High cholesterol is usually discovered on routine screening and has no symptoms. It is more common if you have a family history of it, but lifestyle factors (such as eating a diet high in saturated fat) clearly play a major role.

If you have a routine blood test during a physical exam or while attending a health fair or screening at a shopping center, your blood may reveal a high total cholesterol level, which would require further testing to determine your LDL, HDL, and triglyceride levels (this is known as a lipid panel).

The National Cholesterol Education Program guidelines suggest that everyone aged 20 years and older should have their blood cholesterol level measured at least once every 5 years. It is best to have a blood test called a lipoprotein profile to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about the following items:

• Total cholesterol is the sum of all the cholesterol in your blood (serum cholesterol). The higher your total cholesterol, the greater your risk for heart disease.
• Less than 200 mg/dL is a desirable level that puts you at lower risk for heart disease . A cholesterol level of 200 mg/dL or greater increases your risk.
• A level of 200-239 mg/dL is termed borderline high.
• A level of 240 mg/dL and above is considered high blood cholesterol. Your risk at this level is twice the risk of heart disease compared with someone whose total cholesterol level is 200 mg/dL.
• Low-density lipoprotein (LDL) is considered the "bad" cholesterol. Cholesterol travels in the blood in packages called lipoproteins. Just like oil and water, cholesterol, which is not soluble in water, and blood, which is watery, do not mix. In order to be able to travel in the bloodstream, the cholesterol made in the liver is combined with protein and other substances, making a lipoprotein. This lipoprotein then carries the cholesterol through the bloodstream. LDLs carry most of the cholesterol in the blood, and the cholesterol from LDL is the main source of damaging buildup and blockage in your arteries. Thus, the more LDL cholesterol you have in your blood, the greater your risk of heart disease. Reducing your LDL cholesterol is the main goal of cholesterol-lowering treatment. The lower, the better.
• Less than 100 mg/dL is considered optimal (best).
• A level of 100-129 mg/dL is near optimal/above optimal.
• A level of 130-159 mg/dL is borderline high.
• A level of 160-189 mg/dL is high.
• A level of 190 mg/dL and above is very high.
• High-density lipoprotein (HDL) is called the "good" cholesterol. HDLs carry cholesterol in the blood from other parts of the body back to the liver, which leads to its removal from the body. In this way, HDL helps keep cholesterol from building up in the walls of the arteries. If it is not possible to have a lipoprotein profile done, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels. If your total cholesterol is 200 mg/dL or more, or if your HDL is less than 40 mg/dL, you will need to have a fasting lipoprotein profile done.
• Less than 40 mg/dL is considered a major risk factor for heart disease.
• A level of 40-59 mg/dL is better.
• A level of 60 mg/dL and above is thought to protect you against heart disease.
• Triglycerides are a form of fat carried through the bloodstream. Most of your body's fat is in the form of triglycerides stored in fat tissue. Only a small portion of your triglycerides is found in the bloodstream. High blood triglyceride levels alone do not necessarily cause atherosclerosis (the buildup of cholesterol and fat in the walls of arteries). But some lipoproteins that are rich in triglycerides also contain cholesterol, which causes atherosclerosis in some people with high triglycerides; plus, high triglyceride levels are often accompanied by other factors (such as low HDL and/or a tendency toward diabetes) that raise
• Less than 150 mg/dL is normal.
• A level of 150-199 mg/dL is borderline high.
• A level of 200-499 mg/dL is high.
• A level of 500 mg/dL or above is very high.

Self-Care at Home

If you have high lipoproteins and thus high cholesterol, your doctor will work with you to target your levels with dietary and drug treatment. Depending on your risk factors for heart disease, your target goals may differ for lowering your LDL cholesterol.

• diet: The National Cholesterol Education Program has created dietary guidelines.
  • NCEP dietary guidelines
    • Total fat - Less than 30% of calories
    • Saturated fat - Less than 7% of calories
    • Polyunsaturated fat - Less than or equal to 10% of calories
    • Monounsaturated fat - Approximately 10-15% of calories
    • Cholesterol - Less than 200 milligrams per day
    • Carbohydrates - 50-60% of calories
  • The new guidelines are more stringent than previous ones, mandating more restriction on saturated fat and dietary cholesterol.
  • Some people are able to reduce fat and dietary cholesterol with vegetarian diets. Dean Ornish and his colleagues have shown the value of a very strict fat-reduction diet in unblocking coronary arteries. Whether these dietary restrictions are realistic for most Americans is debatable. Moreover, such a diet also reduces HDL and raises triglyceride levels.
  • Stanol esters can be included in the diet and may reduce LDL by about 14%. Products containing stanol esters include margarine substitutes (marketed as brand names Benecol and Take Control).
  • People with higher triglycerides may benefit from a diet that is higher in monounsaturated fat and lower in carbohydrates, particularly simple sugars. A common source of monounsaturated fat is olive oil.
• Activity: Although exercise has little effect on LDL, aerobic exercise may improve insulin sensitivity, HDL, and triglyceride levels and may thus reduce your heart risk. People who exercise and control their diet appear to be more successful in long-term lifestyle modifications that improve their heart risk profile.

Prevention

Adoption of a healthier lifestyle, including aerobic exercise and a low-fat diet, should reduce the prevalence of obesity, high cholesterol, and, ultimately, the risk of coronary heart disease.

• First, see your doctor. A simple blood test checks for high cholesterol. You may be asked to fast overnight before the test. Just knowing your total cholesterol level isn't enough. A complete lipid profile measures your LDL, total cholesterol, HDL (the good cholesterol), and triglycerides. The guidelines say healthy adults should have this analysis every 5 years.
• Next, set dietary goals based on the guidelines from the National Cholesterol Education Program.
  • Strive for daily intake of less than 7% of your calories from saturated fat and less than 200 mg of cholesterol from the food you eat.
  • You may eat up to 30% of your calories from total fat, but most should be from unsaturated fat, which doesn't raise cholesterol levels.
  • Add more soluble fiber (found in cereal grains, beans, peas, and many fruits and vegetables) and foods that contain plant stanols and sterols (included in certain margarines  and salad dressings) to boost your LDL-lowering power. The best way to know what's in the foods you eat is to read the nutrition label.
  • Lower cholesterol levels start at the grocery store. Read food labels, and buy foods low in saturated fat and low in cholesterol. To help you know what to look for when grocery shopping, the National Heart, Lung, and Blood Institute has a partial shopping list for you.
    • Breads - Whole wheat, rye, pumpernickel, or white
    • Soft tortillas - Corn or whole wheat
    • Hot and cold cereals - Except granola or muesli
    • Rice - White, brown, wild, basmati, or jasmine
    • Grains - Bulgur, couscous, quinoa, barley, hominy, or millet
    • Fruits - Any fresh, canned, dried, or frozen without added sugar
    • Vegetables - Any fresh, frozen, or (low-salt) canned without cream or cheese sauce
    • Fresh or frozen juices without added sugar
    • Fat-free or 1% milk
    • Cheese with 3 grams of fat or less per serving
    • Low-fat or nonfat yogurt
    • Lean cuts of meat - Eye of round beef, top round, sirloin, or pork tenderloin
    • Lean or extra lean ground beef
    • Chicken or turkey - White or light meat, skin removed
    • Fish - Most white meat fish is very low in fat, saturated fat, and cholesterol.
    • Tuna - Light meat canned in water
    • Peanut butter, reduced fat
    • Eggs, egg whites, egg substitutes
    • Low-fat cookies or angel food cake
    • Low-fat frozen yogurt, sorbet, sherbet
    • Popcorn without butter or oil, pretzels, baked tortilla chips
    • Margarine - Soft, diet, tub, or liquid
    • Vegetable oil - Canola, olive, corn, peanut, or sunflower
    • Nonstick cooking spray
    • Sparkling water, tea, lemonade
• Manage your cholesterol. You can take an important first step toward a healthier heart by enrolling in the American Heart Association's Cholesterol Low Down Program. High cholesterol is a leading risk factor for coronary heart disease and stroke. Sign up by phone ([800] AHA-USA1) or online at American Heart Association's Cholesterol Low Down Program to receive life-management tools such as a newsletter, health risk assessment, and healthy-living cookbooks and fitness tips.
• Calculate your 10-year risk of having a heart attack. The risk assessment tool presented at this link is from the National Heart, Lung, and Blood Institute's National Cholesterol Education Program. It uses scientific research information to predict your chance of having a heart attack in the next 10 years. For adults older than 20 years who do not have heart disease or diabetes, click the link to assess your risk score. Those with diabetes and others with a 10-year risk greater than 20% are considered to have the same risk for future heart disease events as people with known coronary heart disease. You'll need to know your total cholesterol, HDL cholesterol level, and systolic blood pressure (the first number).
• The National Cholesterol Education Program Web site will tell you what your LDL cholesterol goal should be. For people with known coronary heart disease and similar risk, the LDL cholesterol goal is less than 100 mg/dL.