High Cholesterol: Assessing Your Risk

High Cholesterol: Assessing Your Risk

Doctor talking with patient.

High cholesterol level is one of the
big risk factor for heart disease and heart attack. It’s also a risk factor for stroke and
peripheral artery disease. Assessing your risk is a first step in preventing these
diseases. Have you been told that your cholesterol is too high? If so, you could be heading
for a stroke or heart attack. This is especially true if you have other risk factors for
heart disease.

Get smart about cholesterol and your
heart disease risk. One of the first things to know is that having high cholesterol can
start early in life and continue throughout your lifetime. It can increase your risk of
developing these conditions over time. Talk with your healthcare provider about how to get
started controlling your cholesterol and other things that can increase your risk.

Why is high cholesterol a problem?

Blood cholesterol is a fatty
substance. The body uses it to make cell membranes and for hormone production. It
travels through the bloodstream and is used by the tissues for normal function. But,
when blood cholesterol is high, it forms plaque and causes inflammation. The plaque
builds up in the walls of arteries that carry blood from the heart to the body. This
narrows the opening for blood flow. Over time, the heart may not get enough oxygen. This
can lead to coronary artery disease or a heart attack. It can lead to stroke if the
plaque builds up in the arteries of the brain

3 steps to assessing your risk

Step 1. Find your risk factors for
heart disease and stroke

How your cholesterol numbers
affect your heart health depends on your other risk factors for heart attack and
stroke. Check off each risk factor below that applies to you:

  • Age. Are you a man 45 years old or older or a
    woman 55 years old or older?

  • Blood pressure. Do you have high blood
    pressure? Do you take medicine to treat high blood pressure?

  • Cholesterol levels. Have
    you been told you have high cholesterol? Do you take medicine to control your
    cholesterol? Have your LDL-C (“bad”) cholesterol and triglyceride levels stayed
    high over time even with a healthy diet and exercise?
  • Smoking. Do you smoke or use tobacco products
    such as electronic cigarettes or other products with nicotine? These products
    increase inflammation in the body and the arteries. Inflamed arteries tend to
    attract cholesterol deposits and are vulnerable to scarring and damage.
    Quitting smoking and other tobacco products can reduce this inflammation and
    reduce the risk for heart disease and stroke.

  • Diabetes. Do you have diabetes? Is your blood
    sugar level well-controlled? If you have diabetes, you may be able to lower
    your risk of heart disease or a stroke by keeping your LDL-C level lower than
    what is advised for people who don’t have diabetes.

  • Exercise. Do you exercise very little or not
    very often? Experts advise 30 minutes of exercise at least 5 days a week. If
    you’re not doing cardiovascular exercise as often as this, it may not be
    enough. You may be at higher risk for high cholesterol and heart disease.

  • Diet. Do you eat a diet that is high in
    saturated or trans fats, cholesterol, sugar, or alcohol? You may be at
    increased risk for heart disease if you don’t eat enough fruits, vegetables,
    lean meats and eat sugars or drink alcohol sparingly.

All of the things listed above can increase risk for blockages in
the arteries of your heart, neck, and legs. This can lead to heart disease, heart
attack, stroke, and peripheral artery disease.

To help find your overall risk, your provider may use a risk
calculator. It takes into account your cholesterol level and other risk factors. Ask
your healthcare provider about your 10-year risk if you are older than 40 or your
lifetime risk if you are age 20 to 39.

Depending on these results, your provider may talk with you about
other conditions that can influence your risk and affect your treatment decisions.
The following things can affect your risk:

  • A family have a history of heart problems before the age of
    55 in male relatives or age 65 in female relatives
  • Primary high cholesterol
  • Metabolic syndrome
  • Chronic kidney disease or chronic inflammatory conditions
    such as rheumatoid arthritis, psoriasis, or HIV/AIDs
  • Menopause before age 40
  • High blood pressure during pregnancy (preeclampsia)
  • Ethnicity (for example, being from South Asia)
  • Other blood lipid disorders

Your provider will want to help you understand your risk and
options for treatment.

If your healthcare provider isn’t sure about your risk and
whether to start medicine, you and your provider may decide that you need more
testing. This might include a coronary artery calcium (CAC) scan. This scan measures
the amount of calcium in the coronary arteries. If you have calcium deposits in an
artery, it means plaque is starting to build up. The results of the test are given as
a calcium score. This can help guide the decision to start cholesterol medicines such
as statins.

Step 2. Test your

High cholesterol has no
symptoms. Getting your blood tested is the only way to know if your cholesterol level
is high. Have your cholesterol tested every 4 to 6 years after the age of 20. Test
more often if you have risk factors. Cholesterol testing most often needs no
preparation. Your healthcare provider will tell you if you need to fast before the
test. This means you don’t eat for a certain amount of time before the test is done.
A blood sample is taken and sent to a lab. There, the amount of cholesterol and
triglyceride in your blood is measured. There are 2 types of cholesterol in the
sample. The first is HDL (“good cholesterol”). The second is LDL (“bad cholesterol”).
Cholesterol test results are most often shown as the total of HDL and LDL cholesterol
numbers. You may also be told the separate HDL and LDL cholesterol results.

The optimal level of LDL has changed over time and depends on your
risk factors. Generally an LDL cholesterol level around 100 mg/dL may be a good goal.
But talk with your provider about what level is best for you. It’s important to know
your cholesterol numbers. But depending on all of your risk factors, your healthcare
provider will talk with you about your results and what is important for overall

Fill in your numbers

HDL cholesterol:                           LDL cholesterol:                         Total cholesterol:                         Triglyceride:                        

Step 3: Discuss the results with your healthcare

If your cholesterol level is higher than normal, your healthcare
provider will advise how you can lower your level. Steps may include lifestyle
changes such as diet, physical activity, and quitting smoking. Your provider may also
prescribe medicine to lower bad cholesterol.

Making a plan that will work for you is an important discussion to
have with your healthcare provider. You and your provider can estimate your risk of
developing heart disease or stroke. This information can guide your decision to start
medicine such as a statin to treat your cholesterol and lower your risk. This
discussion should be ongoing. This is because your risk factors including
cholesterol levels can change over time.

If you have high cholesterol, you may need your cholesterol level
tested more often. This is to make sure your medicine and lifestyle changes are
working to reduce your risks of having a heart attack or stroke.