Introduction

Every cell in our body contains cholesterol and it is an important component of cell membranes and a building block in the formation of some hormones. But your body makes all the cholesterol it needs. Any cholesterol in your diet is extra — and it's up to no good.

Excess cholesterol in your blood will lead to develop fatty deposits in your blood vessels- called atherosclerosis. Eventually, these deposits narrow the arteries and restrict the blood flow to the heart muscles leading to angina and heart attack. Decreased blood flow to your brain can cause a stroke. A healthy diet, regular exercise and other lifestyle changes can go a long way toward reducing high cholesterol. Sometimes you may need medication.

Types of Cholesterol

Cholesterol in your blood is attached to proteins. The cholesterol-protein bondage is called a lipoprotein. The main types of lipoproteins are:

• Low-density lipoprotein (LDL)
  LDL, or "bad," cholesterol transports cholesterol throughout the body. The LDL cholesterol builds up in the walls of your arteries making them hard and narrow.
  
  
• High-density lipoprotein (HDL)
  HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.

Various factors — such as inactivity, obesity and an unhealthy diet contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control - your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce excess cholesterol.

Risk factors

High cholesterol can lead to heart disease; however other factors compound the risk:

• High blood pressure
  High blood pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
  
  
• Diabetes
  High blood sugar contributes to high LDL cholesterol and low HDL cholesterol. High blood sugar also damages the inner lining of your arteries.
  
  
• Smoking
  Cigarette smoking leads to atherosclerosis- accumulation of fatty deposits inside the blood vessels. Smoking lowers your level of HDL cholesterol.
  
  
• Family history
  If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

Screening and diagnosis

Blood test to check cholesterol levels is done after 12 hours fast and typically it reports:

• Total cholesterol
  
  
• LDL cholesterol
  
  
• HDL cholesterol
  
  
• Triglycerides — a type of fat in the blood
  
  
• TC/HDL ratio

Blood Cholesterol Result

The following general guidelines can be used to interpret your test results. LDL targets – not the same

LDL cholesterol is closely associated with heart disease; it's the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.

One is considered very high risk if you've had a heart attack or if you have diabetes. In addition, two or more of the following risk factors might also place you in the very high risk group:

• Smoking
  
  
• High blood pressure
  
  
• Low HDL cholesterol
  
  
• Family history of early heart disease
  
  
• Age older than 45 if you're a man, or older than 55 if you're a woman

Treatment

Lifestyle changes can help improve your cholesterol level. Despite all these if particularly your LDL cholesterol — remains high, you may need medication.

Common drugs include:

• Statins
  Statins — the most commonly prescribed medications for lowering cholesterol — blocks an enzyme needed by your liver to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from accumulated deposits on your artery walls, potentially reversing coronary artery disease.
  
  Some commonly used statins are as follows: Atorvastatin (Lipitor), Pravastatin (Pravachol), Rosuvastatin (Crestor) and Simvastatin (Zocor).
  
  
• Bile-acid-binding resins
  The liver uses cholesterol to make bile acids, a substance needed for digestion. The medications like cholestyramine (Questran), lower cholesterol indirectly by binding to bile acids.
  
  
• Cholesterol absorption
  The small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. It can be used in combination with any of the statin drugs. E.g.: ezetimibe-simvastatin (Vytorin).

If you also have high triglycerides, your doctor may prescribe:

• Fibrates
  The medications fenofibrate and gemfibrozil decreases triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
  
  
• Niacin
  Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. Dietary supplements containing niacin are not effective for lowering triglycerides.

Side Effects

Most of these medications are well tolerated, but effectiveness varies from person to person. If you start taking cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver.