High Blood Cholesterol Prevention

High blood cholesterol is a major risk factor for heart disease. There are a number of things that can be done to maintain normal cholesterol levels and reduce the risk of developing heart disease. All people at any age can take steps to keep normal cholesterol levels. People with high total cholesterol, high LDL cholesterol, or low HDL cholesterol should talk with their doctor about the best way to control or improve their cholesterol.

What affects cholesterol levels?

A number of things can affect the cholesterol levels in your blood. These include the following:

• Diet. Certain foods have types of fat that raise your cholesterol level. These types of fats include saturated fat, trans fatty acids or trans fats, and dietary cholesterol. Saturated fats come largely from animal fat in the diet, but also some vegetable oils such as palm oil. Trans fats are made when vegetable oil is hydrogenated to harden it. Research suggests that trans fatty acids can raise cholesterol levels. Dietary cholesterol is found in foods that come from animal sources such as egg yolks, meat, and dairy products.
   
• Weight. Being overweight tends to increase LDL levels, lowers HDL levels, and increases total cholesterol level.
   
• Physical Inactivity. Lack of regular physical activity can lead to weight gain, which could raise your LDL cholesterol level.
   
• Heredity. High blood cholesterol can run in families. An inherited genetic condition results in very high LDL cholesterol levels. This condition is called familial hypercholesterolemia.
   
• Age and Sex. As people get older, their LDL cholesterol levels tend to rise. Men tend to have lower HDL levels than women. Younger women tend to have lower LDL levels than men, but higher levels at older ages (after age 55 years).

What can you do?

Have your cholesterol checked.  There are usually no signs or symptoms of high blood cholesterol, so it is important to have your blood cholesterol checked. A simple blood test can be done by your doctor to check your blood cholesterol level. A lipoprotein profile can be done to measure several different kinds of cholesterol as well as triglycerides (another kind of fat found in the blood).

Desirable or optimal levels for adults with or without existing heart disease are

• Total cholesterol: Less than 200 mg/dL.
• Low Density Lipoprotein (LDL) cholesterol ("bad" cholesterol): Less than 100 mg/dL.
• High Density Lipoprotein (HDL) cholesterol ("good" cholesterol): 40 mg/dL or higher.
• Triglycerides: Less than 150 mg/dL.

If a full lipoprotein panel is not done, you doctor may check your total and HDL cholesterol with a simpler blood test. The National Cholesterol Education Program recommends that healthy adults have their cholesterol levels checked once every 5 years.

Maintain a Healthy Diet.  An overall healthy diet can help to maintain normal blood cholesterol levels. Saturated fat, trans fats, and dietary cholesterol tend to raise blood cholesterol levels. Other types of fats, such as monounsaturated and polyunsaturated fats can help to lower blood cholesterol levels. Getting enough soluble fiber in the diet can also help to lower cholesterol. For some people, a diet that has too many carbohydrates can lower HDL (the good cholesterol) and raise triglycerides. Alcohol can also raise triglycerides, and excessive alcohol use can lead to high blood pressure, another risk factor for heart disease and stroke. For more information on healthy diet and nutrition, see CDC's Nutrition and Physical Activity Program Web site.

Maintain a Healthy Weight.  Being overweight or obese can raise your bad cholesterol levels. Losing weight can help you lower your blood cholesterol levels. Healthy weight status in adults is usually assessed by using weight and height to compute a number called the "body mass index" (BMI). BMI is used because it relates to the amount of body fat for most people. An adult who has a BMI of 30 or higher is considered to be obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18.5 to 24.9. Proper diet and regular physical activity can help to maintain a healthy weight. Other measures of excess body fat may include waist measurements or waist and hip measurements. If you know your weight and height, you can compute your BMI at the CDC's Nutrition and Physical Activity Program Web site.

Be Active.  Physical activity can help to maintain a healthy weight and lower blood cholesterol levels. The Surgeon General recommends that adults should engage in moderate–level physical activities for at least 30 minutes on most days of the week. For more information, see the CDC's Nutrition and Physical Activity Program Web site.

No Tobacco.  Smoking injures blood vessels and speeds up the process of hardening of the arteries. Further, smoking is a major risk for heart disease and stroke. If you don’t smoke, don’t start. Quitting smoking lowers one’s risk of heart attack and stroke. Your doctor can suggest programs to help you quit smoking. For more information about tobacco use and quitting, see CDC's Tobacco Intervention and Prevention Source Web site.

Medications.  If you are found to have high blood cholesterol, your doctor may prescribe medications, in addition to lifestyle changes, to help bring it under control. The primary focus of treatment is to get LDL cholesterol under control. Your treatment plan and goal will depend on your LDL level and your level of risk for heart disease and stroke. Your risk for heart disease and stroke will be based on whether you also have other risk factors and may include your blood pressure level or high blood pressure treatment, smoking status, age, HDL level, family history of early heart disease, and existing cardiovascular disease or diabetes. People with existing cardiovascular disease or diabetes are considered high risk. You can compute your 10-year risk for heart disease by using the 10-year risk calculator of the National Cholesterol Education Program at the National Heart, Lung, and Blood Institute’s Web site.*

Several types of medicines help to lower cholesterol:

• Statin drugs lower LDL cholesterol by slowing down the production of cholesterol and by increasing the liver's ability to remove the LDL–cholesterol already in the blood.
   
• Bile acid sequestrants help to lower LDL cholesterol by binding with cholesterol-containing bile acids in the intestines, and are then eliminated in the stool.
   
• Niacin, or nicotinic acid, is a B vitamin that can improve all lipoproteins. Nicotinic acid lowers total cholesterol, LDL-cholesterol, and triglyceride levels, while raising HDL-cholesterol levels. Because the levels needed are well above recommended dietary intake levels, niacin treatment for cholesterol should only be done only under medical supervision because of possible adverse side effects.
   
• Fibrates are used mainly to lower triglycerides and, to a lesser extent, to increase HDL levels.

All drugs may have adverse side effects, so their use needs to be checked by your doctor on a usual basis. Once your blood cholesterol level is controlled, your doctor will want to monitor it. The lifestyle changes that your doctor recommends are just as important as taking your medicines as prescribed.

Genetic Factors.  Genes can play a role in high blood cholesterol. Very high blood cholesterol levels can be related to a condition known as familial hypercholesterolemia. It is also possible that high blood cholesterol levels within a family are due to factors such as common diet. Find out more about genetics and disease on CDC's National Office of Public Health Genomics Web site.

Related Guidelines and Recommendations

• Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) from the National Heart, Blood, and Lung Institute Web site.
   
• Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults from the National Heart, Lung, and Blood Institute Web site.
   
• Physical Activity and Health: A Report of the Surgeon General
  This report brings together, for the first time, what has been learned about physical activity and health from decades of research.
   
• Surgeon General's Reports Related to Tobacco Use
  List of reports concerning smoking and health, including reports on tobacco use among ethnic groups and young people.
   
• Dietary Guidelines for Americans 2005
  Dietary Guidelines for Americans is published jointly every 5 years by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA).

 
*Links to non–Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at this link.
 

Page last reviewed: November 8, 2007
Page last modified: November 8, 2007

Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion