cholesterol is a risk factor for heart attacks and strokes – cardiovascular disease
Hyperlipidemia dyslipidemia refers to increased levels of lipids (fats) in the blood, these can include both cholesterol and triglycerides Hyperlipidemia is not a disease but it can significantly increase your risk of developing vascular disease including heart attacks, strokes, NL loss of function for injury to your legs, eyes, or sexual functions. For this reason, treatment is frequently recommended for this process.
Co-factors for worsening cholesterol problems
Dyslipidemia (high cholesterol) is not the only problem but can cause the above risk profile to be escalated. Other contributing potential physiologic and non-physiologic factors include but are not limited to:
Diabetes mellitus, type 1 and 2
Hypertension ( high blood pressure )
Family history of Heart attacks or strokes at lesson 55 years old
personal history of heart attack
Vascular cramping of one’s legs
Evaluating vascular risk using cholesterol
Measuring and Diagnosing Cholesterol Problems
The standard lipid blood tests include a measurement of total cholesterol, LDL (low density lipoproteins) and HDL (high density lipoproteins), and triglycerides.
Total cholesterol — elevated total cholesterol can confer an increased risk of vascular disease, however at this time the major risk determinants are: ldl, hdl, cholesterol/HDL, and non HDL cholesterol.
●A total cholesterol level of less than 200 mg/dL does not confer a high risk
●A total cholesterol level of 200 to 239 mg/dL first of mild increase risk
●A total cholesterol level greater than or equal to 240 mg/dL is a significantly elevated risk
The total cholesterol level can be measured any time of day. It is not necessary to fast (avoid eating for 12 hours) before testing.
Types of Cholesterol
LDL cholesterol —
The low density lipoprotein (LDL) cholesterol is a major parameter we used to evaluate risk, it is typically called the “bad cholesterol”
It is usually considered a good idea to measure LDL cholesterol after you have not eaten 12 hours, though there are studies which indicate that this may not be necessary. People at higher risk are often assigned a lower LDL cholesterol goal. I usually set a goal of less than 130 is set for very low risk patients, the goal of less than 100 for average risk patients, and a goal of less than 70 for high risk patients. The reason for this is that we have shown that at a level of LDL of 100, cholesterol does not worsen arteries, and add less than 70 it begins to improve arteries. High risk conditions include diabetes, previous heart attacks or strokes.
There is a way of evaluating risk which is separate from looking at lipids, and this is to use a 10-year risk of developing coronary artery disease. There are several of these 10 year calculators. The American Heart Association currently thinks that using these calculators is the best way to assess risk. At this time I find this questionable as these calculators do not include many of the important risks, in addition to that, I don’t think they weight the risks appropriately. However, there are many good physicians who disagree with me, and believe that these calculators are the best way of evaluating your cardiac risk.
— High triglycerides levels are also associated with an increased risk of cardiovascular disease, although they are not normally viewed as being as significant as the different types of cholesterol. Elevated triglycerides levels also confer a risk for pancreatic damage ( which is very important since it can cause pain, disability, death, and worsening diabetes- which in and of itself can worsen cardiovascular risk.)
Low risk is less than 150 mg/dL (1.69 mmol/L)
Borderline high risk is 150 to 199 mg/dL
High risk is 200 to 499 mg/dL
Very high risk is greater than 500 mg/dL
Triglycerides should be measured after fasting for 12.
HDL cholesterol —
As opposed to total cholesterol, and LDL cholesterol, HDL actually confers a decreased risk of cardiovascular disease. A level greater than 60 mg/dL helps to decrease your risk for cardiovascular disease. A HDL cholesterol level of less than 40 mg/dL confers little or no protection and may also increase your risk. There are no pharmacological treatments for raising HDL cholesterol that has been proven to reduce the risk of heart attacks and strokes, although there are non-pharmacologic methods which definitely do help reduce risk. These lifestyle modification risks include, but are not limited to, exercise and avoiding smoking. A method which is not proven to decrease risk is the use of appropriate omega-3 fatty acids.
HDL-cholesterol can be measured on any blood specimen Without fasting.
Non-HDL cholesterol —
Non-HDL cholesterol is calculated by subtracting HDL cholesterol from total cholesterol. This indicator does not require fasting. Non-HDL cholesterol is a very good predictor of cardiovascular risk, and is actually superior at predicting risk in people with Type 2 diabetes and in women, then is evaluating LDL cholesterol. Goals for HDL cholesterol are essentially the same as those for LDL cholesterol +30. Thus, if the goal for LDL is 70, the goal for non-HDL cholesterol is 100.
Cholesterol evaluation can start at any age. There are different societies which make different recommendations. The American Academy of pediatrics recommends that we start screening very young, as unfortunately ( with the obesity epidemic) cholesterol risk and other cardiovascular risk now start at an older age. Other organizations recommend different ages for the beginning of cholesterol screening, based on their concept of went risk modification would begin to make sense.
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