What is cholesterol?

Cholesterol is found in every cell of the body and has important natural functions. It is manufactured by the body but can also be taken in from food. It is waxy and fat-like in appearance.

Cholesterol is oil-based and so does not mix with the blood, which is water-based. It is therefore carried around the body in the blood by lipoproteins.

The parcels of cholesterol are carried by two types of lipoprotein:

Low-density lipoprotein (LDL - cholesterol carried by this type is known as 'bad' cholesterol)
High-density lipoprotein (HDL - cholesterol carried by this type is known as 'good' cholesterol).

Cholesterol has four main functions, without which we could not live. It:

Contributes to the structure of cell walls
Makes up digestive bile acids in the intestine
Allows the body to produce vitamin D
Enables the body to make certain hormones.
Causes and Symptoms of High Cholesterol.
Causes of high cholesterol
High cholesterol is a major risk factor for coronary heart disease, a cause of heart attacks, and reducing blood lipid levels lowers the cardiovascular risk.High levels of LDL lead to a build-up of cholesterol in the arteries, whereas HDL carries cholesterol to the liver for removal from the body.2 A build-up of cholesterol is part of the process that narrows arteries, called atherosclerosis, in which plaques form and cause restriction of blood flow.High cholesterol levels are a result of modifiable and non-modifiable risk factors. Two major risk factors, diet and exercise, are highly modifiable, meaning that something can be done to change these risk factors and reduce the likelihood of having high cholesterol.2Limiting intake of fat in the diet helps manage cholesterol levels. In particular, it is helpful to limit foods that contain:2
Food sources of cholesterol
Meat, cheese and egg yolks are sources of cholesterol.
Cholesterol (from animal foods, such as egg yolks, meat and cheese)
Saturated fat (found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods)
Trans fat (found in some fried and processed foods).

Being overweight or obese can also lead to higher blood LDL levels, with regular exercise helpful in managing this risk factor.2

The primary causes of high cholesterol are genetic - very high LDL levels are found in the inherited condition familial hypercholesterolemia.

Abnormal cholesterol levels may also be secondary to the following:
Diabetes
Liver or kidney disease
Polycystic ovary syndrome
Pregnancy and other conditions that increase levels of female hormones
Underactive thyroid gland.
Drugs that increase LDL cholesterol and decrease HDL cholesterol (progestins, anabolic steroids and corticosteroids).
Symptoms of high cholesterol.
Having high cholesterol levels, while a risk factor for other conditions, does not itself present any signs or symptoms. Unless routinely screened through regular blood testing, high cholesterol levels will go unnoticed and could present a silent threat of heart attack or stroke.
Cholesterol tests and diagnosis.
High cholesterol can only be diagnosed by blood testing. Doctors' guidelines state that everyone over the age of 20 years should have their cholesterol levels checked once every five years.The cholesterol test is done after a period of fasting - no food, drink or pills for 9 to 12 hours - to enable an accurate reading of LDL cholesterol from the blood test. The screening also gives information about total cholesterol, HDL cholesterol and triglyceride levels.The guidelines set cholesterol levels that help determine the individual heart risk, as follows:LDL cholesterol
Optimal: less than 100 mg/dL
Near-optimal: 100 to 129 mg/dL
Borderline high: 130 to 159 mg/dL
High: 160 to 189 mg/dL
Very high: 190 mg/dL and above.

Guidance is also set out for the other measures in the lipid profile:

Total cholesterol
Desirable: less than 200 mg/dL
Borderline high: between 200-239 mg/dL
High: 240 mg/dL or above.

HDL cholesterol
Low: below 40 mg/dL
High: 60 mg/dL or above
After more than a decade of recommendations that physicians treat patients in an attempt to lower cholesterol to less than 100mg/dL or less than 70mg/dL, new guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA), developed with the National Heart, Lung, and Blood Institute (NHLBI) abandon this idea of LDL- and non-HDL-cholesterol targets.There is no evidence from randomized, controlled clinical trials to support treatment to a specific target. So, instead of physicians prescribing numerous medications simply for the sake of reducing cholesterol levels, even when patients have no other risk factors for heart disease, the new guidelines recommend that physicians identify four groups of patients who are likely to benefit from statin treatment to better prevent primary and secondary cardiovascular events:
People with clinical atherosclerotic cardiovascular disease
People who have LDL-cholesterol levels over 190 mg/dL, such as those with familial hypercholesterolemia
People aged 40 to 75 years old with diabetes and LDL-cholesterol levels of 70-189 mg/dL and with no evidence of atherosclerotic cardiovascular disease
People without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels of 70-189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease greater than 7.5%.
Treatment and prevention of high cholesterol
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