Cholesterol

Cholesterol isn't entirely the health villain it's made out to be, its name darkly linked to heart attack, stroke, and other types of cardiovascular disease. Our bodies need cholesterol, which is a type of lipid (another name for fat) to make cell membranes, key hormones like testosterone and estrogen, the bile acids needed to digest and absorb fats, and vitamin D. Cholesterol is so important to the body that the liver and intestines make it from scratch.

What is "bad" about cholesterol isn't the substance itself — in fact, we can't live without it — but how much of it is in the bloodstream.

The body packages cholesterol in two main particles: low-density lipoprotein (LDL), the so-called bad cholesterol, and high-density lipoprotein (HDL), the so-called good cholesterol. Too much LDL in the bloodstream helps create the harmful cholesterol-filled plaques that grow inside arteries. Such plaques are responsible for angina (chest pain with exertion or stress), heart attacks, and most types of stroke.

What causes a person's LDL level to be high? Most of the time diet is the key culprit. Eating foods rich in saturated fats, trans fats, and easily digested carbohydrates boost LDL. Genes are sometimes at the root of high cholesterol, and some medications can boost LDL.

If you have high cholesterol, making changes in your diet can help bring it down into the healthy range. Exercise can help boost the level of protective HDL. Several types of medication, notably the family of drugs known as statins, can powerfully lower LDL. Depending on your cardiovascular health, your doctor may recommend taking a statin.

Cholesterol Articles

Cholesterol: What's diet got to do with it?

For many people, focusing on lowering dietary cholesterol alone has little effect on their blood cholesterol level. Limiting saturated fat (found mainly in animal-based foods like meat and cheese) may help lower blood cholesterol. But the source of calories used to replace those missing calories makes a difference. Substituting with unsaturated fats (found in fish, nuts, and plant oils) is likely beneficial, while substituting with refined carbohydrates (foods full of white flour or sugar) is not. (Locked) More »

The new cholesterol-lowering drugs

Two new injected drugs can dramatically reduce “bad” LDL cholesterol. They can be lifesaving for people who have extremely high LDL because of a genetic condition called familial hypercholesterolemia. Men with high cholesterol who can’t take statins because of side effects can also benefit. The long-term safety and effectiveness of the drugs are still being studied. The drugs are expensive, which will likely limit their use at first.  (Locked) More »

Can LDL be too low?

A low-density lipoprotein (LDL) level of 50 mg/dL reduces the risk of a recurrent heart attack and does not appear to impair cognition. Ongoing trials are looking at the effects of reducing LDL to 40 mg/dL or lower. More »

New studies support statin guidelines

The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-effective than the previous guidelines. (Locked) More »

Cholesterol Resource Center

Welcome to our Cholesterol Resource Center.  For more information about cholesterol, see our Special Health Report on Managing Your Cholesterol.  Watch the Rethinking Cholesterol webcast? Tell us how you liked it, take our survey. More »

Beyond statins: New medicines for hard-to-manage cholesterol

Statins succeed as the first-line drug therapy to lower LDL cholesterol levels in most people who need medications, but at least one in five individuals still fails to reach the desired target. A novel class of drugs called PCSK9 inhibitors may pick up the slack where other cholesterol medications leave off. The first group of people to benefit will be those with a condition known as familial hypercholesterolemia (FH), an inherited disorder that affects about one in 200 individuals. These people carry a genetic variant that causes cholesterol levels to skyrocket. (Locked) More »

Ask the doctor: Statins and liver tests

Continuing liver function tests are not required for most people taking cholesterol-lowering statin drugs. One test before starting the drug is all that is required unless the person is at elevated risk of liver problems. More »

Know your triglycerides: Here's why

Triglycerides are fatty substances (lipids) in the blood that, like “bad” LDL cholesterol, may contribute to risk of heart attacks and strokes. Unless triglycerides are very high, they do not require medication to lower them. Men with mildly to moderately high triglycerides are advised to exercise, lose weight if they are overweight, improve their diet, and reduce alcohol consumption to lower their risk and bring triglycerides to the normal range. Men at above-average cardiovascular risk with high triglycerides can benefit from taking a cholesterol-lowering statin drug. (Locked) More »

For "bad" cholesterol, lower is better; dual drug therapy may help

High cholesterol, in particular high low-density lipoprotein (LDL), the so-called bad cholesterol, is a key cause of heart disease. A large clinical trial called IMPROVE-IT set out in 2005 to answer two key questions about LDL: The results of IMPROVE-IT were recently published in The New England Journal of Medicine. Dr. Deepak L. Bhatt, Editor in Chief of the Harvard Heart Letter, talked about the significance of the IMPROVE-IT findings with Dr. Christopher P. Cannon, the trial's lead investigator, and Dr. John A. Jarcho, an editor of The New England Journal of Medicine. More »