceride in your blood is measured. There are 2 types of cholesterol in the sample. The first is HDL (“good cholesterol”). The second is LDL (“bad cholesterol”). Cholesterol test results are most often shown as the total of HDL and LDL cholesterol numbers. You may also be told the separate HDL and LDL cholesterol results.

The optimal level of LDL has changed over time and depends on your risk factors. Generally an LDL cholesterol level around 100 mg/dL may be a good goal. But talk with your provider about what level is best for you. It's important to know your cholesterol numbers. But depending on all of your risk factors, your healthcare provider will talk with you about your results and what is important for overall health.

Fill in your numbers below.

HDL cholesterol:                            LDL cholesterol:                          Total cholesterol:                          Triglyceride:                         

Step 3: Discuss the results with your healthcare provider

If your cholesterol level is higher than normal, your healthcare provider will advise how you can lower your level. Steps may include lifestyle changes such as diet, physical activity, and quitting smoking. Your provider may also prescribe medicine to lower bad cholesterol.

Making a plan that will work for you is an important discussion to have with your healthcare provider. You and your provider can estimate your risk of developing heart disease or stroke. This information can guide your decision to start medicine such as a statin to treat your cholesterol and lower your risk. This discussion should be ongoing. This is because your risk factors including cholesterol levels can change over time.

If you have high cholesterol, you may need your cholesterol level tested more often. This is to make sure your medicine and lifestyle changes are working to reduce your risks of having a heart attack or stroke.

Online Medical Reviewer: Anne Clayton APRN
Online Medical Reviewer: Glenn Gandelman MD MPH
Online Medical Reviewer: Lu Cunningham
Date Last Reviewed: 3/1/2020
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