hypercholesterolemia

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. Cholesterol is also found in foods from animal sources, such as egg yolks, meat, and cheese.

If you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque. Plaque sticks to the walls of your arteries. This buildup of plaque is known as atherosclerosis. It can lead to coronary artery disease, a condition in which your coronary arteries become narrow or even blocked.

What are HDL, LDL, and VLDL?

HDL, LDL, and VLDL are lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. Different types of lipoproteins have different purposes:

• HDL stands for high-density lipoprotein. It is sometimes called "good" cholesterol because it helps your body get rid of cholesterol. It carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
• LDL stands for low-density lipoprotein. It is sometimes called "bad" cholesterol because a high LDL level leads to the buildup of plaque in your arteries.
• VLDL stands for very low-density lipoprotein. Some people also call VLDL a "bad" cholesterol because it too contributes to the buildup of plaque in your arteries. But VLDL and LDL are different; VLDL mainly carries triglycerides and LDL mainly carries cholesterol.

What causes high cholesterol?

The most common cause of high cholesterol is an unhealthy lifestyle. This can include:

• Unhealthy eating habits, such as eating lots of saturated fats. These fats are found in red meats, full-fat dairy products, chocolate, some baked goods, and many deep-fried and processed foods. Eating too much saturated fat can raise your LDL (bad) cholesterol.
• Lack of physical activity, with lots of sitting and little exercise. This lowers your HDL (good) cholesterol.
• Smoking, which lowers HDL cholesterol, especially in women. It also raises your LDL cholesterol.
• Stress, which may raise levels of certain hormones such as corticosteroids. These can cause your body to make more cholesterol.
• Drinking too much alcohol, which can raise your total cholesterol level.

Genetics may also cause people to have high cholesterol. For example, familial hypercholesterolemia (FH) is an inherited condition that causes very high levels of cholesterol in the blood. Other medical conditions and certain medicines may also raise LDL cholesterol levels or lower HDL cholesterol levels.

What can raise my risk of high cholesterol?

A variety of things can raise your risk of high cholesterol:

• Age. Your cholesterol levels tend to rise as you get older. Even though it is less common, younger people, including children and teens, can also have high cholesterol.
• Sex. Between ages 20 and 39, men have a greater risk of high total cholesterol than women. But after menopause, a woman's risk goes up. This happens because menopause lowers levels of female hormones that may protect against high blood cholesterol.
• Family history. High blood cholesterol can run in families.
• Other health conditions. Conditions such as diabetes, chronic kidney disease, HIV, and lupus can raise your risk of high cholesterol.
• Medicines. Certain medicines can raise your level of LDL cholesterol or lower your level of HDL cholesterol, including:
  • Steroids
  • Some chemotherapy medicines
  • Medicines taken after an organ transplant
  • Medicines for certain heart conditions
  • Certain acne medicines
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high cholesterol. For example, Asian Americans are more likely to have high levels of LDL cholesterol than other groups. And non-Hispanic White people are more likely than other groups to have high levels of total cholesterol.
• Weight. Being overweight or having obesity raises your cholesterol level.

What other health problems can high cholesterol cause?

Undiagnosed or untreated high blood cholesterol can lead to serious health problems:

• If you have large deposits of plaque in your arteries, an area of plaque can rupture (break open). This can cause a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block blood flow in a coronary artery.
• If the flow of oxygen-rich blood to your heart muscle is reduced or blocked, it can cause angina (chest pain) or a heart attack.
• Plaque also can build up in other arteries in your body, including the arteries that bring oxygen-rich blood to your brain and limbs. This can lead to problems such as carotid artery disease, stroke, and peripheral arterial disease.

How is high cholesterol diagnosed?

There are usually no signs or symptoms that you have high cholesterol. A blood test can measure your cholesterol levels. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are ages 20 to 65::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people over age 65:

• They should be tested every year

How can I lower my cholesterol?

You can lower your cholesterol through heart-healthy lifestyle changes. They include a heart-healthy eating plan, weight management, and regular physical activity.

If the lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering medicines available, including statins. If you take medicines to lower your cholesterol, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

What is cholesterol?

Cholesterol is a waxy, fat-like substance that that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk of coronary artery disease and other heart diseases.

How do you measure cholesterol levels?

A blood test called a lipoprotein or lipid panel can measure your cholesterol levels. Before the test, you'll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your:

• Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
• HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
• Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides. This is another type of fat in your blood that can raise the risk of heart disease, especially in women.

What do my cholesterol numbers mean?

Cholesterol numbers are measured in milligrams per deciliter (mg/dL). Talk with your healthcare provider about what your cholesterol numbers should be. The numbers that are best for you may depend on your age, race, blood pressure, weight, family history, and more. However, here are some general guidelines showing the desirable levels (levels that are healthy for most people):

Anyone age 19 or younger:

Type of CholesterolHealthy LevelTotal CholesterolLess than 170 mg/dLNon-HDLLess than 120 mg/dLLDLLess than 110 mg/dLHDLMore than 45 mg/dL

Men age 20 or older:

Type of CholesterolHealthy LevelTotal CholesterolLess than 200 mg/dLNon-HDLLess than 130 mg/dLLDLLess than 100 mg/dLHDLGreater than or equal to 60 mg/dL is best. Levels less than 40 mg/dL are considered low.

Women age 20 or older:

Type of CholesterolHealthy LevelTotal CholesterolLess than 200 mg/dLNon-HDLLess than 130 mg/dLLDLLess than 100 mg/dLHDLGreater than or equal to 60 mg/dL is best. Levels less than 50 mg/dL are considered low.

Triglycerides are not a type of cholesterol, but they are also measured in this test. A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

How often should I get a cholesterol test?

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

For people who are ages 20 to 65:

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people older than 65::

• They should be tested every year

What affects my cholesterol levels?

Many factors can affect your cholesterol levels. Some of them are things you can change:

• Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include red meats, full-fat dairy products, chocolate, some baked goods, and deep-fried and processed foods.
• Weight. Being overweight or having obesity are risk factors for heart disease. They also tend to increase your cholesterol
• Lack of physical activity. Not being physically active is a risk factor for heart disease.
• Smoking. Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove cholesterol from your arteries, having a lower HDL level can contribute to a higher cholesterol level.

Some factors that you cannot change can also affect cholesterol levels, such as:

• Age. Your cholesterol levels tend to rise as you get older. Even though it is less common, younger people, including children and teens, can also have high cholesterol.
• Sex. Between ages 20 and 39, men have a greater risk of high total cholesterol than women. But after menopause, a woman's risk goes up. This happens because menopause lowers levels of female hormones that may protect against high blood cholesterol.
• Family history. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high cholesterol. For example, Asian Americans are more likely to have high levels of LDL cholesterol than other groups. And non-Hispanic White people are more likely than other groups to have high levels of total cholesterol.

How can I lower my cholesterol?

You can lower your cholesterol through heart-healthy lifestyle changes. They include a heart-healthy eating plan, weight management, and regular physical activity.

If the lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol-lowering medicines available, including statins. If you take medicines to lower your cholesterol, you still should continue with the lifestyle changes.

NIH: National Heart, Lung, and Blood Institute

What is cholesterol?

Cholesterol is a waxy, fat-like substance that that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol is made by your liver. It travels through the blood on proteins called lipoproteins. One type of lipoprotein, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

The main treatments for high cholesterol are heart-healthy lifestyle changes and medicines. The lifestyle changes include healthy eating, weight management, and regular physical activity.

How can I lower cholesterol with diet?

Heart-healthy lifestyle changes include a diet to lower your cholesterol. The DASH eating plan is one example. Another is the Therapeutic Lifestyle Changes (TLC) diet, which recommends that you:

Choose healthier fats.You should limit both total fat and saturated fat. No more than 25 to 35% of your daily calories should come from dietary fats, and less than 7% of your daily calories should come from saturated fat. Depending upon how many calories you eat per day, here are the maximum amounts of saturated fats that you should eat:

Calories per DaySaturated Fat1,2008 grams1,50010 grams2,00013 grams2,50017 grams

Saturated fat is a bad fat because it raises your LDL (bad cholesterol) level more than anything else in your diet. It is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Instead of saturated fats, switch to foods with healthier fats, such as lean meat, nuts, and unsaturated oils like canola, olive, and safflower oils.

Limit foods with cholesterol. If you are trying to lower your cholesterol, you should have less than 200 mg a day of cholesterol. Cholesterol is in foods from animals, such as liver and other organ meats, egg yolks, shrimp, and whole milk dairy products.

Eat plenty of soluble fiber. Soluble fiber helps prevent your digestive tract from absorbing cholesterol. You should try to get 10 to 25 grams of it per day. Foods that are high in soluble fiber include:

• Whole-grain cereals such as oatmeal and oat bran
• Fruits such as apples, bananas, oranges, pears, and prunes
• Legumes such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans

Eat lots of fruits and vegetables. They are important sources of vitamins, fiber, and other nutrients.

Increase plant stanols and sterols in your diet.These are substances that also help prevent your digestive tract from absorbing cholesterol. You should try to get 2 grams of them per day. They can be found in whole grains, nuts, legumes, and oils, such as olive oil and avocado oil. They are also added to some foods, such as certain types of orange juice, margarine, and bread.

Eat foods that are high in omega-3 fatty acids. These special fats can lower LDL and triglyceride levels. They can also help control blood pressure and may lower your risk of heart rhythm problems. If you have heart disease, they may lower your risk of heart attack. Omega-3 fatty acids can be found in:

• Fish such as salmon, tuna (canned or fresh), and mackerel. Most people should try to eat these fish two times a week. But if you are pregnant or breastfeeding, you should avoid fish that could be high in mercury, such as mackerel.
• Plant sources such as walnuts, flaxseed, chia seeds, and canola and soybean oils. But they have smaller amounts of omega-3 acids than the fish sources.
• Fortified foods, such as certain brands of eggs, yogurt, juices, milk, soy beverages, and infant formulas.

Limit salt. You should try to limit the amount of sodium (salt) that you eat to no more than 2,300 milligrams (about 1 teaspoon of salt) a day. That includes all the sodium you eat, whether it's added in cooking, used at the table, or already present in food products. Limiting salt won't lower your cholesterol, but it can lower your risk of heart diseases by helping to lower your blood pressure. You can reduce your sodium by instead choosing low-salt and "no added salt" foods and seasonings at the table or while cooking.

Limit alcohol. Alcohol adds extra calories, which can lead to weight gain. Being overweight can raise your LDL level and lower your HDL level. Too much alcohol can also increase your risk of heart diseases because it can raise your blood pressure and triglyceride level. It's best not to drink, but if you do:

• Have no more than 2 drinks per day if you are a man
• Have no more than 1 drink per day if you are a woman

Nutrition labels can help you figure out how much fat, saturated fat, cholesterol, fiber, and sodium is in the foods that you buy. This can help you eat healthier and lower your cholesterol.

NIH: National Heart, Lung, and Blood Institute

What is cholesterol?

Cholesterol is a waxy, fat-like substance that that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol is made by your liver. It travels through the blood on proteins called lipoproteins. One type of lipoprotein, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are the treatments for high cholesterol?

If you have high cholesterol, lifestyle changes can help you lower your cholesterol levels. But sometimes the lifestyle changes are not enough, and you need to take cholesterol medicines. But you should still continue with the lifestyle changes even though you are taking medicines.

Who needs cholesterol medicines?

Your health care provider may prescribe cholesterol medicines for you if:

• You have already had a heart attack or stroke, or you have peripheral arterial disease
• Your LDL (bad) cholesterol level is 190 mg/dL or higher
• You are 40-75 years old, you have diabetes, and your LDL cholesterol level is 70 mg/dL or higher
• You are 40-75 years old, you have a high risk of developing heart disease or stroke, and your LDL cholesterol level is 70 mg/dL or higher

What are the different types of cholesterol medicines?

There are several types of cholesterol-lowering drugs available, including:

• Statins. They reduce the amount of cholesterol made in the liver. They also increase your liver's ability to remove LDL cholesterol that is already in the blood. Statins are the most common medicines used to treat high cholesterol.
• Bile acid sequestrants. They keep bile acids, which digest fats and oils, from being absorbed into the body. But your body needs bile acids, so your liver will make more of them. It makes them by breaking down LDL cholesterol, so this helps lower your LDL cholesterol. Your provider may prescribe these medicines if you cannot take statins or if statins alone are not lowering your cholesterol enough.
• Cholesterol absorption inhibitors. They block how cholesterol is absorbed into the body. They are also used if you cannot take statins or if statins alone are not lowering your cholesterol enough.
• Nicotinic acid (niacin). It is a type of B vitamin. It reduces the amount of fats made by your liver, so it lowers your LDL cholesterol and triglycerides. Niacin also raises HDL cholesterol. Even though you can buy niacin without a prescription, you should talk to your provider before taking it to lower your cholesterol. High doses of niacin can cause serious side effects.
• PCSK9 inhibitors. These are medicines that you inject under your skin. They block a protein called PCSK9. This helps your liver remove and clear LDL cholesterol from your blood. Your provider may prescribe a PCSK9 inhibitor and a statin if you are at high risk of complications like heart attack or stroke, or if you have familial hypercholesterolemia (FH). FH is an inherited disorder that causes very high levels of cholesterol in the blood.
• Fibrates. They lower triglycerides in several complex ways, including reducing the amount of triglycerides made by the liver. They may also help increase HDL cholesterol and may lower LDL levels a bit. If you take them with statins, it might increase the risk of side effects.
• Combination medicines. They include more than one type of cholesterol-lowering medicine. There are also combination medicines that can treat both high blood pressure and cholesterol.

There are also a few other cholesterol medicines (lomitapide and mipomersen) that are only for people who have FH.

How does my health care provider decide which cholesterol medicine I should take?

When deciding which medicine you should take and which dose you need, your provider will consider:

• Your cholesterol levels.
• Your risk for heart disease and stroke.
• Your age.
• Any other health problems you have.
• Possible side effects of the medicines. Higher doses are more likely to cause side effects, especially over time.

Medicines can help control your cholesterol, but they don't cure it. You need to keep taking your medicines and get regular cholesterol checks to make sure that your cholesterol levels are in a healthy range.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are HDL and LDL?

HDL and LDL are two types of lipoproteins.They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. HDL and LDL have different purposes:

• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.

How do I know what my HDL level is?

A blood test can measure your cholesterol levels, including HDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What should my HDL level be?

With HDL cholesterol, higher numbers are better, because a high HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:

GroupHealthy HDL LevelAge 19 or youngerMore than 45mg/dlMen age 20 or olderMore than 40mg/dlWomen age 20 or olderMore than 50mg/dlHow can I raise my HDL level?

If your HDL level is too low, lifestyle changes may help. These changes may also help prevent other diseases, and make you feel better overall:

• Eat a healthy diet. To raise your HDL level, you need to eat good fats instead of bad fats. This means limiting saturated fats, which include full-fat milk and cheese, high-fat meats like sausage and bacon, and foods made with butter, lard, and shortening. You should also avoid trans fats, which may be in some margarines, fried foods, and processed foods like baked goods. Instead, eat unsaturated fats, which are found in avocado, vegetable oils like olive oil, and nuts. Limit carbohydrates, especially sugar. Also try to eat more foods naturally high in fiber, such as oatmeal and beans.
• Stay at a healthy weight. You can boost your HDL level by losing weight, especially if you have lots of fat around your waist.
• Exercise. Getting regular exercise can raise your HDL level, as well as lower your LDL. You should try to do 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes.Smoking and exposure to secondhand smoke can lower your HDL level. If you are a smoker, ask your health care provider for help in finding the best way for you to quit. You should also try to avoid secondhand smoke.
• Limit alcohol. Moderate alcohol may lower your HDL level, although more studies are needed to confirm that. What we do know is that too much alcohol can make you gain weight, and that lowers your HDL level.

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don't usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.

What else can affect my HDL level?

Taking certain medicines can lower HDL levels in some people. They include:

• Beta blockers, a type of blood pressure medicine
• Anabolic steroids, including testosterone, a male hormone
• Progestins, which are female hormones that are in some birth control pills and hormone replacement therapy
• Benzodiazepines, sedatives that are often used for anxiety and insomnia

If you are taking one of these and you have a very low HDL level, ask your provider if you should continue to take them.

Diabetes can also lower your HDL level, so that gives you another reason to manage your diabetes.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in the body. The liver makes cholesterol, and it is also in some foods, such as meat and dairy products. The body needs some cholesterol to work properly. But if your child or teen has high cholesterol (too much cholesterol in the blood), it can stick to the walls of their arteries and narrow or even block the arteries. This can put your child or teen at risk of coronary artery disease and other heart diseases.

What causes high cholesterol in children and teens?

Three main factors contribute to high cholesterol in children and teens:

• An unhealthy diet, especially one that is high in saturated fats
• A family history of high cholesterol, especially when one or both parents have high cholesterol
• Having obesity

Some diseases, such as diabetes, kidney disease, and certain thyroid diseases, can also cause high cholesterol in children and teens.

What are the symptoms of high cholesterol in children and teens?

There are usually no signs or symptoms that your child or teen has high cholesterol.

How do I know if my child or teen has high cholesterol?

There is a blood test to measure cholesterol levels. The test gives information about:

• Total cholesterol. This is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
• LDL cholesterol. LDL is often called "bad" cholesterol because it is the main source of cholesterol buildup and blockage in the arteries.
• HDL cholesterol. HDL is often called "good" cholesterol because it helps remove cholesterol from your arteries.
• Non-HDL. This number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
• Triglycerides. This is another type of fat in your blood that can raise the risk of heart disease.

For anyone aged 19 or younger, the healthy levels of cholesterol are

Type of CholesterolHealthy LevelTotal CholesterolLess than 170 mg/dLNon-HDLLess than 120 mg/dLLDLLess than 110 mg/dLHDLMore than 45 mg/dL

When and how often your child or teen should get this test depends on their age, risk factors, and family history. The general recommendations are:

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high cholesterol, heart attack, or stroke

What are the treatments for high cholesterol in children and teens?

Lifestyle changes are the main treatment for high cholesterol in children and teens. These changes include:

• Being more active. This includes getting regular physical activity and spending less time sitting (in front of a television, at a computer, on a phone or tablet, etc.).
• Healthy eating. A diet to lower cholesterol includes limiting foods that are high in saturated fat, sugar, and cholesterol. It is also important to eat plenty of fresh fruits, vegetables, and whole grains.
• Losing weight, if your child or teen is overweight or has obesity.

If everyone in the family makes these changes, it will be easier for your child or teen to stick to them. It is also an opportunity to improve your health, and the health of the rest of your family.

Sometimes these lifestyle changes are not enough to lower your child or teen's cholesterol. Their health care provider may consider giving your child or teen cholesterol medicines if they:

• Are at least 10 years old.
• Have an LDL (bad) cholesterol level that is higher than 190 mg/dL, even after six months of diet and exercise changes.
• Have an LDL (bad) cholesterol level that is higher than 160 mg/dL AND are at high risk for heart disease.
• Have familial hypercholesterolemia (FH). FH is an inherited disorder that causes very high levels of cholesterol in the blood.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol is made by your liver. It travels through the blood on proteins called lipoproteins. One type of lipoprotein, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

There are steps that you can take to lower your LDL (bad) cholesterol and raise your HDL (good) cholesterol. By keeping your cholesterol levels in range, you can lower your risk of heart diseases.

What are the main treatments for high cholesterol?

The main treatments for high cholesterol are lifestyle changes and medicines.

Lifestyle changes to lower cholesterol

Heart-healthy lifestyle changes that can help you lower or control your cholesterol include:

• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. It recommends that you eat and drink only enough calories to stay at a healthy weight and avoid weight gain. It also encourages you to choose a variety of nutritious foods, including fruits, vegetables, whole grains, and lean meats. Examples of eating plans that can lower your cholesterol include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
• Aiming for a healthy weight. If you are overweight or have obesity, losing weight can help lower your LDL cholesterol and raise your HDL cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of conditions that together raise your risk of heart diseases and other health problems.
• Getting regular physical activity. Studies have shown that physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol. Before you start an exercise program, ask your health care provider what level of physical activity is right for you.
• Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol.
• Quitting smoking. Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.
• Getting enough good-quality sleep. Getting 7 to 9 hours of sleep every night lowers your risk of high LDL cholesterol and total cholesterol levels.

Medicines to lower cholesterol

For some people, making lifestyle changes alone does not their lower cholesterol enough. They may also need to take cholesterol medicines. There are several types. They work in different ways and can have different side effects. If your provider recommends that you take cholesterol medicines, ask them which medicine would be right for you.

Even if you take medicines to lower your cholesterol, you still need to continue with lifestyle changes.

What are some other possible treatments for high cholesterol?

Some other possible treatments for high cholesterol may include:

Lipoprotein apheresis to lower cholesterol

Familial hypercholesterolemia (FH) is an inherited condition that causes very high levels of cholesterol in the blood. Some people who have FH may get a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from your blood. Then the machine returns the rest of your blood back to your body.

Supplements to lower cholesterol

Many companies sell supplements that they say can lower cholesterol. For many of these supplements, there isn't enough evidence to show that they can lower cholesterol levels. But for some supplements, research has found that they have cholesterol-lowering effects. For example:

• Plant stanols and sterols supplements, when taken with meals, can reduce cholesterol levels.
• Some soy products have a small cholesterol-lowering effect. But research has found that eating soy foods gives you more of a benefit than taking supplements.
• Whole flaxseed and flaxseed lignans may help to lower cholesterol levels. However, flaxseed oil does not.
• Garlic supplements may lower cholesterol levels, but the effect is small when compared to the effects of cholesterol medicines.

Supplements may cause side effects and interactions with medicines. Always check with your provider before you take any supplements.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What are LDL and HDL?

LDL and HDL are two types of lipoproteins. They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. LDL and HDL have different purposes:

• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.
• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.

How can a high LDL level raise my risk of coronary artery disease and other diseases?

If you have a high LDL level, this means that you have too much LDL cholesterol in your blood. This extra LDL, along with other substances, forms plaque. The plaque builds up in your arteries; this is a condition called atherosclerosis.

Coronary artery disease happens when the plaque buildup is in the arteries of your heart. It causes the arteries to become hardened and narrowed, which slows down or blocks the blood flow to your heart. Because your blood carries oxygen to your heart, this means that your heart may not be able to get enough oxygen. This can cause angina (chest pain), or if the blood flow is completely blocked, a heart attack.

How do I know what my LDL level is?

A blood test can measure your cholesterol levels, including LDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

For people who are older than 65:

• They should have the test every year.

You may need to get your cholesterol checked more often if you have heart disease, diabetes, or a family history of high cholesterol.

What can affect my LDL level?

Things that can affect your LDL level include:

• Diet. Saturated fat and cholesterol in the food you eat make your LDL level rise
• Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
• Physical Activity. A lack of physical activity can lead to weight gain, which can raise your LDL level
• Smoking.Cigarette smoking lowers your HDL cholesterol. Since HDL helps to remove LDL from your arteries, if you have less HDL, that can contribute to you having a higher LDL level.
• Age and Sex. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women's LDL levels tend to rise.
• Genetics. Your genes partly determine how much cholesterol your body makes. High cholesterol can run in families. For example, familial hypercholesterolemia (FH) is an inherited form of high blood cholesterol.
• Medicines. Certain medicines, including steroids, some blood pressure medicines, and HIV medicines, can raise your LDL level.
• Other medical conditions. Diseases such as chronic kidney disease, diabetes, and HIV can cause a higher LDL level.
• Race or ethnicity. People from certain racial or ethnic groups may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than White Americans. Asian Americans are more likely to have higher LDL levels than other groups.

What should my LDL level be?

With LDL cholesterol, lower numbers are better, because a high LDL level can raise your risk for coronary artery disease and related problems. The general ranges for healthy adults are:

LDL (Bad) Cholesterol LevelLDL Cholesterol CategoryLess than 100 mg/dLOptimal100-129 mg/dLNear optimal/above optimal130-159 mg/dLBorderline high160-189 mg/dLHigh190 mg/dL and aboveVery High

If you have coronary artery disease or are at high risk for it, your health care provider may have different goals for your LDL level.

How can I lower my LDL level?

There are two main ways to lower your LDL cholesterol level:

• Heart-healthy lifestyle changes, which include:
• Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples of eating plans that can lower your LDL level include the Therapeutic Lifestyle Changes diet and the DASH eating plan.
• Weight management. If you are overweight, losing weight can help lower your LDL level.
• Physical Activity. Everyone should get regular physical activity.
• Drug Treatment. If lifestyle changes alone do not lower your LDL level enough, you may also need to take medicines. There are several types of cholesterol-lowering drugs available, including statins. The medicines work in different ways and can have different side effects. Talk to your provider about which one is right for you. While you are taking medicines to lower your LDL level, you still should continue with the lifestyle changes.

Some people with familial hypercholesterolemia (FH) may receive a treatment called lipoprotein apheresis. This treatment uses a filtering machine to remove LDL cholesterol from the blood. Then the machine returns the rest of the blood back to the person.

NIH: National Heart, Lung, and Blood Institute

What is cholesterol?

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

What is VLDL cholesterol?

VLDL stands for very-low-density lipoprotein. Your liver makes VLDL and releases it into your bloodstream. The VLDL particles mainly carry triglycerides, another type of fat, to your tissues. VLDL is similar to LDL cholesterol, but LDL mainly carries cholesterol to your tissues instead of triglycerides.

VLDL and LDL are sometimes called "bad" cholesterols because they can contribute to the buildup of plaque in your arteries. This buildup is called atherosclerosis. The plaque that builds up is a sticky substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, the plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your body. It can lead to coronary artery disease and other heart diseases.

How do I know what my VLDL level is?

There isn't a way to directly measure your VLDL level. Instead, you will most likely get a blood test to measure your triglyceride level. The lab can use your triglyceride level to estimate what your VLDL level is. Your VLDL is about one-fifth of your triglyceride level. However, estimating your VLDL this way does not work if your triglyceride level is very high.

What should my VLDL level be?

Your VLDL level should be less than 30 mg/dL (milligrams per deciliter). Anything higher than that puts you at risk for heart disease and stroke.

How can I lower my VLDL level?

Since VLDL and triglycerides are linked, you can lower VLDL level by lowering your triglyceride level. You may be able to lower your triglycerides with a combination of losing weight, diet, and exercise. It is important to switch to healthy fats, and cut back on sugar and alcohol. Some people may also need to take medicines.

What is cholesterol?

Cholesterol is a waxy, fat-like substance that that's found in all the cells in your body. Your body needs some cholesterol to work properly. But if you have too much of it in your blood, it can stick to the walls of your arteries and narrow or even block them. This puts you at risk for coronary artery disease and other heart diseases.

Cholesterol is made by your liver. It travels through the blood on proteins called lipoproteins. One type of lipoprotein, LDL, is sometimes called the "bad" cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Another type, HDL, is sometimes called the "good" cholesterol. It carries cholesterol from other parts of your body back to your liver. Then your liver removes the cholesterol from your body.

What are statins?

Statins are a type of cholesterol medicine. Your health care provider may prescribe them if you have high cholesterol and making lifestyle changes does not lower your cholesterol enough. Statins are the most common medicines used to treat high cholesterol.

How do statins lower cholesterol?

Statins lower LDL cholesterol by slowing down how much cholesterol the liver makes. They also increase your liver's ability to remove LDL cholesterol that is already in the blood. This can slow the formation of plaques in your arteries. Studies have shown that statins lower the risk of heart attack and stroke in people with high LDL cholesterol.

Statins can lower your triglyceride level as well. Triglycerides are another type of fat in your blood that can raise the risk of heart disease. Statins may also increase your HDL cholesterol.

What are the risks of taking statins?

Statins usually don't cause side effects, but they may raise the risk of type 2 diabetes. However, this mainly happens in people already at high risk of diabetes, such as those who are overweight or have obesity, prediabetes, or metabolic syndrome.

Statins may also cause abnormal results on liver enzymes tests, but actual liver damage is very rare. Another uncommon side effect is muscle damage. In rare cases, this muscle damage can lead to muscle pain and kidney damage.

You should not take statins if you are pregnant or breastfeeding. They are also not recommended for people who have certain types of liver disease.

How can I safely take statins?

To safely take statins, you should:

• Take your statin as prescribed. You should not stop taking this medicine on your own, since that can lead to a serious problem or, in rare cases, even cause death. Talk to your provider if you have any concerns about your statin or if you would like to stop or change to a different treatment.
• Ask your provider which other medicines, supplements, or foods you should avoid. Some of these can interact with statins and cause serious side effects or make statins less effective. For example, grapefruit (fresh or as juice) affects how your liver breaks down some statins.
• Tell your provider about any symptoms or side effects you are having. Sometimes, people report muscle problems while taking statins. If you start having muscle pain, your provider may order a blood test to look look for muscle damage. The pain may go away if you switch to a different statin. Muscle damage with statins is rare, and your muscles may heal when you switch to a different medicine.