Cholesterol What is Cholesterol? The Centers for Disease Control and Prevention defines cholesterol as a waxy, fat-­‐
like substance found in your body and many foods. Your body needs it to work properly and makes all that you need. Too much cholesterol can accumulate depending on the kind of foods you eat and the rate at which your body breaks it down. Extra cholesterol can build up in your arteries. Over time, cholesterol deposits, called plaque, can narrow your arteries and allow less blood to pass through. When plaque totally blocks an artery carrying blood to the heart, a heart attack occurs. It also can happen when a deposit ruptures and causes a clot in a coronary artery. Chest pain, also called angina, is caused by plaque partially blocking a coronary artery, reducing blood flow to the heart. LDL and HDL: What is the “Good Cholesterol?” Lipoproteins are particles in your blood that carry cholesterol. There are two kinds of lipoproteins you need to know about: LDL and HDL. Low-­‐density lipoproteins (LDL): majority of the body's cholesterol. LDL is known as "bad" cholesterol because having high levels can lead to a buildup in the arteries and result in heart disease. High-­‐density lipoproteins (HDL) cholesterol absorb cholesterol and carry it back to the liver, which flushes it from the body. High levels of HDL, or "good" cholesterol, reduce the risk of heart disease and stroke. Cholesterol Levels: Desirable Levels Total cholesterol Less than 200 mg/dL* LDL (“bad” cholesterol) Less than 100 mg/dL HDL (“good” cholesterol) 40 mg/dL or higher * Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
Risk Factors: Age: Because cholesterol tends to rise as people get older, everyone's risk for high cholesterol increases with age. Women's LDL ("bad" cholesterol) levels rise more quickly than do men's. Until around age 55, women tend to have lower LDL levels than men do. At any age, men tend to have lower HDL ("good" cholesterol) levels than women do. Heredity: High cholesterol can run in families. People who have an inherited genetic condition, called familial hypercholesterolemia, have very high LDL cholesterol levels beginning at a young age. Cholesterol Diabetes: Having diabetes can also make you more likely to develop high cholesterol. Diabetes affects the body's use of a hormone called insulin. This hormone tells the body to remove sugar from the blood. With diabetes, the body either doesn't make enough insulin, can't use its own insulin as well as it should, or both. This causes sugars to build up in the blood. Diet: Certain foods raise your cholesterol levels. These foods tend to contain saturated fats, trans fatty acids (trans fats), dietary cholesterol, or triglycerides. Weight: Being overweight can raise LDL, lower HDL, and raise total cholesterol levels. Lack of Exercise: Not getting enough exercise can make you gain weight, which can lead to increased cholesterol levels. Lowering Your Cholesterol Levels: Steps to help maintain a normal cholesterol level: Get a blood test. Eat a healthy diet. Maintain a healthy weight. Exercise regularly. Don't smoke. Treat high cholesterol. If you have high cholesterol, your doctor may prescribe medications in addition to lifestyle changes. Talk with your doctor about how to reduce your risk for heart disease. Find out more about preventing and controlling high cholesterol. Sources: CDC. Health, United States, 2010. Hyattsville, MD: Cholesterol. http://www.cdc.gov/cholesterol/about.htm CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics. 2008. CDC: High serum total cholesterol—an indicator for monitoring cholesterol lowering efforts; U.S. adults, 2005–
2006. www.cdc.gov/nchs/data/ databriefs/db02.pdf National Cholesterol Education Program. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). [PDF-­‐1MB] NIH Pub. No. 93-­‐3095. Bethesda, MD: National Heart, Lung, and Blood Institute. 1993. Glucose test -­‐ A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the body, including those in the brain. Carbohydrates (or carbs) are found in fruit, cereal, bread, pasta, and rice. They are quickly turned into glucose in your body. This raises your blood glucose level. Hormones made in the body called insulin and glucagon help control blood glucose levels. Glucose tolerance test A blood sample is needed. For information on how this is done, see: Venipuncture. The test may be done in 2 ways: After you have not eaten anything for at least 8 hours (fasting) At any time of the day (random) What do your results mean? Normal Abnormal 100-­‐125mg/dL Between 70 and100 (prediabetes) Fasting Blood Glucose Test milligrams per deciliter (mg/dL) 126 mg/dL and higher (often means you have diabetes)* Nonfasting Below 125 mg/dL. More than 180 *Higher-­‐than-­‐normal random blood glucose levels may be a sign of diabetes. In someone with diabetes, it may mean the diabetes is not well controlled. Your healthcare provider will likely order a fasting blood glucose or a glucose tolerance test, depending on your random test result. What Abnormal Results Mean Many forms of severe stress (for example, trauma, stroke, heart attack, and surgery) can temporarily raise blood glucose levels. Drugs that can increase glucose measurements. Look at the website below for a list of drugs. Source: Medline Plus. Glucose Testing. 2012 http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Triglycerides: Your body makes some triglycerides. Triglycerides also come from the food you eat. Leftover calories are turned into triglycerides and stored in fat cells for later use. If you eat more calories than your body needs, your triglyceride level may be high. Levels: Normal: Less than 150 mg/dL Borderline High: 150 -­‐ 199 mg/dL High: 200 -­‐ 499 mg/dL Very High: 500 mg/dL or above Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. Risk Factors: High triglyceride levels may be due to: Cirrhosis or liver damage Being overweight Diet low in protein and high in Lack of physical activity carbohydrates Smoking Hypothyroidism (underactive thyroid) Excessive alcohol use Nephrotic syndrome (a kidney A very high carbohydrate diet disorder) Certain diseases and medicines Poorly controlled diabetes Some genetic disorders Low triglyceride levels may be due to: Low fat diet Hyperthyroidism (overactive thyroid) Malabsorption syndrome (conditions in which the small intestine does not absorb fats well) Malnutrition Treatment: You may be able to lower your triglycerides with a combination of losing weight, diet, and exercise. You also may need to take medicine to lower your triglycerides. Source: NIH. Triglyceride Levels. United States. 2012. http://www.nlm.nih.gov/medlineplus/ency/article/003493.htm Waist Circumference Another way to assess your weight is to measure your waist size. Your waistline may be telling you that you have a higher risk of developing obesity-­‐related conditions if you are: Male more than 40 inches Non-­‐pregnant woman more than 35 inches Risk Factors Excessive abdominal fat is serious because it places you at greater risk for developing obesity-­‐related conditions, such as Type 2 Diabetes, high blood cholesterol, high triglycerides, high blood pressure, and coronary artery disease. Individuals who have excessive abdominal fat should consult with their physicians or other health care providers to develop a plan for losing weight. How To Measure Your Waist Size To measure your waist size (circumference), place a tape measure around your bare abdomen just above your hip bone. Be sure that the tape is snug, but does not compress your skin, and is parallel to the floor. Relax, exhale, and measure your waist. Source: CDC. Healthy Weight. 2011. http://www.cdc.gov/healthyweight/assessing/ Body Fat Percentage is the percent of your weight that is fat. Body Fat Percentage Levels: A study in the American Journal of Clinical Nutrition published the following information based on your sex and age for whites or African Americans: Age 20-­‐39 40-­‐59 60-­‐79 Body Fat Guidelines Male Age Healthy Body Fat % 8%-­‐19% 11%-­‐21% 13%-­‐24% Female Age Healthy Body Fat % 21% -­‐ 32% 23%-­‐33% 24%-­‐35% How to Reduce your Body Fat? Increase you physical activity Decrease your caloric intake (Pay attention to portion sizes) “Eat right” cut out excess fat Lose on average 1-­‐2 pounds per week 3,500 calories = 1 pound. Reduce 500 calories per day to lose 1 pound in a week OR Reduce 1000 calories per day to lose 2 pounds in a week. This can be achieved by eating fewer calories or using up more through physical activity. A combination of both is best. Sources: Nutrition.gov. 2013. http://www.nutrition.gov/weight-­‐management/commonly-­‐asked-­‐questions-­‐faqs Tulane Medical Center. Body Fat Percentage. 2013. http://tulanehealthcare.com/your-­‐health/?/41373/Body-­‐
mass-­‐index What is BMI? Body mass index (BMI) is a measure of weight adjusted for height, calculated as weight in kilograms divided by the square of height in meters (kg/m2). Although BMI is often considered an indicator of body fatness, it is a surrogate measure of body fat because it measures excess weight rather than excess fat. Two ways to calculate: BMI Guidelines BMI Below 18.5 18.5-­‐24.9 25.0 – 29.9 30.0 and Above Weight Status Underweight Normal Overweight Obese What are the Risk Factors? The higher your BMI, the higher your risk for certain diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers. Although BMI can be used for most men and women, it does have some limits: -­‐ It may overestimate body fat in athletes and others who have a muscular build. -­‐ It may underestimate body fat in older persons and others who have lost muscle. Sources: CDC. Body Mass Index: Considerations for Practitioners. http://www.cdc.gov/obesity/downloads/BMIforPactitioners.pdf National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm What is High Blood Pressure? Blood pressure is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time. High blood pressure can lead to heart disease and stroke—leading causes of death in the United States. Blood pressure is measured using two numbers. The first (systolic) number represents the pressure in your blood vessels when your heart beats. The second (diastolic) number represents the pressure in your vessels when your heart rests between beats. If the measurement reads 120 systolic and 80 diastolic, you would say "120 over 80" or write "120/80 mmHg."ø Normal At risk (prehypertension) High Blood Pressure Levels systolic: less than 120 mmHg diastolic: less than 80 mmHg systolic: 120–139 mmHg diastolic: 80–89 mmHg systolic: 140 mmHg or higher diastolic: 90 mmHg or higher Risk Factors: One in three American adults has high blood pressure—that’s an estimated 67 million people. Anyone, including children, can develop it. Several factors that are beyond your control can increase your risk for high blood pressure. Age Sex Race or ethnicity How can you control your Blood Pressure? Reduce your risk by eating a healthy diet, maintaining a healthy weight, not smoking, and being physically active. What are the signs and symptoms? High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it. That’s why it’s important to visit your doctor regularly. Be sure to talk with your doctor about having your blood pressure checked. How is it treated? If you have high blood pressure, your doctor may prescribe medication to treat it. Lifestyle changes, such as the ones listed above, can be just as important as taking medicines. Talk with your doctor about the best ways to reduce your risk for high blood pressure. Source: CDC. Blood Pressure. http://www.cdc.gov/bloodpressure/docs/ConsumerEd_HBP.pdf What Is Metabolic Syndrome? According to the National Heart, Lung, and Blood Institute, Metabolic Syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. Metabolic Syndrome Levels: Body Mass Fast Blood High Density Gender Index & Waist Glucose Pressure Triglycerides Lipoproteins Circumference Male >= 25 OR Waist >= 100 or >= 130/85 >= 150 <40 Line > 40 Non-­‐
Fasting Glucose >= 140 Female >= 25 OR >=100 or BP >= >= 150 < 50 WAIST LINE > NFG >= 140 130/85 35 *Body Mass Index and WAIST LINE ONE POINT IF EITHER OF THESE OR BOTH ARE ABNORMAL* Metabolic Syndrome is present if there are 3 or more risk factors present: 1. BMI or waist line (counts as 1 point only, even if both waist line and BMI are abnormal) 2. Glucose (Fasting >= 100 or Non Fasting >=140) 3. Blood pressure (one point if Systolic or Diastolic or both are abnormal >=130/85) 4. Triglycerides (>=150) 5. HDL (men <40; women <50) Levels from Blue Cross Blue Shield How Is Metabolic Syndrome Treated? The National Heart, Lung, and Blood Institute states that healthy lifestyle changes are the first line of treatment for metabolic syndrome. These lifestyle changes can include losing weight, being physically active, following a heart healthy diet, and quitting smoking. If lifestyle changes aren't enough, your doctor may prescribe medicines. Medicines are used to treat and control risk factors such as high blood pressure, high triglycerides, low HDL cholesterol, and high blood sugar. Blood-­‐thinning medicines, such as aspirin, also may be used to reduce the risk of blood clots. Excessive blood clotting is a condition that often occurs with metabolic syndrome. Source: NHLBI, NIH, United States, 2011. Metabolic Syndrome. http://www.nhlbi.nih.gov/health/health-­‐topics/topics/ms/