Source: National Library of Medicine

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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?

There are two main types of cholesterol: LDL (bad) cholesterol and HDL (good) cholesterol:

LDL stands for low-density lipoproteins. It is 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 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. Since 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 called a lipoprotein panel can measure your cholesterol levels. The test tells you what your total cholesterol, LDL, HDL, and triglyceride levels are. Triglycerides are not a type of cholesterol; they are a different type of fat found in the blood.

If you are age 20 or older, you should have your cholesterol measured at least once every five years.

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 blood cholesterol level rise
Weight. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level
Physical Activity. 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 Gender. 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.
Heredity. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.

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:

LDL (Bad) Cholesterol Level

LDL Cholesterol Category

Less than 100mg/dL

Near optimal/above optimal

130-159 mg/dL
Borderline high

160-189 mg/dL

190 mg/dL and above
Very High

How can I lower my LDL level?

The treatment for high LDL level, also called high cholesterol, is with therapeutic lifestyle changes (TLC). The main parts of TLC are:

The TLC Diet. This diet is a low-saturated-fat, low-cholesterol eating plan. According to the plan, you should get less than 7 percent of your calories from saturated fat and eat less than 200mg of dietary cholesterol per day. The TLC diet encourages you to choose a variety of nutritious and tasty foods. Choose fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, poultry without the skin, and, in moderate amounts, lean meats. The TLC diet recommends only enough calories to stay at a desirable weight and avoid weight gain. If your LDL cholesterol is not lowered enough by reducing saturated fat and cholesterol intake, you should increase the amount of soluble fiber in your diet. You can also add foods that contain "plant sterols" or "plant stanols," such as cholesterol-lowering margarines.
Weight Management. If you are overweight, losing weight can help lower your LDL cholesterol. This is especially important for people with metabolic syndrome. Metabolic syndrome is a group of risk factors that includes high triglyceride levels, low HDL cholesterol levels, and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women).
Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
Drug Treatment. Even if you take medicines to lower your cholesterol, you still need to continue with the lifestyle changes. This will keep the dose of medicine as low as possible, and lower your risk in other ways as well. There are several types of cholesterol-lowering drugs available, including

Statins, which block the liver from making cholesterol
Bile acid sequestrants, which decrease the amount of fat absorbed from food
Cholesterol absorption inhibitors, which decrease the amount of cholesterol absorbed from food and lower triglycerides
Nicotinic acid (niacin), which lowers LDL cholesterol and triglycerides and raises HDL cholesterol. You should only use this type of medicine with a health care provider's supervision.
Fibrates, which lower triglycerides. They may also raise HDL cholesterol. If you take them with statins, they may increase the risk of muscle problems.
Ezetimibe, which lowers LDL cholesterol. It works by blocking your intestine from absorbing cholesterol

NIH: National Heart, Lung, and Blood Institute

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