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High blood cholesterol and triglycerides

Definition

The medical term for high blood cholesterol and triglycerides is lipid disorder. Such a disorder occurs when you have too many fatty substances in your blood. These substances include cholesterol and triglycerides.

Alternative Names

Lipid disorders; Hyperlipoproteinemia; Hyperlipidemia; Dyslipidemia; Hypercholesterolemia

Causes, incidence, and risk factors

A lipid disorder increases your risk for atherosclerosis, and thus for heart disease, stroke, high blood pressure (hypertension), and other problems.

There are many types of cholesterol. The ones talked about most are:

• Total cholesterol - all the cholesterols combined
• High density lipoprotein (HDL) cholesterol - often called "good" cholesterol
• Low density lipoprotein (LDL) cholesterol - often called "bad" cholesterol

There are several genetic disorders (passed down through families) that lead to abnormal levels of cholesterol and triglycerides. They include:

• Familial combined hyperlipidemia
• Familial dysbetalipoproteinemia
• Familial hypercholesterolemia
• Familial hypertriglyceridemia

Abnormal cholesterol and triglyceride levels may also be caused by:

• Being overweight or obese. See: Metabolic syndrome
• Certain medications, including birth control pills, estrogen, corticosteroids, certain diuretics, beta blockers, and certain antidepressants
• Diseases such as diabetes, hypothyroidism, Cushing syndrome, polycystic ovary syndrome, and kidney disease
• Excessive alcohol use
• Fatty diets that are high in saturated fats (found mainly in red meat, egg yolks, and high-fat dairy products) and trans fatty acids (found in commercial processed food products)
• Lack of exercise and sedentary lifestyle
• Smoking (which reduces HDL "good" cholesterol)

Signs and tests

See Coronary risk profile for information on when to be tested.

Tests to diagnose a lipid disorder may include:

• HDL test
• LDL test
• Lipoprotein-a analysis
• Total cholesterol test
• Triglyceride test

Treatment

Treatment depends on your age, health history, if you smoke, and other risk factors for heart disease, such as:

• Diabetes
• Poorly controlled high blood pressure
• Family history of heart disease

The recommended values for adults are different depending on the above risk factors, but in general:

• LDL: 70-130 mg/dL (lower numbers are better)
• HDL: more than 40-60 mg/dL (high numbers are better)
• Total cholesterol: less than 200 mg/dL (lower numbers are better)
• Triglycerides: 10-150 mg/dL (lower numbers are better)

There are steps that everyone can take to improve their cholesterol levels, and help prevent heart disease and heart attack. Here are the most important ones:

• Eat a heart-healthy diet with plenty of fiber-rich fruits and vegetables. Avoid saturated fats (found mostly in animal products) and trans-fatty acids (found in fast foods and commercially baked products). Instead, choose unsaturated fats
• Exercise regularly to help raise your HDL ("good" cholesterol)
• Get periodic health checkups and cholesterol screenings
• Lose weight if you are overweight
• Quit smoking

If lifestyle changes do not change your cholesterol levels enough, your doctor may recommend medication. There are several types of drugs available to help lower blood cholesterol levels, and they work in different ways. Some are better at lowering LDL cholesterol, some are good at lowering triglycerides, while others help raise HDL cholesterol.

The most commonly used and most effective drugs for treating high LDL cholesterol are called statins. You doctor will choose one of these: lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), torvastatin (Lipitor), rosuvastatin (Crestor).

Other drugs that may be used include bile acid sequestering resins, cholesterol absorption inhibitors, fibrates, and nicotinic acid (niacin).

Expectations (prognosis)

If you are diagnosed with high cholesterol, you will probably need to continue lifestyle changes and drug treatment throughout your life. Periodic monitoring of your cholesterol blood levels may be necessary. Reducing high cholesterol levels will slow the progression of atherosclerosis.

Complications

Possible complications of high cholesterol include:

• Atherosclerosis
• Coronary artery disease
• Stroke
• Heart attack or death

Possible complications of high triglycerides include:

• Pancreatitis

Calling your health care provider

If you have high cholesterol or other risk factors for heart disease, make appointments as recommended by your doctor.

Prevention

Cholesterol and triglyceride screening is important to identify and treat abnormal levels. The U.S. Preventive Service Task Force recommends that men age 35 or older and women age 45 or older should have their cholesterol levels checked.

To help prevent high cholesterol:

• Eat a well-balanced, low-fat diet
• Keep a healthy body weight
• Get regular exercise

References

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. Updated 2004.

U.S. Preventive Services Task Force. Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jun.

U.S. Preventive Services Task Force. Screening for Lipid Disorders in Children. US Preventive Services;Task Force recommendation statement. Pediatrics. 2007;120(1):e215-9.

Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122(1):198-208.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 217.