Cholesterol

Highlights

Total Cholesterol Goals

A blood test is used to measure cholesterol levels. A person’s total cholesterol count includes measurements of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Standard total cholesterol goals for adults are:

• Less than 200 mg/dL is desirable
• Between 200 - 239 mg/dL is considered borderline
• Over 240 mg/dL is considered high

Lifestyle Changes

The first step to improving cholesterol levels is through lifestyle changes (especially diet and exercise). Even when drug therapy is required, lifestyle changes are also necessary. These include:

• 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 (particularly omega-3 fatty acids found in fish oils and canola).
• Exercise regularly. Studies have shown that regular aerobic exercise can help boost HDL (“good” cholesterol) levels.
• Quit smoking.
• No dietary supplements have been shown to improve cholesterol levels, and some can cause health risks. In 2007, the FDA issued a warning about red yeast rice products, many of which contain unauthorized use of prescription drugs.

Drug Therapy

A person’s LDL (“bad” cholesterol) level generally determines if drug therapy is required. Most cholesterol drugs are used to help lower LDL levels. Some drugs are also used to help raise HDL levels. Drugs used in cholesterol treatment include:

• Statins
• Nicotinic acid (niacin)
• Bile-acid binding resins
• Fibrates
• Ezetimbe

Cholesterol Screening and Treatment for Children

In 2008, the American Academy of Pediatrics (AAP) recommended expanded screening and treatment of high cholesterol in children.

• The AAP now recommends cholesterol screening for children with risk factors beginning as early as age 2 and no later than age 10.
• The AAP also recommends statin drug treatment for children as young as age 8 who have high LDL levels.
• The issue of prescribing statin drugs to children is being hotly debated. Lifestyle modifications (diet, exercise) are still the recommended first treatment approach for children.

Highlights
Introduction
Risk Factors
Complications
Symptoms
Diagnosis
Treatment
Medications
Lifestyle Changes
Resources
References

Review Date: 5/5/2009
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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