WebMD Feature
A lot of people don't take the risks of high cholesterol very seriously. After all, one out of five people have high cholesterol. A staggering 50% of Americans have levels above the suggested limit. Could something so common really be a serious health risk?
Unfortunately, yes. Cholesterol is a direct contributor to cardiovascular disease, which can lead to strokes and heart attacks.
"Despite all of the amazing medicines and treatments we have, cardiovascular disease is still the number one cause of death and illness in our society," says Laurence S. Sperling, MD, director of preventive cardiology at the Emory University School of Medicine, Atlanta, Ga.
The World Health Organization estimates that almost 20% of all strokes and over 50% of all heart attacks can be linked to high cholesterol.
But if you've been diagnosed with high cholesterol, don't despair. The good news is that high cholesterol is one risk factor for strokes and heart attacks that you can change. You just need to take action now, before your high cholesterol results in more serious disease.
All About High-Risk Cholesterol Numbers
When it comes to high cholesterol risks, it's tough to keep the details straight. We might have a vague idea of whether our cholesterol is "good" or "bad," but we forget the actual numbers by the time we get to the parking lot outside our doctor's office. So it may be worth reviewing the basics.
Cholesterol is a fat-like substance circulating in your blood. Some of your cholesterol comes from the foods you eat. But the bulk of it is actually made in your own body, specifically in the liver. Cholesterol does have some good uses. It is needed to make some hormones and it is important for the function of our cells. But an excess of it in the bloodstream can lead to trouble.
Cholesterol comes in several different forms, but doctors focus mostly on two: LDL cholesterol and HDL cholesterol.
- LDL is also called "bad cholesterol" -- Sperling suggests that you think of the "L" as standing for lousy. LDL cholesterol can clog your arteries, increasing the risk of heart attack and stroke. Most people should aim for a level of less than 100 mg/dL. However, people who already have heart disease may need to aim for under 70 mg/dL.
- HDL is "good cholesterol." Imagine the "H" stands for healthy, Sperling suggests. This type of cholesterol attaches to bad cholesterol and brings it to the liver, where it's filtered out of the body. So HDL cholesterol reduces the amount of bad cholesterol in your system. You should aim for 60 mg/dL or higher.
- Triglycerides are not cholesterol but another type of fat floating in your blood. Just as with bad cholesterol, having a high level of triglycerides increases your risk of cardiovascular problems. Aim for a level of less than 150 mg/dL.
So although we all talk about high cholesterol risks, the term is a little misleading. What we really mean is high levels of bad LDL cholesterol and triglycerides and alow level of good HDL cholesterol.
What about total cholesterol? While anything under 200 mg/dL is still considered the target, most experts don't focus on the number. It doesn't mean all that much. "Someone can have a total cholesterol of under 200 -- which is lower than average for Americans -- but still have unhealthy levels of HDL or LDL," says Sperling.
Realizing the Risks: How Harmful Is High Cholesterol?
Everyone has cholesterol in their blood. But if your levels of LDL are too high, the excess can accumulate on the walls of your arteries. This build-up of cholesterol and other substances -- called plaque -- can narrow the artery like a clogged drain. It can also lead to arteriosclerosis, or hardening of the arteries, which turns the normally flexible tissue into more brittle.
Plaques can form anywhere. If they form in the carotid artery in the neck, it's carotid artery disease. When they form in the coronary arteries -- which supply the heart muscle with blood -- it's called coronary artery disease. Like any organ, the heart needs a good supply of blood to work. If it doesn't get that blood, you could get angina, which causes a squeezing pain in the chest and other symptoms.
There are other high cholesterol risks. If these plaques break open, they can form a clot. If a clot lodges in an artery and completely chokes off the blood supply, the cells don't get the nutrients and oxygen they need and die.
If a clot gets to the brain and blocks blood flow, it can cause a stroke. If a clot lodges in the coronary arteries, it can cause a heart attack.
Do We Underestimate High Cholesterol Risks?
The risks of high cholesterol are quite clear. "If you look at populations of people," says Sperling, "the higher the cholesterol, the higher the level of heart and blood vessel disease." It's that simple.
But experts say that people don't take high cholesterol risks seriously enough. According to the CDC, in 2005 almost a quarter of American adults said they hadn't had their cholesterol checked in the last five years.
One problem is that high cholesterol doesn't cause symptoms that make people pay attention.
"People naturally respond more to medical conditions that cause symptoms," says Nathan D. Wong, PhD, fellow of the American College of Cardiology and director of the Heart Disease Prevention Program at the University of California, Irvine. Since you won't feel your rising cholesterol levels, you won't go to the doctor about it.
By the same token, people may be less likely to stick to treatment for high cholesterol than they would be for a painful condition.
"People on cholesterol-lowering medicine don't feel any better," says Sperling. "It's not like taking a painkiller for an aching knee, where you know it's working." As a result, people may be less likely to follow their treatment plan over the long-term, Sperling says.
Also, high cholesterol risks are usually not immediate. The damage accumulates over years and decades -- high cholesterol in your 20s and 30s can take its toll in your 50s and 60s. Because the effects take time, many people don't feel real urgency in treating it. They feel they can just deal with it later.
"Unfortunately, I think that many people are too casual about their high cholesterol," says Adolph Hutter, MD, a cardiologist at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. "They ignore it for years and it only gets their attention when they actually develop vascular disease."
Taking Action to Lower High Cholesterol Risks
There are many good treatments for heart disease, arteriosclerosis, and other serious conditions caused by high cholesterol. But it's a terrible shame to let things get that far when making changes now could prevent these life-threatening illnesses. Reducing your high cholesterol risks is a crucial step.
So what should you do? First, go to the doctor. "It's very important for all adults to get their cholesterol tested," says Wong. Every adult over 20 should have a cholesterol test at least once every five years.
Also, keep track of your cholesterol levels yourself. Write down your current numbers and, if they're high, what numbers you should be striving for.
If you do have high cholesterol, get serious. Talk with your doctor about what your goals should be and how you should achieve them. Make sure you understand what lifestyle changes you need to make. If you already have heart disease or other risk factors like diabetes, you need to be even more careful.
Whatever you do, don't ignore your high cholesterol risks. Don't put off treatment for another year.
"Having high cholesterol may not hurt you today or tomorrow," says Sperling. "But if you don't do something about it, it can have a terrible cost down the road."
