DIAGNOSIS
A simple blood test, called a lipid profile, is used to diagnose high cholesterol. A lipid profile measures all of the fats in your blood, including total, LDL, and HDL cholesterol.
Lipid screening should start at age 35 in men without other risk factors for coronary artery disease and at age 20 to 35 in men with risk factors. These include men with:
- Diabetes
- A family history of heart disease in a close male relative younger than age 50 or a close female relative younger than age 60
- A family history of high cholesterol
- A personal history of multiple coronary disease risk factors (eg, smoking, high blood pressure).
TREATMENT
Adopting healthy lifestyle changes is the first step to controlling high cholesterol.
These include:
- Quitting smoking
- Losing excess pounds or maintaining a healthy weight
- Avoiding alcohol
- Eating a heart-healthy diet
- Being physically active
However, if lifestyle changes do not substantially lower your cholesterol levels, your doctor may recommend cholesterol-lowering therapy based on your individual risk factors, age, current health and possible side effects. Common choices include:
Statins are among the most powerful drugs for lowering LDL cholesterol and are the most effective drugs for prevention of coronary heart disease, heart attack, stroke, and death. Statins include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. These medications decrease the body’s production of cholesterol and can reduce LDL levels by as much as 20 to 60 percent. In addition, statins can lower triglycerides and slightly raise HDL cholesterol levels.
Ezetimibe impairs the body’s ability to absorb cholesterol from food as well as cholesterol that the body produces internally. It lowers LDL cholesterol levels and has relatively few side effects. When used in combination with a statin in treatment after an acute coronary syndrome (eg, heart attack), ezetimibe provides a small additional reduction in cardiovascular events.
Bile acid sequestrants bind to bile acids in the intestine, reducing the amount of cholesterol absorbed from foods. Examples include cholestyramine, colestipol, and colesevelam.
