3.2.6. Lipid abnormalities, lipid panels

Behaviors

Your lifestyle choices can increase your risk for high cholesterol. To reduce your risk, your doctor may recommend changes to your lifestyle. The good news is that healthy behaviors can lower your risk for high cholesterol. Unhealthy Diet Diets high in saturated fats, trans fat, and cholesterol have been linked to high cholesterol and related conditions, such as heart disease. Physical Inactivity Not getting enough physical activity can make you gain weight, which can lead to high cholesterol. Obesity Obesity is excess body fat. Obesity is linked to higher triglycerides and higher "bad" cholesterol levels, and lower "good" cholesterol levels. In addition to high cholesterol, obesity can also lead to heart disease, high blood pressure, and diabetes. Talk to your health care team about a plan to reduce your weight to a healthy level.

Cholesterol basics

Cholesterol is a waxy, fat-like substance that travels through the blood on proteins called lipoproteins. It comes from two sources: It's made by your body and used to do important things, like make hormones and digest fatty foods. It's found in many foods, like egg yolks, fatty meats, and regular cheese. When your body has too much cholesterol, it can build up on the walls of your blood vessels. These deposits are called plaque. As your blood vessels build up plaque deposits over time, the inside of the vessels narrow and allows less blood to flow through to your heart and other organs. When plaque buildup totally blocks a coronary artery carrying blood to the heart, it causes a heart attack. Another cause of heart attack is when a plaque deposit bursts and releases a clot in a coronary artery. Angina is caused by plaque partially blocking a coronary artery, reducing blood flow to the heart and causing chest pain.

Risk factors for high cholesterol, including: o Medical conditions

Diabetes mellitus increases the risk for high cholesterol.1 Your body needs glucose (sugar) for energy. Insulin is a hormone made in the pancreas that helps move glucose from the food you eat to your body's cells. If you have diabetes, your body doesn't make enough insulin, can't use its own insulin as well as it should, or both. Diabetes causes sugars to build up in the blood. Talk to your doctor about ways to manage diabetes and control other risk factors.

Genetics, family history, and other characteristics

Family members share genes, behaviors, lifestyles, and environments that can influence their health and their risk for disease. High cholesterol can run in a family, and your risk for high cholesterol can increase based on your age and your race or ethnicity. Genetics and Family History When members of a family pass traits from one generation to another through genes, that process is called heredity. Genetic factors likely play some role in high cholesterol, heart disease, and other related conditions. However, it is also likely that people with a family history of high cholesterol share common environments and other potential factors that increase their risk. If you have a family history of high cholesterol, you are more likely to have high cholesterol. You may need to get your cholesterol levels checked more often than people who do not have a family history of high cholesterol. The risk for high cholesterol can increase even more when heredity combines with unhealthy lifestyle choices, such as eating an unhealthy diet. Some people have an inherited genetic condition called familial hypercholesterolemia. This condition causes very high "bad" cholesterol levels beginning at a young age. Find out more about genetics and disease on CDC's Office of Public Health Genomics website. Family health history is a record of the diseases and health conditions present in your family. Family health history is a useful tool for understanding health risks and preventing disease. To help people collect and organize their family history information, CDC's Office of Public Health Genomics collaborated with the U.S. Surgeon General and other federal agencies to develop a Web-based tool called "My Family Health Portrait." Other Characteristics Both men and women can have high cholesterol. Some other characteristics that you cannot control, like your age and race or ethnicity, can affect your risk for high cholesterol. Age. Because your cholesterol tends to rise as you get older, your risk for high cholesterol increases with age. Sex. Levels of low-density lipoprotein (LDL), or "bad" cholesterol, rise more quickly for women than for men. However, until around age 55, women tend to have lower LDL levels than men do.1 At any age, men tend to have lower high-density lipoprotein, or "good" cholesterol, than women do. Race or ethnicity. Cholesterol levels vary by race, ethnicity, and sex. The chart below shows the percentages of people with high LDL cholesterol (130 mg/dL or more) in the United States.2 What are the ideal levels of cholesterol? Racial or Ethnic Group Men (%) Women (%) Non-Hispanic blacks 30.7 33.6 Mexican Americans 38.8 31.8 Non-Hispanic whites 29.4 32.0 All 31.0 32.0

Reference values (Note: the coach is required to know only normal lipid values; i.e., does not need to know borderline high vs. high vs. very high)

LDL Cholesterol Optimal: Less than 100 mg/dL (2.59 mmol/L); for those with known disease (ASCVD or diabetes), less than 70 mg/dL (1.81 mmol/L) is optimal Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L) Borderline high: 130-159 mg/dL (3.37-4.12 mmol/L) High: 160-189 mg/dL (4.15-4.90 mmol/L) Very high: Greater than 190 mg/dL (4.90 mmol/L) Total Cholesterol Desirable: Less than 200 mg/dL (5.18 mmol/L) Borderline high: 200-239 mg/dL (5.18 to 6.18 mmol/L) High: 240 mg/dL (6.22 mmol/L) or higher HDL Cholesterol Low level, increased risk: Less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women Average level, average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women High level, less than average risk: 60 mg/dL (1.55 mmol/L) or higher for both men and women Fasting Triglycerides Desirable: Less than 150 mg/dL (1.70 mmol/L) Borderline high: 150-199 mg/dL(1.7-2.2 mmol/L) High: 200-499 mg/dL (2.3-5.6 mmol/L) Very high: Greater than 500 mg/dL (5.6 mmol/L) Non-HDL Cholesterol Optimal: Less than 130 mg/dL (3.37 mmol/L) Near/above optimal: 130-159 mg/dL (3.37-4.12mmol/L) Borderline high: 160-189 mg/dL (4.15-4.90 mmol/L) High: 190-219 mg/dL (4.9-5.7 mmol/L) Very high: Greater than 220 mg/dL (5.7 mmol/L) Unhealthy lipid levels and/or the presence of other risk factors such as age, family history, cigarette smoking, diabetes and high blood pressure, may mean that the person tested requires treatment. The NCEP Adult Treatment Panel III guidelines uses the results of lipid tests and these other major risk factors to define target LDL cholesterol levels. According to those guidelines, if individuals have LDL-C above the target values, they will be treated. The target LDL-C value is: Less than 100 mg/dL (2.59 mmol/L) if the person has heart disease or diabetes [and ideally less than 70 mg/dL (1.81 mmol/L)] Less than 130 mg/dL (3.37 mmol/L) if the person has 2 or more risk factors Less than 160 mg/dL (4.14 mmol/L) if the person has 0 or 1 risk factor Youths A full, fasting lipid panel is recommended for screening youths with risk factors for developing heart disease, according to the American Academy of Pediatrics. Fasting prior to lipid screening in children without risk factors is unnecessary. Non-high-density lipoprotein cholesterol (non-HDL-C) is the recommended test for non-fasting lipid screening. Non-HDL-C-is calculated by testing for total cholesterol and HDL-C and taking the difference between the two levels. Recommended cut-off values include: Test Acceptable (mg/dL) Borderline (mg/dL) High (mg/dL) Children and Adolescents Total Cholesterol Less than 170 170-199 Greater than or equal to 200 Non-HDL Cholesterol Less than 120 120-144 Greater than or equal to 145 Young Adults Total Cholesterol Less than 190 190-224 Greater than or equal to 225 Non-HDL Cholesterol Less than 150 150-189 Greater than or equal to 190

Types of cholesterol (LDL, HDL, triglycerides)

Molecules called lipoproteins carry cholesterol in the blood. Two important kinds of lipoproteins are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). When checking LDL and HDL, doctors often include another type of fat called triglycerides. Total cholesterol is a measure of the total amount of cholesterol in your blood and is based on the HDL, LDL, and triglycerides numbers. LDL cholesterol makes up the majority of the body's cholesterol. LDL is known as "bad" cholesterol because having high levels can lead to plaque buildup in your arteries and result in heart disease and stroke. HDL cholesterol absorbs cholesterol and carries it back to the liver, which flushes it from the body. HDL is known as "good" cholesterol because having high levels can reduce the risk for heart disease and stroke. Triglycerides are a type of fat found in your blood that your body uses for energy. The combination of high levels of triglycerides with low HDL cholesterol or high LDL cholesterol can increase your risk for heart attack and stroke. Know Your Risk Your health care team can do a simple blood test to check your cholesterol levels. The test is called a lipid profile. The test measures several kinds of total cholesterol and its individual parts including triglycerides. Some doctors do another blood test that just checks total and HDL cholesterol. Whether your lipid levels require treatment is not solely based on your lipid profile numbers. Your primary care provider will look at these numbers, and your other risk factors, to determine your overall risk for heart disease and help decide if you need treatment. There are no signs or symptoms of high LDL cholesterol. That is why it's so important to get your cholesterol checked. Talk to your doctor about what your numbers mean for you. Who needs to get their cholesterol checked? Cholesterol is something that needs to be monitored just like blood pressure. Talk to your health care team about what's best for you. All adults, aged 20 or older, need to get their cholesterol checked. If you are 20 years or older and have not been diagnosed with heart disease, it is recommended that your cholesterol be checked every 5 years. Some people need to get their cholesterol checked more often.1 All children and adolescents should have their cholesterol monitored at least once between the ages of 9 and 11 years, and again between ages 17 and 21 years.2 Lowering Cholesterol Knowing your cholesterol levels together with other factors, such age, gender, race/ethnicity, smoking status, and blood pressure, will help your health care team decide whether you should take cholesterol-lowering medication to help reduce your risk for heart disease and stroke.