Cholesterol is a type of
fat called a
lipid. The body uses it for many things, such as
making new cells. Your liver makes the cholesterol that your body needs. You
also get cholesterol from the foods you eat.
Your body needs some
cholesterol. But if you have too much, it starts to build up in your arteries.
(Arteries are the blood vessels that carry blood away from the heart.) This is
called hardening of the arteries, or
atherosclerosis. It is usually a slow process that
gets worse as you get older.
To understand what happens, think
about how a clog forms in the pipe under a kitchen sink. Like the buildup of
grease in the pipe, the buildup of cholesterol narrows your arteries and makes
it harder for blood to flow through them. It reduces the amount of blood that
gets to your body tissues, including your heart. This can lead to serious
problems, including
heart attack and
stroke.
A simple blood test tells you
how much cholesterol you have. The test results are given in mg/dL of
cholesterol but most people just say the numbers. Your cholesterol numbers help
your doctor know your risk of heart attack. To know this risk, your doctor will
also take into account other factors like your age, blood pressure,
family history, and if you smoke.
For a
general idea about your total cholesterol number, compare your number to the
following:
Best is less than
200.
Borderline-high is 200 to
239.
High is 240 or above.
What are the symptoms?
High cholesterol doesn't
make you feel sick. But if cholesterol builds up in your arteries, it can block
blood flow to your heart or brain and cause a heart attack or stroke.
By the time you find out you have it, it may already be clogging your
arteries. So it is very important to start treatment even though you may feel
fine.
What are the different kinds of cholesterol?
Cholesterol travels through the blood attached to a protein. This package
of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are
either high-density or low-density, based on how much protein and fat they
have.
Low-density lipoproteins (LDL) are the 'bad'
cholesterol. LDL is mostly fat with only a small amount of protein. It can clog
your arteries. If you have high cholesterol, your doctor will want you to lower
your LDL.
High-density lipoproteins (HDL) are the 'good' cholesterol. HDL is more protein than fat.
It helps clear the bad cholesterol from your blood so it does not clog your
arteries. A high level of HDL can protect you from a heart attack.
Triglycerides are another type
of fat in the blood that can affect your health. If you have high triglycerides
and high LDL, your chances of having a heart attack are higher.
It may help to think of HDL as the 'Healthy' cholesterol
and LDL as the 'Lousy' cholesterol. Or you could remember that HDL should be
High and LDL should be Low.
Experts have come up with goals for
each type of cholesterol. Your doctor will help you decide on cholesterol goals
based on your risk of heart attack and stroke. Your doctor will help you know
this risk. To find out your risk of a heart attack, you can use the
Interactive Tool: Are You at Risk for a Heart Attack?
LDL should be low.
Your LDL goal depends on your risk of heart attack and stroke. If you are at
very high risk, your goal may be less than 70. If you are at high risk, your
goal is less than 100. If you are at moderate risk, your goal is less than 130.
If you are at low risk, your goal is less than 160.
HDL should be high. A good HDL goal is 40 or higher. HDL over
60 helps protect against a heart attack. HDL below 40 increases your risk of
heart problems. A high HDL number can help offset a high LDL
number.
Triglycerides should be less than
150. A level above 150 may increase your risk for heart problems.
What causes high cholesterol?
Many things can
cause high cholesterol, including:
Diet. Eating too much saturated fat, trans
fat, and cholesterol can raise your cholesterol. Saturated fat, trans fat, and
cholesterol are in foods that come from animals (such as meats, whole milk, egg
yolks, butter, and cheese), many packaged foods, and snack foods like cookies,
crackers, and chips.
Weight. Being overweight may raise
triglycerides and lower 'good' HDL.
Activity level. Not
exercising may raise 'bad' LDL and lower HDL.
Overall health.
Diseases such as
hypothyroidism can raise cholesterol. Smoking may
lower HDL.
Age. Cholesterol starts to rise after age 20. In men,
it usually levels off after age 50. In women, it stays fairly low until
menopause. After that, cholesterol levels rise to
about the same levels as in men.
Family. Some people inherit a
rare disease called a
lipid disorder. It can cause very high total
cholesterol, very low HDL, and high triglycerides. If you have this problem,
you will need to start treatment at a young age.
How is high cholesterol diagnosed?
Doctors use a
blood test to check cholesterol.
A fasting cholesterol test (also called a
lipoprotein analysis) is the most complete test. It measures total cholesterol,
HDL, LDL, and triglycerides. You cannot have food for 9 to 12 hours before this
test.
A direct LDL test measures your LDL level only. You can have
this test done at any time, even if you recently had a meal or
snack.
A simple cholesterol test can measure total cholesterol and
HDL. You can eat before this test. Sometimes doctors do this test first. If it
shows you have high cholesterol or low HDL, then you will get a fasting
cholesterol test.
How is it treated?
The two main treatments are
lifestyle changes and medicines. The goal of treatment is to lower your "bad"
LDL cholesterol and reduce your risk of a heart attack. You may also need to
raise your "good" HDL cholesterol. A high level of HDL helps reduce your risk
of heart problems.
Some lifestyle changes are important for
everyone with high cholesterol. Your doctor will probably want you to:
Follow the
Therapeutic Lifestyle Changes (TLC) diet. The goal is
to reduce the amount of saturated fat you eat. Eating saturated fat raises your
cholesterol. The TLC diet helps you learn to make better food choices by
picking lean meats, low-fat or nonfat products, and good fats like olive and
canola oils.
Lose weight, if you need to. Losing just 5 lb to 10
lb (2.3 kg to 4.5 kg) can lower your cholesterol and triglycerides. Losing
weight can also help lower your blood pressure.
Be more active.
Exercise can raise your 'good' HDL and may help you control your weight.
Quit smoking, if you smoke. Quitting can help raise your HDL and
improve your heart health.
Sometimes lifestyle changes are enough on their own. But
if you try them for a few months and they don't lower your cholesterol enough,
your doctor may prescribe a cholesterol-lowering medicine called a
statin. You also may need medicines to lower
triglycerides or raise HDL.
You may need to start taking medicine
right away if your cholesterol is very high or if you have another problem that
increases your chance of having a heart attack. People who have a high risk for
heart attack benefit from taking higher doses of statins to lower their LDL
cholesterol as much as possible. The more these people can lower their LDL, the
less likely they are to have a heart attack.1 To find
out your risk, use the
Interactive Tool: Are You at Risk for a Heart Attack?
It is important to take your medicine just the way
your doctor tells you to. If you stop taking your medicine, your cholesterol
will go back up.
You will need to have your cholesterol checked
regularly. Your results can help your doctor know if lifestyle changes have
helped or if you need more or different medicines.
High cholesterol may run in your family. The foods you eat may also cause
high cholesterol. Causes include:
What you eat. Eating too
much
saturated fat,
trans fat, and cholesterol can cause high cholesterol. Saturated fat and
cholesterol are in foods that come from animals, such as meats, whole milk, egg
yolks, butter, and cheese. Trans fat is found in fried foods and packaged
foods, such as cookies, crackers, and chips.
Your weight. Being overweight may increase
triglycerides and decrease
HDL.
Your activity level. Lack of physical activity, which may increase
LDL and decrease HDL.
Your age and gender.After you reach age 20, your cholesterol levels
naturally begin to rise. In men, cholesterol levels generally level off after
age 50. In women, cholesterol levels stay fairly low until
menopause, after which they rise to about the same
level as in men.
Your family history. If family members have or had high cholesterol, you may also
have it.
Cigarette smoking.Smoking can
lower your good cholesterol.
Certain medicines. Some medicines can
raise triglyceride levels and lower HDL (good) cholesterol levels. These
medicines include thiazide
diuretics,
beta-blockers,
estrogen, and
corticosteroids.
In rare cases, high cholesterol is caused by an inherited
problem called a
lipid disorder that changes the way the body handles
cholesterol. People with lipid disorders may have total cholesterol levels well
over 250 milligrams per deciliter (mg/dL). Certain types of inherited lipid
disorders may be more difficult to treat.
Some people with
lipid disorders, such as familial
hypercholesterolemia, may have other distinct symptoms such as deposits of
excess cholesterol that collect in the skin. These cholesterol deposits can
also cause bumps in tendons in the hands or feet.
What Happens
Either high
LDL cholesterol or low
HDL cholesterol may lead to the buildup of cholesterol
(plaque) in artery walls. This buildup, called
atherosclerosis, hardens and narrows arteries and
reduces blood flow to body tissues, including the heart muscle. Atherosclerosis
can lead to:
Peripheral arterial disease, which is caused by
atherosclerosis in blood vessels that supply blood to the legs, arms, and other
parts of the body. Reduced blood flow to the legs may cause pain or cramps in
the calf, thigh, or rear end (buttock). For more information, see the topic
Peripheral Arterial Disease of the Legs.
Cholesterol levels naturally increase with age.
They also increase after
menopause in women and as a result of certain medical
conditions, such as
diabetes.
What Increases Your Risk
Some things that increase
your risk for
high cholesterol are within your control; some are
not. It is important to lower your risk as much as possible.
You may be able to control some other conditions that can
raise cholesterol, including
diabetes and
metabolic syndrome.
Things you cannot control include:
Family history. If high cholesterol
runs in your family, you may develop it, and it may be harder to treat.
Age and gender. After you reach age 20, your cholesterol levels
naturally begin to rise. In men, cholesterol levels generally level off after
age 50. In women, cholesterol levels stay fairly low until
menopause, after which they rise to about the same
level as in men.
When to Call a Doctor
High cholesterol usually has no symptoms. Sometimes the first sign that you
have high cholesterol or other risk factors for heart disease is a
heart attack, a
stroke, or a
transient ischemic attack (TIA). If you have any
symptoms of these, call 911 or other emergency services.
Symptoms of aheart attack include:
Severe chest pain, also described as
discomfort, pressure, squeezing, or heaviness.
Pain or discomfort
that radiates to the back, jaw, throat, or arm.
Discomfort in the
upper abdomen that is often mistaken for heartburn.
Sweating,
nausea, and vomiting.
Difficulty breathing,
palpitations, dizziness, and
fainting.
Weakness, numbness, and anxiety.
Symptoms of a stroke or TIA
include:
Numbness, weakness, or paralysis of the face,
arm, or leg, especially on one side of the body.
Vision problems
in one or both eyes, such as double vision or loss of vision.
Confusion, trouble speaking or understanding.
Trouble walking,
dizziness, loss of balance or coordination.
People who have rare
lipid disorders, which can be more difficult to treat,
may need to see a specialist, often an endocrinologist.
You may
need to see a cardiologist if you are diagnosed with heart disease.
Exams and Tests
You will need a blood test to check
whether you have
high cholesterol.
A total cholesterol test measures whether your cholesterol is
high or low. You can have this test done at any time, even if you recently had
a meal or snack.
A
lipoprotein analysis is a more thorough test. It
measures your total cholesterol as well as your
LDL,
HDL, and
triglyceride levels. It is called a fasting test
because you are not supposed to eat for 9 to 12 hours before having your blood
drawn.
A direct LDL test measures your LDL level only. You can
have this test done at any time, even if you recently had a meal or
snack.
Your total cholesterol level is important but the levels of
your lipoproteins, including LDL, HDL, and triglycerides, help your doctor make
decisions about whether you need treatment for high cholesterol. Your doctor
will also take into account your overall health and your risk of heart
attack.
The following tables will help you understand the results
of your cholesterol tests. All numbers are milligrams per deciliter (mg/dL),
but most people just say the numbers.
Total cholesterol
Your total cholesterol level shows if your
cholesterol is high or low. If you have high cholesterol, your doctor will want
to know your LDL and HDL levels before deciding whether you need treatment and
what sort of treatment you need.
Total cholesterol
Best
Less than 200
Borderline high
200 to 239
High
240 or above
LDL cholesterol
You want your LDL level to be low. But how low your LDL should be depends
on your risk of heart attack. This table shows the LDL levels for someone with
an average risk of heart attack. Your own LDL goal may change, based on your
risk of heart attack. This risk is based on your age and on whether you smoke,
have
high blood pressure, have a low HDL level, have
diabetes, or have one or more
close relatives who have or had early coronary artery
disease.
LDL (bad) cholesterol
Best
Below 100
Near best
100 to 129
Borderline high
130 to 159
High
160 to 189
Very high
190 and above
Your doctor will help decide what your LDL goal is and if
you need any treatment to lower your LDL. The higher your risk of heart attack,
the lower your LDL goal.
HDL cholesterol
You want your HDL level high. HDL (good)
cholesterol goals are different for men and women. But for everyone, the higher
your HDL, the better. HDL over 60 helps protect against a heart attack. HDL
below 40 increases your risk of heart problems. A high HDL number can help
offset a high LDL number.
HDL (good) cholesterol
Best
60 or higher protects against heart disease
Good
40 or higher
Bad
Below 40
Triglycerides
You want
your triglyceride level to be low.
Triglyceride levels
Normal
Less than 150
Borderline-high
150 to 199
High
200 to 499
Very high
500 or higher
When you visit your doctor to talk about your cholesterol
test, you will talk about other things that increase your risk for heart
problems, such as smoking, diabetes, high blood pressure, and a family history
of high cholesterol and heart attack. Your doctor will use all of this
information, along with your cholesterol numbers, to decide whether you need
treatment and what type of treatment you need.
If you have a high risk of a heart attack, or if you
already have heart problems, your doctor will be more likely to prescribe
medicine along with lifestyle changes. For more information about heart
disease, see the topic
Coronary Artery Disease.
You may need
other tests to determine whether another health problem, such as
hypothyroidism, is causing your high cholesterol. Some
medicines may also cause high cholesterol, so it is important to tell your
doctor about everything you take.
If you have high cholesterol,
your doctor may suggest that you get a test for
diabetes.
A
C-reactive protein (CRP) test may be done for some
people who are at risk for getting
coronary artery disease. A special type of CRP test,
the high-sensitivity CRP test (hs-CRP), can help find out your chance of having
a sudden heart problem, such as a
heart attack. This test may be done even if you have a
normal or low level of LDL cholesterol.
Some doctors and health
organizations recommend that everyone older than 20 be checked for high
cholesterol. How often you need to be checked depends on whether you have other
health problems and your overall chance of heart disease.
Most people need to adjust their
lifestyles to eat less
saturated fat and trans fat, be more active, and lose
weight if needed. Others also need to take one or more medicines.
No matter what approach you need, your treatment will focus on lowering
your "bad"
LDL cholesterol.
You may also need to
raise your "good"
HDL cholesterol at the same time. Although it may seem
odd to raise a type of cholesterol, HDL can help remove the LDL from your
arteries.
Initial treatment
After your doctor has looked at
your
cholesterol test, he or she will base your treatment
on your cholesterol levels and overall health.
First, you will
need some guidance on how to eat. Your doctor may suggest that you follow a
cholesterol-lowering diet that cuts back on saturated
fat while still allowing good fat such as olive and canola oils.
Increasing your activity is very important. Exercise can
raise your HDL and may help you lose weight, if you need to. If you smoke,
quitting will also help you raise your HDL. For more information on quitting
smoking, see the topic
Quitting Smoking.
If you have
diabetes,
high blood pressure, or
coronary artery disease (CAD) or if your cholesterol
is very high, you may need to start on medicine right away. This is because
your chances of having a heart attack are high, and medicines can reduce this
risk.
This interactive tool will tell you your
percentage of risk. After you know this, you can find your risk category for
treatment. Your doctor will base your need for medicine on your risk category.
After you have checked your risk, you can
learn more about your treatment.
If you need medicine, it likely
will be a
statin. These drugs reduce the body's natural
production of cholesterol. They are proved to lower the risk of heart attack,
stroke, and death in people with a high risk of heart attack or stroke.2, 3
Guidelines from the U.S. National Cholesterol Education
Panel (NCEP) recommend higher doses of statins for people who have a moderate
to high risk of heart attack.4 The goal is to lower
your chances of having a heart attack or stroke. Side effects are more likely
and may be more severe when higher doses of statins are used.
Work with your doctor to treat other diseases that you
may have, such as high blood pressure and diabetes, and to stop smoking, if you
smoke.
Ongoing treatment
As you continue your treatment
for
high cholesterol, your doctor will check your
cholesterol at times, to see how you are doing. If you have been trying
lifestyle changes alone, another cholesterol test can show if those changes
have helped or if you need to add medicine to your treatment.
If
you are taking medicine already, a cholesterol test can show whether you need
your dose lowered or increased or whether you need a different drug.
At this time you may also want to ask for help if you are having trouble
changing how you eat. Your doctor can recommend a
dietitian to help you plan meals.
Staying
physically active is important. Managing your weight and exercising are
important because they can help you raise your
HDL and lower your
LDL levels. Research shows that people who exercise
longer have more improvement in their LDL and HDL levels.5
Losing weight can also help lower high blood
pressure. For more information, see the topics
Fitness and
Healthy Weight.
Treatment if the condition gets worse
It is
important to follow your doctor's advice for making lifestyle changes and
taking medicines, if prescribed. If
high cholesterol is not treated, it can lead to
coronary artery disease, heart attack, and stroke.
What to think about
High cholesterol that is
caused by inherited (genetic)
lipid disorders usually is treated with
medicines.
Prevention
Eating a diet low in
saturated fat, trans fat, and cholesterol, getting
plenty of exercise, managing your weight, and not smoking can help prevent
high cholesterol. Because cholesterol levels tend to
increase with age, paying attention to diet and exercise is particularly
important as you get older.
Remember that high cholesterol is just
one of the things that increase your risk for
coronary artery disease (CAD) and heart attack.
Controlling other health problems, such as
high blood pressure and
diabetes, is also important to reduce your overall
risk.
Lifestyle Changes
Eating a sensible diet low in
saturated fat, trans fat, and cholesterol, getting moderate exercise, and
losing excess weight are important ways you can lower your
high cholesterol level. For many people, these
lifestyle changes may be all that is needed to decrease
LDL cholesterol and raise
HDL cholesterol.
If high cholesterol runs
in your family, you may not be able to reduce your cholesterol level by
following a strict diet and exercise routine only. In this case, you may need
to take medicine.
As part of the treatment for high cholesterol,
your doctor may recommend using the
Therapeutic Lifestyle Changes (TLC) recommended by the
National Cholesterol Education Program of the U.S. National Institutes of
Health.
The TLC diet is low in
saturated fat and cholesterol. Less than 7% of your
daily calories should come from saturated fat, and you should limit your
cholesterol to no more than 200 milligrams a day.
Saturated fat
and cholesterol are in foods that come from animals, such as meats, poultry,
fish, whole milk, egg yolks, butter, and cheese.
Trans fat is found in fried foods and packaged foods,
such as cookies, crackers, and chips.
The TLC plan also
recommends increasing the amount of
fiber you eat and adding plant stanols and sterols to
your diet.
Plant sterols are found in small quantities in many
fruits, vegetables, nuts, seeds, cereals, legumes, and other plant sources.
Plant stanols come from some of the same sources. Vegetable oils, for example,
contain both plant sterols and plant stanols. You can also find them in some
salad dressings and
margarines, such as Benecol and Take Control. They are
safe for children who have genetic high cholesterol, but pregnant women need to
avoid them.
You might also consider following the
Mediterranean diet, which is similar to the TLC diet.
On the Mediterranean diet, an average of 35% of calories can come from fat,
mainly from unsaturated oils, such as fish oils, olive oil, and certain nut or
seed oils (such as canola, soybean, or flaxseed oil).
See the
following for more information about food and high cholesterol:
Garlic. Studies have
shown that eating lots of garlic or taking garlic supplements does not
effectively lower cholesterol levels. Eating too much garlic can have side
effects, including allergic reaction, gas (flatulence), heartburn, garlic odor
from the skin, interference with some drugs, and longer blood-clotting
time.
Very low-fat diets. Although very
low-fat diets may indeed lower cholesterol levels, they are not recommended.
Very low-fat diets usually allow less than 15% of total calories from fat. In
comparison, a
cholesterol-reducing diet allows 25% to 35% of
calories to come from total fat, with 7% from saturated fat. A diet with less
than 25% of its calories from fat can increase triglycerides and decrease HDL
(good) cholesterol. Such a diet may deplete your body of other important
nutrients and vitamins.
Policosanol.
Policosanol, which is made from sugar cane, has not been shown to lower
cholesterol.6
Statins are the
most effective and widely used medicines to treat
high cholesterol. Evidence shows that statins can
reduce the risk for
heart attack,
stroke, and death in people who are at high risk of a
heart attack or stroke.3 Other medicines also lower
cholesterol, and some may be used to lower
triglycerides or raise
HDL.
Some people can try diet and exercise for at
least 3 months before medicines are started. But people who have
coronary artery disease (CAD) should start taking
medicines immediately.1
Other people who
may need to start taking medicine as soon as possible include those who have a
family history of early CAD, those who have inherited
forms of high cholesterol, and those who have
peripheral arterial disease or
diabetes or who have had a previous heart attack or
stroke.
Your doctor may follow NCEP and American Heart Association
medicine guidelines in deciding whether you should take medicine to lower your
cholesterol. The guidelines base treatment on your
LDL level and your risk for CAD.
Cholesterol treatment guidelines will continue to evolve as experts learn
more about how best to treat heart disease. But everyone can benefit from
eating a balanced low-fat diet, getting regular exercise, and reducing other
heart disease risks, such as smoking.
Medication Choices
The following medicines can be
used to lower LDL and triglyceride levels in the blood and to raise HDL.
Most people who have
high cholesterol can be successfully treated with
medicine and lifestyle changes. If high cholesterol causes
coronary artery disease, you eventually may need
surgery to open or bypass a blocked artery.
Other Places To Get Help
Books
American Heart Association Low-Fat Low-Cholesterol Cookbook
Author/Editor:
American Heart Association
Publisher:
Crown Publishing Group
Publication Date:
June 2004
Eater's Choice: A Food Lover's Guide to Lower Cholesterol
Author/Editor:
R. Goor, N. Goor
Publisher:
Houghton Mifflin
Publication Date:
5th edition, 1999
Organizations
American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-800-AHA-USA1 (1-800-242-8721)
Web Address:
www.americanheart.org
Call the American Heart Association (AHA) to find your
nearest local or state AHA group. AHA can provide brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support. AHA's Web site also has information on
physical activity, diet, and various heart-related conditions.
National Cholesterol Education Program (NCEP) of the
National Heart, Lung, and Blood Institute of the National Institutes of
Health
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov/about/ncep
Contact the National Heart, Lung, and Blood Institute
(NHLBI) of the U.S. National Institutes of Health (NIH) for information on the
National Cholesterol Education Program (NCEP). The NCEP can provide information
on high cholesterol as a risk factor for heart disease and stroke. You'll also
find information on cholesterol-lowering diets, recipes, exercise, weight loss,
and lifestyle changes.
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486-2497.
Pignone M (2007). Primary prevention: Dyslipidaemia,
search date March 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Gami A (2007). Secondary prevention of ischaemic
cardiac events, search date July 2004. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227-239.
[Erratum in Circulation, 110(6): 763.]
Kraus WE, et al. (2002). Effects of the amount and
intensity of exercise on plasma lipoproteins. New England Journal of Medicine, 347(19): 1483-1492.
Berthold HK, et al. (2006). Effect of policosanol on
lipid levels among patients with hypercholesterolemia or combined
hyperlipidemia. JAMA, 295(19): 2262-2269.
Other Works Consulted
Brunzell JD, Failor RA (2006). Diagnosis and treatment
of dyslipidemia. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 11. New York: WebMD.
Genest J, Libby P (2008). Lipoprotein disorders and
cardiovascular disease. In P Libby et al., eds., Braunwald's Heart Disease, 8th ed., vol. 1, pp. 1071-1092. Philadelphia: Saunders
Elsevier.
Kavey RW, et al. (2003). American Heart Association
guidelines for primary prevention of atherosclerotic cardiovascular disease
beginning in childhood. Circulation, 107(11): 1562-1566.
Krummel DA (2008). Medical nutrition therapy for
cardiovascular disease. In LK Mahan, S Escott-Stump, eds., Krause's Food and Nutrition Therapy, 12th ed., pp. 833-864.
St. Louis: Saunders Elsevier.
Maron DJ, et al. (2008). Risk factors for which
interventions have proved to lower risk of coronary heart disease section of
Preventative strategies for coronary heart disease. In V Fuster et al., eds.,
Hurst's The Heart, 12th ed., pp. 1208-1217. New York:
McGraw-Hill.
Mosca L, et al. (2007). Evidence-based guidelines for
cardiovascular disease prevention in women: 2007 update. Circulation, 115(11): 1481-1501.
Stone NJ, Blum CB (2004). Management of Lipids in Clinical Practice. Caddo, OK:
Professional Communications.
U.S. Preventive Services Task Force (2008). Screening
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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Grundy SM, et al. (2001). Executive summary of the
third report of the National Cholesterol Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA, 285(19):
2486-2497.
Pignone M (2007). Primary prevention: Dyslipidaemia,
search date March 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Gami A (2007). Secondary prevention of ischaemic
cardiac events, search date July 2004. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Grundy SM, et al. (2004). Implications of recent
clinical trials of the National Cholesterol Education Program Adult Treatment
Panel III Guidelines. Circulation, 110(2): 227-239.
[Erratum in Circulation, 110(6): 763.]
Kraus WE, et al. (2002). Effects of the amount and
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