Our FREE cholesterol guide will help you understand and manage your cholesterol, so you can take action and live healthy! Know your numbers. And what to do about them. Lifestyle changes include: Eating a heart-healthy diet From a dietary standpoint, the best way to lower your cholesterol is reduce your intake of saturated fat and trans fat.
To be smarter about what you eat, pay more attention to food labels. As a starting point: Know your fats. Cook for lower cholesterol. A heart-healthy eating plan can help you manage your blood cholesterol level. Becoming more physically active A sedentary lifestyle lowers HDL cholesterol. Learn more about getting active. Quitting smoking Smoking and vaping lowers HDL cholesterol. Losing weight Being overweight or obese tends to raise bad cholesterol and lower good cholesterol. Learn more about losing weight.
Last Reviewed: Nov 11, Doctors categorize them by the different types of fat they involve and how each type impacts the body.
Type I: Type I, or hyperlipidemia familial lipoprotein lipase deficiency, typically occurs in childhood and is severe. It is an inherited condition that disrupts the normal breakdown of fats and can lead to abdominal pain, repeated infections of the pancreas, and enlargement of the liver and spleen. They can lead to deposits of fat in the skin and around the eyes and can also increase the risk of heart problems.
A typical feature of type III is the occurrence of xanthomas, or flat, yellow-gray plaques on the eyelids and around the eyes. Type III increases the risk of early onset cardiovascular and peripheral artery disease. Type IV: Type IV, or hypertriglyceridemia, increases levels of triglycerides in the blood rather than cholesterol. This type may also lead to obesity, high blood glucose, and high insulin levels.
Learn more about familial hypercholesterolemia. Hyperlipidemia is a major risk factor for heart disease. It refers to excess levels of LDL cholesterol and triglycerides in the blood. Hypothyroidism, a high fat diet, and being overweight contribute to high cholesterol.
However, some types of hyperlipidemia have genetic causes. Regular physical activity and a diet rich in healthful fats can improve the balance of cholesterol in the blood and help a person prevent related health problems. Blood lipids are fatty substances, such as triglycerides and cholesterol. When a person's levels are too high or low, they have dyslipidemia. It can…. The liver has many roles, one being to make cholesterol while another is to remove excess amounts.
Healthy cholesterol levels are essential for the…. Eating a healthy diet is one way to keep cholesterol levels in check. Learn which foods to avoid and which to prioritize to maintain healthy….
Pure hypercholesterolemia is a form of high cholesterol that parents pass down to their children in their genes. Find out more here. High cholesterol is a risk factor for heart attacks and coronary heart disease, because it builds up in the arteries, narrowing them.
An mRNA is a molecule that carries code for making a particular protein. In the case of Inclisiran, the drug blocks, or interferes with, the production of an enzyme called PCSK9 proprotein convertase subtilisin kexin type 9. This enzyme causes problems with the LDL receptors in the liver that are necessary for the uptake of LDL cholesterol by liver cells. Nexlitol contains bempedoic acid, which has been shown in clinical trials to inhibit cholesterol. Nexlizet contains ezetimibe, which lowers cholesterol by preventing the body from absorbing cholesterol from foods.
Both Nexlitol and Nexlizet can cause serious side effects. Your doctor can help you decide if one of these drugs would benefit your treatment plan. Praluent alirocumab was approved by the FDA in as an add-on treatment for familial hypercholesterolemia. This is a genetic condition that causes severely high cholesterol. Praluent was originally approved by the FDA in for treating heart disease and primary inherited hyperlipidemia.
Alirocumab, the active drug in Praluent, is a monoclonal antibody. This is a protein synthesized in a laboratory that behaves like antibodies made by the human body. Praluent comes as a liquid solution in a prefilled pen. You deliver it as an injection every 2 to 4 weeks, which can be done at home. It has a number of reported possible side effects, so be sure to discuss with your doctor whether it would suit your treatment plan.
You can make changes to your lifestyle to prevent high cholesterol or reduce your risk of developing hyperlipidemia:. You may want to try a heart healthy eating plan like the Mediterranean diet , which includes a lot of the nutritious foods mentioned above. People with untreated hyperlipidemia have double the risk of developing coronary heart disease as those with normal-range cholesterol levels. Coronary heart disease can lead to heart attack, stroke, or other serious problems.
You may be able to prevent complications and manage hyperlipidemia by making lifestyle choices, like:. If lifestyle choices are not sufficient, you can talk with your doctor about adding medications such as statins to help bring your cholesterol and triglycerides down to healthy levels. A new study has shed light on the benefits and risks of people over 75 taking this medication.
It found that older adults who stopped taking statins…. When should you start getting screened for high cholesterol? The evidence supporting treatment of hyperlipidemia for primary prevention is inconsistent.
Patients with the highest baseline risk are most likely to benefit. Medications should be chosen based on a favorable balance between the likelihood of benefits e. Bile acid—binding resins 7. Constipation, nausea, and bloating are common, leading to poor adherence in most patients. Many drug interactions; separate from warfarin Coumadin , digoxin, and amiodarone by at least two hours.
Well tolerated as monotherapy; side effect profile similar to placebo. Arthralgias and myalgias more common when combined with a statin 9 , Lacks clinical outcome data monotherapy or combined with a statin.
Contraindicated in active liver disease when combined with a statin e. Fibrates 7 , 11 — HMG-CoA reductase inhibitors statins 7 , 14 — Liver function test results greater than three times the upper limit of normal occur in less than 2 percent of patients. Nicotinic acid niacin 7 , Contraindicated in severe peptic ulcer disease, chronic liver disease, and severe gout. Omega-3 fatty acids Information from references 7 through Two large meta-analyses have evaluated statins for primary prevention of CVD.
The second analysis, which excluded such groups and included newer studies, showed no difference between statins and placebo for all-cause mortality.
Studies have evaluated statin therapy based on C-reactive protein level. However, the benefit of statin therapy on individual outcomes varied widely, with NNT ranging from for arterial revascularization to for myocardial infarction.
Several authors had financial ties to the sponsor, and one held the patent to the high-sensitivity C-reactive protein assay used to determine study eligibility.
No statin has been proven superior at preventing CHD and, at equivalent doses, all statins substantially reduce LDL cholesterol. Some patients will have low levels of high-density lipoprotein HDL cholesterol or high levels of triglycerides even after meeting their LDL cholesterol target. Evidence for treating these secondary lipid abnormalities with medications other than statins for primary prevention is not convincing.
For example, there is no evidence that fibrates have mortality benefit in primary prevention, and there is some evidence that they are harmful. Niacin is the only drug consistently proven to raise HDL cholesterol levels 32 — 34 ; however, there is no evidence that it reduces all-cause or cardiovascular mortality in primary prevention.
When used in primary prevention, bile acid—binding resins e. The one study evaluating resins in patients with moderate risk 0. Although omega-3 fatty acids were previously thought to reduce CHD risk, a systematic review concluded that it is unclear if dietary or supplemental omega-3 fatty acids reduce the risk of total mortality or cardiovascular events in persons at high risk of CVD or in the general population. Statins may benefit patients with CHD independent of baseline cholesterol levels or age.
The ideal starting dose in patients with CHD depends on the presence of acute coronary syndrome. A meta-analysis including patients with recent acute coronary syndrome compared high-dose statin therapy 40 mg of simvastatin daily for one month followed by 80 mg daily, or 80 mg of atorvastatin daily with moderate-dose therapy placebo for four months followed by 20 mg of simvastatin daily, or 40 mg of pravastatin daily.
A second meta-analysis compared the effectiveness of high-dose statin therapy 80 mg of simvastatin daily with lower-dose statin therapy up to 20 mg of simvastatin daily in patients with recent acute coronary syndrome or stable CHD. High-dose statins did not reduce mortality in patients with stable CHD, but decreased adverse cardiovascular events by 1. Based on these findings, it is reasonable to initiate lower doses of statins in patients with stable CHD and reserve initial high-dose statins for those with recent acute coronary syndrome.
Niacin monotherapy for secondary prevention does not reduce the risk of overall mortality. Individual trials have yielded conflicting evidence for omega-3 fatty acids in secondary risk reduction. Although their benefit is small, using omega-3 fatty acids may be a reasonable alternative after myocardial infarction in patients who cannot tolerate statin therapy. In an acute setting, initiating statin therapy may reduce stroke severity and disability, with data supporting 40 to 80 mg of atorvastatin daily over 20 to 80 mg of simvastatin daily.
A Cochrane review concluded that statin use did not reduce mortality in patients with peripheral arterial disease. Lipid therapy did not change ankle-brachial index scores. All women with a history of CHD should be offered treatment with a statin.
There are arguments for and against recommending statins in women to reduce primary CHD risk. Women also have a different baseline risk than men and therefore may not derive the same benefit.
A systematic review concluded that lipid-lowering therapy in women does not change overall mortality, but may reduce the risk of coronary events in secondary, but not primary, prevention. Clinical trials rarely include older patients, and extrapolating data from younger to older populations may be problematic.
Data Sources : A PubMed search was completed in Clinical Queries using the key terms primary cardiovascular risk reduction, secondary cardiovascular risk reduction, hyperlipidemia, cholesterol, HMG CoA reductase inhibitors, fibric acid derivatives, bile-acid binding agents, ezetimibe, niacin, and omega-3 fatty acids. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews.
Preventive Services Task Force. Search dates: June 3, ; September 10, ; and February 11, Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Allen R. Morrison St. Reprints are not available from the authors. American Heart Association.
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