Cholesterol is a waxy substance found only in foods that come from animals. It is also manufactured by the body in the liver. You need small amounts of cholesterol to make and maintain nerve cells and to manufacture natural hormones. When you have too much cholesterol in your bloodstream it is called hypercholesterolemia, or high cholesterol. Hypercholesterolemia increases your risk of heart disease. The two most important components of cholesterol are low-density lipoprotein (LDL), the so-called "bad" cholesterol, and high-density lipoprotein (HDL), the "good" cholesterol. The goal of most cholesterol treatment is to decrease the LDL in your blood and to raise the HDL.

How does high cholesterol occur?

The most common cause of high cholesterol is eating foods that are high in saturated fat or cholesterol. Other possible causes are:

an inherited disorder in which cholesterol is not metabolized properly by the body
a disease that raises the cholesterol level (for example, diabetes mellitus, kidney disease, liver disease, or hypothyroidism).

Excess cholesterol causes deposits to form inside blood vessels. These deposits, called plaque, are made of fats carried by the bloodstream. Atherosclerosis, a condition in which blood vessels become hardened and narrowed by the fatty deposits, may result. Atherosclerosis causes decreased blood flow. Blood clots may form in these narrowed vessels and totally stop blood flow. When this happens in the heart it causes a heart attack. Atherosclerosis causes more deaths from heart disease than any other single condition.

What are the symptoms?

Hypercholesterolemia is a silent disease. There are no symptoms until complications have already developed, such as the chest pain of a heart attack or calf pain with walking, caused by narrowed or blocked arteries to the legs.

How is it diagnosed?

The doctor will order a blood test to check your cholesterol level. These lab tests usually measure your total cholesterol level as well as the levels of LDL, HDL, and triglyceride in your blood. You may need to fast before your blood test. This means you do not eat or drink anything except water for 12 hours before the test. The doctor may give you a physical exam and ask about your diet and diseases and health problems in your family.

Why is it important to treat hypercholesterolemia?

For every 1% reduction in cholesterol level, the risk of heart disease is reduced 2%.

How is it treated?

A diet high in soluble fiber and low in total fat, saturated fat, and cholesterol can help to lower cholesterol levels. Follow these guidelines for a healthy diet:

Increase the soluble fiber in your diet by eating fruits and vegetables (especially leafy vegetables and fresh fruits), peas, dried beans, and whole grains.
Choose poultry, fish, or meatless entrees more often than you choose red meats.
Remove the skin before eating chicken or turkey.
Use lean cuts of meat and trim off all visible fat. Keep portion sizes moderate.
Limit the amount of nuts you eat, especially nuts high in saturated fat. Examples of nuts that are especially high in saturated fat are cashews, pistachios, and Brazil and macadamia nuts.
Replace saturated fats in your diet with moderate amounts of monounsaturated and polyunsaturated fats. For example, strictly limit your use of butter, margarine, regular cheeses, shortening, and tropical oils (such as coconut and palm oils), which are high in saturated fat. Use instead sunflower, safflower, soybean, canola, or olive oil and small amounts of soft tub margarine, which are high in monounsaturated and polyunsaturated fat.
Replace whole milk dairy products with nonfat or low-fat milk, cheese, spreads, and yogurt.
Eat no more than four egg yolks per week. Use egg substitutes.
Avoid fatty desserts including ice cream, cream-filled cakes, cheesecakes, etc. Choose fresh fruits, nonfat frozen yogurt, Popsicles, etc.
Reduce the amount of fried foods, vending machine food, and fast food you eat.
Look for low-fat or nonfat varieties of the foods you like to eat, or look for substitutes.
Reduce the amount of cholesterol you consume. The American Heart Association recommends limiting the cholesterol in your diet to 250 to 300 milligrams per day.
Read labels on food packages.

You will need to lose weight if you are overweight. You should also exercise as approved by your doctor. If neither diet nor exercise substantially reduce your cholesterol level, your doctor may prescribe drugs. Drugs that can lower cholesterol include cholestyramine (Questran), colestipol (Colestid), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), probucol (Lorelco), gemfibrozil, or niacin. Some of these drugs have side effects your doctor will need to discuss with you. Sometimes you will need a combination of medications to decrease your total cholesterol.

How can I take care of myself and prevent hypercholesterolemia?

In addition to changing your diet, you can help lower your cholesterol by the following:

Get more exercise, especially aerobic exercise. Ask your doctor about an exercise prescription. Start slowly to avoid injury. Exercise helps raise HDL levels, improve circulation, decrease body fat, and tone muscles.
Don't smoke.
Maintain a normal weight.
Have your cholesterol levels and weight checked by your doctor. Doctors and researchers are formulating guidelines for evaluation of hypercholesterolemia in children. Ask your children's doctor about when to check them.

Robert B. McWilliams, MD

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Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

High Cholesterol (Hypercholesterolemia)

Return to Infertility and Women's Health Care Articles

Robert B. McWilliams, MD
Reproductive Endocrinology
and Gynecology