QWhat is cholesterol?

AIt is a fatty, wax-like compound that is manufactured in the liver or intestines, but it is also found in some of the foods we eat, specifically animal products.

QWhy does our body need cholesterol?

A Cholesterol is essential for normal body functions. It is needed to make vitamin D and some steroidal hormones, build cell walls and create bile salts that help digest fat.

QAre there different types?

AThere are various types of sterol compounds. However, cholesterol is often designated and labeled by the type of protein that carries it in the bloodstream. The primary types are low density lipoprotein, often referred to as "bad" cholesterol, and high density lipoprotein, or "good" cholesterol.

LDL cholesterol is deposited in vessel walls leading to plaque development. HDL cholesterol returns harmful cholesterol from vessel walls back to the liver. Triglycerides are a different chemical compound. They are carried in the bloodstream along with small amounts of cholesterol in very low density lipoproteins known as VLDL cholesterol.

QWhat are acceptable cholesterol levels?

ATotal cholesterol less than 200mg/dl and LDL less than 130mg/dl are often considered acceptable. Levels should be lower than this, however, in someone with known coronary or peripheral arterial disease. A desirable level in someone who has had a heart attack is a total cholesterol less than 150mg/dl with LDL levels less than 70mg/dl.

QWhat are the risks associated with elevated cholesterol?

AElevated cholesterol is one of the major primary risk factors for heart attack and stroke.

Cholesterol is one of the main components of artery plaque, which continues to grow and progress if total and particularly LDL cholesterol levels remain elevated.

QWhat affects cholesterol levels?

ASerum cholesterol levels are determined by both genetic factors as well as dietary and lifestyle habits. There are several inherited abnormalities of cholesterol metabolism. These are often discovered by significant elevations of cholesterol and triglycerides at young ages. In the absence of inherited disorders, diets high in saturated fat and overall calories will increase level of both total and LDL cholesterol while decreasing the "good" or HDL cholesterol. Sedentary lifestyles also contribute to abnormal cholesterol levels.

Diets low in saturated fat, high in monounsaturated or polyunsaturated fat such as olive oil, canola oil or omega-3 fish oils and daily exercise will decrease LDL cholesterol while increasing HDL cholesterol.

QWhat are the treatment options?

ASeveral treatment options exist. First and foremost is lifestyle modification. Specific dietary recommendations can be discussed with a physician or specially trained dieticians. Daily exercise should also be a primary component of any treatment program. When necessary, multiple different drug treatments are available to help reduce cholesterol levels. These include statin drugs which decrease cholesterol production in the liver. Other drugs commonly known as Wellchol or Zetia decrease cholesterol absorption in the intestine and are used alone or in combination with a statin drug. Lastly, niacin, fibrates and high doses of fish oils may be used alone or in combination with the aforementioned drugs. These tend to decrease triglyceride production in the liver, resulting in a decrease of both total cholesterol and triglycerides. Pharmaceutical therapy is almost always necessary in individuals who have had a heart attack to achieve the aggressive reductions in cholesterol indicated in these patients. Rarely, treatment known as LDL apheresis may be necessary. This is a filter process similar to dialysis that can remove both cholesterol and triglycerides from the bloodstream. This treatment is reserved for very high levels of cholesterol which do not respond to conventional drug therapy

QCan cholesterol levels be controlled without medication?

AIndividuals at lower cardiac risk can often control their cholesterol adequately with appropriate dietary habits. Certain other more aggressive dietary programs such as the Dean Ornish Program have been shown to reduce the progression of plaque and significantly reduce cholesterol. These dietary regimens, however, can be difficult to sustain without a significant support system.

Target cholesterol levels in patients at higher risk are often not achieved with dietary measures alone. Physicians are often obligated therefore to initiate some form of drug treatment along with lifestyle modification to achieve and sustain the much lower levels of cholesterol necessary to reduce the risk of heart attack in these individuals.

QAre there any adverse side effects from cholesterol medications?

AAdverse side effects range from mild to severe. The most common side effects of cholesterol medications are muscle aches, known as myalgias, and elevated liver function tests. Physicians will monitor patients recently placed on medications for the development of muscle aches and check liver function tests with follow-up lipid panels.

Severe side effects include advanced muscle inflammation, known as rhabdomyolysis, as well as kidney injury. Fortunately, these are rare. Rhabdomyolysis has been reported with statin therapy with an incidence of one in a million treated patients.

Generally, the benefits of cholesterol medications far outweigh the risks associated with therapy, particularly in those with established vascular disease.