Cholesterol Patient Education Handout Patient Education Handout associated with UMHS Clinical Care Guideline

This information is not a tool for self-diagnosis or a substitute for medical treatment. You should speak to your health-care provider or make an appointment to be seen if you have questions or concerns about this information or your medical condition.

Why is high cholesterol bad?

Cholesterol is a natural substance found in our diet and made by our liver.  It is key for many functions throughout our body.  Yet, high levels of cholesterol are linked with atherosclerotic vascular disease, as well as, stroke, heart attacks, heart disease and peripheral vascular disease (arteries of the legs).  Over decades, high blood cholesterol levels may result in damage and narrowing of arteries (atherosclerosis) that supply the heart, brain and other organs.  In time, the poor blood flow may damage those organs and cause sudden heart attacks and strokes.

What are the good and bad cholesterols?

Cholesterol travels in the body in little packets of fat or droplets known as lipoprotein particles. These fat droplets which begin in the liver contain cholesterol or triglycerides, the other major fat in the blood. The two chief lipoprotein particles of fat are low-density lipoprotein (LDL) and high-density lipoprotein (HDL) each of which carries cholesterol. LDL cholesterol is the “bad” cholesterol (LDL = lethal). HDL is the “good” cholesterol (HDL = healthy). LDL carries most of the cholesterol in the blood, and can stay in blood vessels over time and lead to atherosclerosis (fatty deposits. in the blood vessels). Studies have shown that high levels of LDL cholesterol are linked to a greater risk for stroke and heart attacks [myocardial infarction or MI]. HDL particles help remove cholesterol from the arteries and helps return cholesterol to the liver. Studies have shown that high HDL cholesterol levels protect you from a heart attack. HDL also lowers your risk of a first heart attack or a second one.

When should I be checked?

Experts agree that screening for the level of cholesterol and HDL cholesterol is very important for men over 35 and women over 45 years of age. Many doctors support screening all men and women 20 years and older, and children from families with a high risk of heart disease. People with healthy levels (total cholesterol less than 200 or LDL cholesterol less than 100) should be rechecked every five years.

What should my cholesterol be?

Know your numbers! Your doctor may screen total cholesterol and/or HDL cholesterol non-fasting or a fasting full lipid profile in which the triglycerides and LDL cholesterol are measured. Fasting is no food or drink with calories for 12 hours before testing.

What makes cholesterol high or low?

Family History: High cholesterol often runs in families. Many patients will remain high despite doing things right. Young women have lower LDL cholesterol and higher HDL cholesterol levels than men. After menopause, women’s risks are the same as men’s.

Diet: Diets should contain less than 30% calories from fat, less than 8% from saturated fat, and enriched in marine or plant omega-3 fatty acids. Avoid high saturated fats, like diary fats (ice cream, butter) and palm and coconut oils. Limit high cholesterol foods, like eggs and organ meats (liver). Eat higher fiber foods, fruit and vegetables. Eat more fish and skinless chicken breasts. Avoid fried foods and frying which soaks up the fat .  Choose low fat and non-fat dairy products, avoid hard margarines which have trans-fatty acids, and try to use products made from plants instead.

Weight: Lose weight if overweight. Excess weight is linked with high cholesterol, low HDL cholesterol, high triglycerides, diabetes, and higher risk of heart disease.

Exercise: Even mild regular exercise has been shown to raise HDL cholesterol levels and lower triglycerides.  This works even better when a weight loss program is part of the plan.
Smoking: Quit smoking! Smoking clearly increases your risk of heart attack and stroke. It also lowers your HDL cholesterol.

Alcohol: One or two drinks daily has been shown to increase HDL cholesterol.  But too much alcohol damages other organs, so it is not a good way to prevent heart disease.

Should I be placed on medication for my cholesterol?

Medications are reserved for people at high risk for heart disease or those with known vascular disease (stroke, MI, peripheral vascular disease). There is proof that middle aged and older men and women with vascular disease or diabetes are helped from a drug class known as the ‘statins’, no matter what their cholesterol levels are. Patients with diabetes are at a greater risk of vascular disease, and need strong treatment. 

Most often, patients without vascular disease who have high cholesterol with or without other risk factors should try diet, exercise, and weight loss (if overweight) prior to using medications.  Those with high cholesterol or high triglycerides, overweight, diabetes, and any vascular disease should see a nutritionist before starting medications. If you have known vascular disease, your doctor may start medications right away.  Even so, lifestyle changes are still very vital lowering your risk.

Medications for cholesterol are most often long-term medications. They have to be taken everyday, often for the rest of your life. Drugs that are most often prescribed are the statins. Statins help the liver remove LDL cholesterol, and reduce production of cholesterol. These drugs most often do not have side effects, but may interact with other drugs you are taking. Make sure you ask your doctor about how statins will work with other drugs and herbal products you are taking. Things such as grapefruit juice should be avoided with certain statins since it blocks their metabolism. Rarely, these drugs can cause liver or muscle damage. If you start to notice muscle aches all over your body or weakness while taking these drugs, stop the drug and call your doctor.

Information updated by UMHS Clinical Practice Guidelines, December 2007

Information maintained by the UMHS Clinical Care Guidelines Committee