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How Do I Find Out If I Have Cholesterol Problems?

A blood test to determine your blood cholesterol (also called 'total cholesterol') level is now a routine part of most physical checkups. In fact, it is now recommended that all people over the age of 20 have their cholesterol checked every five years. In addition to checking your total cholesterol, your doctor will probably check your HDL cholesterol.

In some instances, your doctor will also check your LDL cholesterol, which is a better indicator of heart disease than total cholesterol. You will need to fast overnight before getting an LDL cholesterol test. Your triglycerides are measured whenever your LDL cholesterol is checked.

Inside the Numbers:

Total cholesterol below 200 is considered "desirable" and puts you at low risk for heart disease.

Total cholesterol levels between 200 and 239 are considered borderline-high.

A total level of 240 or more is definitely high and more than doubles your risk of developing heart disease.

HDL levels should be ABOVE 40. The American College of Cardiology recommends that women have an HDL level above 45.

LDL ("bad") cholesterol should ideally be below 100, but less than 130 is still considered desirable for most people. However, if you have other risk factors for heart disease, meaning that you have diabetes, high blood pressure, are a man, or already have heart disease, then your LDL should be below 100.

LDL levels between 130 and 159 are considered borderline-high risk.

An LDL above 159 is high and puts you at high risk for developing heart disease.

LDL greater than 190 is considered very high.

Your fasting triglyceride level should be below 200.

Optimum cholesterol levels are different for everyone, depending on how many risk factors they have for heart disease (like smoking, diabetes, obesity, diet high in fat).

What Are the Treatments?

Advice from your doctor about managing your cholesterol is likely to echo that of nutritionists and most alternative practitioners: Adopt a diet low in saturated fat and cholesterol, increase your fiber intake, lose weight, exercise regularly, and if you smoke - quit.

Diet. People with heart disease should reduce saturated fat intake to less than 7% of total calories.

People also should be wary of trans fat - found in processed foods like chips, cookies and some margarines. Diets high in trans fats are associated with increased risk of heart disease. And trans fats accelerate atherosclerosis. Look for labels that list partially hydrogenated vegetable oil or hydrogenated vegetable oil and avoid them.

Note that products that say "low cholesterol" or "no cholesterol" may not be that healthy because they could be loaded with saturated fats.

Garlic is a food item that has been shown in studies to reduce LDL cholesterol, but not others. Talk to your health care provider before using garlic or garlic supplements to lower cholesterol.

Low cholesterol products. If your cholesterol is only mildly elevated, your doctor may suggest that you substitute the cholesterol-lowering margarines, Benecol and Take Control, into your diet.

Exercise. Studies show that regular exercise lowers cholesterol levels.

Medical Treatments. Drug treatment for high cholesterol centers on reducing the LDL level and the degree of LDL lowering depends on a person's risk category (based on the LDL value and a person's risk of having a heart attack within the next 10 years.). These risk factors include age older than 45 for men and 55 for women (unless she went through premature menopause), high blood pressure, diabetes, diet high in saturated fat, smoking, obesity, sedentary lifestyle and a family history of cardiovascular disease.

Statin drugs are among the most widely used to lower total and LDL cholesterol. Statins available in the U.S. are: Mevacor, Altocor, Pravachol, Lescol, Zocor, and Lipitor. These drugs work by blocking the liver's ability to produce cholesterol. Though they usually don't cause problems, in rare instances, they can cause reversible damage to the liver and muscle. Because of this, your doctor will periodically perform blood tests to check your liver function.

Niacin is an alternative for some people, but to be effective it must be taken in large doses. Unfortunately, in these amounts it often causes skin flushing and upset stomach. Newer versions of niacin made to minimize these problems do work a little better but must always be taken under a doctor's supervision.

A group of drugs called bile acid binders (cholestyramine and colestipol) may also lower total and LDL cholesterol in some people by depleting the supply of LDL cholesterol. But these drugs also have side effects - namely bloating, gas and constipation.

Another group of drugs called fibric acid derivatives are occasionally used to increase HDL cholesterol and lower triglyceride levels. They also mildly lower LDL.

Zetia is a new drug that directly blocks the absorption of cholesterol in the small intestine. Usually it is used in combination with a statin - getting up to an additional 25% reduction of cholesterol.

If your cholesterol level can't be controlled using one of these medicines, your doctor may try to combine two drugs, most commonly a bile acid binder and a statin.

A blood-cleansing procedure called LDL apheresis may help people with severe genetic cholesterol disorders. Over several hours, blood is removed from the body, chemically cleansed of LDL cholesterol, then returned to the body. Treatments every two to three weeks can reduce average LDL cholesterol by 50%-80% but are costly in both time and money.