What is it?

Hypercholesterolemia (hi-per-ko-LES-ter-all-e-mee-uh) ) means having too much cholesterol in your blood. Cholesterol is a type of fat that the body uses as a building block to make hormones and other important compounds. There are two main types of cholesterol. One is low density lipoprotein (LDL) and often called "bad" cholesterol. The other is high density lipoprotein (HDL) and is often called "good" cholesterol. LDL damages the walls of the arteries and attaches to them, causing hardening of the arteries. HDL scoops up cholesterol deposits in the arteries and sends them back to the liver for disposal.

Causes:

We eat cholesterol in our diets from animal foods. We can also make cholesterol from the food we eat. Most of us make considerably more cholesterol than we eat. Therefore, even though diet does play an important level, genetics may play an even larger role. An underactive thyroid gland may also cause increased cholesterol levels.

Signs and Symptoms:

Most people have no signs or symptoms of a high cholesterol. Since high cholesterol is a risk factor for heart attacks and strokes, the first signs or symptoms can be a heart attack or a stroke.

Wellness Recommendations:

Regular exercise can lower cholesterol and raise HDL levels and decrease the risk of heart disease and stroke. Do not smoke! Smoking increases the risk of problems from hypercholesterolemia. Controlling your stress may help to decrease your cholesterol.

Medical Care:

• Eat food that is low in animal fats (which contain cholesterol) and that is low in saturated fats (coconut oil, palm oil, and hydrogenated oils).
• Lose weight if you are overweight.
• Medicine may be used to decrease your cholesterol.
• You may have a blood test to check your thyroid gland. Sometimes an underactive thyroid gland can cause high cholesterol.

Dietary Measures:

Ask your caregiver for more information about a healthy heart diet. This diet means eating the right foods to control your weight and lower your risk for heart disease. Eating low fat foods and high fiber foods helps control the amount of cholesterol in your blood. This helps prevent hardening of the arteries and heart attacks. You also need to avoid high sodium (high salt) foods. This helps to control your blood pressure and also improves the health of your heart.

Keep your fat intake to 30% or less of your calories. Eat mostly low fat foods and avoid high fat foods. Other suggestions for eating a healthy diet include:

• A vegetarian diet decreases cholesterol.
• A high calcium diet helps to lower cholesterol.
• Use avocado as a spread instead of butter or margarine. Avocado may decrease blood cholesterol.
• Beans may decrease cholesterol.
• Soybeans or soy products decrease cholesterol.
• Remove fat from all meats before cooking. You should also remove the skin from poultry. Do not fry meat, fish, or poultry. Instead, bake, roast, boil, or broil these foods.
• Always choose low fat or fat free dairy products. Fat free foods may be used as often as you like as long as you do not eat too many calories.
• If you buy margarine, choose one that is soft or in a squeeze bottle. Buy only margarines that have liquid oils as the first and second ingredients listed on the food label. Avoid margarines and other foods that contain hydrogenated oils.
• If you buy packaged foods, choose those with less than 25% of calories as fat.
• Eat less than 2000 milligrams (mg) sodium every day.
• Do not use salt when cooking or eating food.
• Many stores have low sodium cheese, soup, crackers, bread, salad dressing, and snack chips.
• Choose low sodium products if you buy frozen or canned foods. Frozen meals should have less than 400 milligrams (mg) of sodium in each serving.
• Fiber helps to decrease cholesterol. Try to eat 25 to 35 grams of fiber every day. Slowly increase the amount of fiber you eat.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

Supplements:

Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

• You would like medicine to treat hypercholesterolemia.
• Your symptoms have not gone away or improved by these self-help measures.
• You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

• You have crushing chest pressure or pain in the center of the chest that spreads to your shoulders, arms, jaw, neck, or back. The pain may be like a burning feeling that feels like heartburn. Chest pain may last more than a few minutes or the pain may go away and come back.
• You have cold sweats or sweating.
• You are short of breath.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care will be used to treat you. You always have the right to refuse treatment.

References:

1. Agarwal V, Gupta B, Singhal U et al: Examination stress: changes in serum cholesterol, triglycerides and total lipids. Indian J Physiol Pharmacol 1997; 41(4):404-408.

2. Anderson JW, Smith BM & Washnock CS: Cardiovascular and renal benefits of dry bean and soybean intake. Am J Clin Nutr 1999; 70(3 suppl):464S-474S.

3. Appleby PN, Thorogood M, Mann JI et al: The Oxford Vegetarian Study: an overview. Am J Clin Nutr 1999; 70(3 suppl):525S-531S.

4. Aronov DM, Keenan JM, Achmedzhanov NM et al: Clinical trial of wax-matrix sustained-release niacin in a Russian population with hypercholesterolemia. Arch Fam Med 1996; 5(10):567-575.

5. Batista J, Stusser R, Saez F et al: Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patients. A 14-month pilot study. Int J Clin Pharmacol Ther 1996; 34(3):134-137.

6. Bell L, Halstenson CE, Halstenson CJ et al: Cholesterol-lowering effects of calcium carbonate in patients with mild to moderate hypercholesterolemia. Arch Intern Med 1992; 152(12):2441-2444.

7. Bordia A, Verma SK & Srivastava KC: Effect of ginger (Zingiber officinale rosc.) and fenugreek (Trigonella foenumgraecum L) on blood lipids, blood sugar and platelet aggregation in patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 1997; 56(5):379-384.

8. Cattin L, Da Col PG, Fonda M et al: Treatment of hypercholesterolemia with pantithine (b5) and fenofibrate: an open randomized study on 43 subjects. Curr Ther Res 1985; 38(3):386-395.

9. Denke MA, Fox MM & Schulte MC: Short-term dietary calcium fortification increases fecal saturated fat content and reduces serum lipids in men. J Nutr 1993; 123(6):1047-1053.

10. FDA: FDA approves new health claim for soy protein and coronary heart disease. FDA Talk Paper October 20, 1999. available http://www.cfsan.fda.gov/~lrd/tpsoypr2.html (cited 8/18/03).

11. Gardner CD, Chatterjee LM & Carlson JJ: The effect of a garlic preparation on plasma lipid levels in moderately hypercholesterolemic adults. Atherosclerosis 2001; 154(1):213-220.

12. Grajeta H: Effect of amaranth and oat bran on blood serum and liver lipids in rats depending on the kind of dietary fats. Nahrung 1999; 43(2):114-117.

13. Guivernau M, Meza N, Barja P et al: Clinical and experimental study on the longer-term effect of dietary gamma-linolenic acid on plasma lipids, platelet aggregation, thromboxane formation, and prostacycline production. Prostaglandins Leukot Essent Fatty Acids 1994; 51:311-316.

14. Halbert JA, Silagy CA, Finucane P et al: Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials. Eur J Clin Nutr 1999; 53(7):514-522.

15. Knight S, Bermingham MA & Mahajan D: Regular non-vigorous physical activity and cholesterol levels in the elderly. Gerontology 1999; 45(4):213-219.

16. Knopp RH, Superko HR, Davidson M et al: Long-term blood cholesterol-lowering effects of a dietary fiber supplement. Am J Prev Med 1999; 17(1):18-23.

17. Ledesma RL, Frati Munari AC, Hernandez BC et al: Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia. Arch Med Res 1996; 27(4):519-523.

18. Lee NA & Reasner CA: Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care 1994; 17(12):1449-1452.

19. Nigon F, Serfaty-Lacrosniere C, Beucler I et al: Plant sterol-enriched margarine lowers plasma LDL in hyperlipidemic subjects with low cholesterol intake: effect of fibrate treatment. Clin Chem Lab Med 2001; 39(7):634-640.

20. Nikkila M: Influence of fish oil on blood lipids in coronary artery disease. Eur J Clin Nutr 1991; 45:209-213.

21. Petrowicz O, Gebhardt R, Donner M et al: Effects of artichoke leaf extract (ALE) on lipoprotein metabolism in vitro and in vivo.

22. Roeback JR Jr, Hla KM, Chambless LE et al: Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers: a randomized, controlled trial. Ann Intern Med 1991; 115(12):917-924.

23. Salonen RM, Nyyssonen K, Kaikkonen J et al: Six-year effect of combined vitamin C and E supplementation on atherosclerotic progression. Circulation 2003; 107:947-953.

24. Schaefer EJ & Levy RI: Pathogenesis and management of lipoprotein disorders. N Engl J Med 1985; 312:1300-1310.

25. Singh RB, Niaz MA & Ghosh S: Hypolipidemic and antioxidant effects of commiphora mukul as an adjunct to dietary therapy in patients with hypercholesterolemia. Cardiovasc Drugs Ther 1994; 8(4):659-664.

26. Stevinson C, Pittler MH & Ernst E: Garlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trials. Ann Intern Med 2000; 133(6):420-429.

27. Stoney CM, Bausserman L, Niaura R et al: Lipid reactivity to stress: II. Biological and behavioral influences. Health Psychol 1999; 18(3):251-261.

28. Tai TS, Sheu WHH, Lee WJ et al: Effect of chitosan on plasma lipoprotein concentrations in type 2 diabetic subjects with hypercholesterolemia. Diabetes Care 2000; 23(11):1703-1704.

29. Todd PA, Benfield P & Goa KL: Guar gum: a review of its pharmacological properties and use as a dietary adjunct in hypercholesterolemia. Drugs 1990; 39(6):917-928.

30. Tuomilehto J, Karttunen P, Vinni S et al: A double-blind evaluation of guar gum in patients with dyslipidemia. Human Nutr Clin Nutr 1983; 37C:109-116.

31. Wojcicki J, Pawlik A, Samochowiec L et al: Clinical evaluation of lecithin as a lipid-lowering agent. Phytother Res 1995; 9:597-599.

32. Yoshino G, Kazumi T, Amano M et al: Effects of gamma oryzanol on hyperlipidemic subjects. Curr Ther Res 1989a; 45(4):543-552.

PD0068