Alternate Names : Dietary Cholesterol, Blood Cholesterol
Blood cholesterol and dietary cholesterol are two different types of cholesterol. Dietary cholesterol is found in food of animal origin. Blood cholesterol is a waxy substance that occurs naturally in the body. Since cholesterol is not soluble in blood, it is carried around in a protein-coated package called a lipoprotein. High-density lipoprotein or HDL is known as the good package for cholesterol. Low-density lipoprotein or LDL is the bad package for cholesterol.
Cholesterol is a significant factor in the development of coronary heart disease, or CHD.
Risk factors and risk equivalents
The higher a person's LDL level and the more risk factors a person has, the greater the chance of developing CHD. People who already have CHD and those who have certain conditions called CHD "risk equivalents" are at the greatest risk of having a major heart-related problem. If a person has CHD risk equivalents, it means that he or she has the same level of risk for a major heart-related problem as someone who already has CHD. These conditions include:
other clinical signs of atherosclerosis, such as peripheral arterial disease,
abdominal aortic aneurysm, or certain types of carotid artery disease
the presence of multiple risk factors (listed below) that give the person a greater than 20% chance of developing CHD within 10 years
A person's risk of developing CHD within 10 years is determined by using information from the Framingham Heart Study. This 10-year risk is calculated from a formula that takes the following into account:
systolic blood pressure, which is the top number on a blood pressure reading
treatment for high blood pressure
A blood lipid test will provide information about a person's:
HDL, or high-density lipoprotein, cholesterol
LDL, or low-density lipoprotein, cholesterol
The National Heart, Lung, and Blood Institute has set the following guidelines for blood cholesterol levels:
desirable range is less than 200 milligrams per deciliter or mg/dL
borderline high is 200 to 239 mg/dL
high cholesterol is 240 mg/dL or greater
LDL results in healthy adults are evaluated as follows:
optimal is less than 100 milligrams per deciliter, or mg/dL
near optimal/above optimal is 100 to 129 mg/dL
borderline high is 130 to 159 mg/dL
high is 160 to 189 mg/dL
very high is 190 mg/dL or greater
If an individual has certain other risk factors, LDL cholesterol guidelines goals are stricter. LDL goals for these groups are as follows:
less than 100 mg/dL for people with CAD or CAD risk equivalents
less than 130 mg/dL for individuals with two or more risk factors
less than 160 mg/dL for people with 0 to 1 risk factor
A low HDL level is less than 40 milligrams per deciliter, or mg/dL. Low HDL increases a person's risk for CHD. A high HDL is 60 mg/dL or above. High HDL lowers the risk of CHD.
Therapeutic lifestyle changes
The treatment of high blood cholesterol focuses on reduction of LDL cholesterol to the optimal level, whenever possible. LDL can be lowered with therapeutic lifestyle changes or TLC. Medicines may be necessary in addition to TLC for some people. Therapeutic lifestyle changes include regular physical activity and weight management. TLC also includes the following dietary guidelines:
20 to 30 grams of total fiber per day, including 10 to 25 grams of soluble fiber. Soluble fiber is found in oat bran, oatmeal, rice bran, and barley. It is also found in beans, peas, citrus fruits, strawberries, and apple pulp.
saturated fat less than 7% of daily calories
polyunsaturated fat less than 10% of daily calories
monounsaturated fat up to 20% of daily calories
total fat 25% to 35% of daily calories
carbohydrates 50% to 60% of daily calories
protein about 15% of daily calories
cholesterol less than 200 mg per day
sodium limited to 2,400 milligrams a day
TLC guidelines also recommend 2 grams of plant sterols or stanols a day. These are found in enriched food products such as spreads that lower cholesterol.
Putting these recommendations into practice includes:
becoming physically active on most days
boiling, baking, broiling, roasting, poaching, steaming sauteing, stir-frying, or microwaving food items
choosing to eat five or more servings of fruits and vegetables each day
eating no more than 6 ounces of cooked lean meat, fish, or skinless poultry per day
eating six or more servings of breads, cereals, grains, pasta, or dried beans each day
including two servings of baked or grilled fish every week. Select fish high in omega-3 fatty acids. Good choices include albacore tuna, salmon, mackerel, lake trout, herring, and sardines.
incorporating pasta, rice, beans, and vegetables into meals
limiting the intake of fats to no more than 5 to 8 teaspoons per day. It's helpful to select margarines or vegetable oils that list liquid vegetable oil as the first ingredient. They should contain no more than 2 grams of saturated fat per tablespoon. Good choices include canola, corn, olive, safflower, sesame, soybean, and sunflower oils. Other good choices include almond, avocado, and hazelnut oils. Liquid or tub margarines are better choices than stick margarine.
limiting intake of liver, brains, chitterlings, kidneys, heart, and other organ meats
replacing meat with cooked beans, peas or lentils, peanut butter, or soy products such as tofu
selecting dairy products with 1% or less fat
trimming all fat from meat products before cooking and removing poultry skin. All fat should be removed after browning meat. Fat can also be skimmed off the top of refrigerated soups and stews.
If a person is not able to lower blood cholesterol levels enough with lifestyle changes, the healthcare provider may suggest medicine that lowers cholesterol.
The FDA has approved health claims for soy products. These plant products can lower cholesterol levels. Diets high in soy products have been shown to reduce LDL cholesterol levels in people with an LDL level above 200 mg/dL when they are substituted for foods high in fat and cholesterol. The soy products can lower LDL cholesterol if the person follows these guidelines:
eats a total of 25 grams of soy protein a day
follows recommended dietary guidelines
replaces saturated fat and cholesterol foods with soy products
stays physically active