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Ask the Expert: Telling the good cholesterol from the bad

Dr. Lisa Carey, an internal medicine and pediatrics physician at Greater Baltimore Medical Center at Hunt Manor.
Dr. Lisa Carey, an internal medicine and pediatrics physician at Greater Baltimore Medical Center at Hunt Manor. (Courtesy of Greater Baltimore Medical Center at Hunt Manor)

Our bodies need some cholesterol, but many people have levels that are too high, which can lead to health problems. Factors like poor diet, age and genetics contribute to increases in the kind of cholesterol that is most troubling. Fortunately, there are ways to lower levels of bad cholosterol and heighten levels of the good kind. Dr. Lisa Carey, an internal medicine and pediatrics physician at Greater Baltimore Medical Center at Hunt Manor, explains the different types of cholesterol and the roles they play in the body.

What is the role of cholesterol in the body?

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Cholesterol is a waxy, fat-like material that's in all cells of the body. Your body needs some of it to make things like hormones and vitamins. Eventually, it gets broken down into bile salts, which help you absorb molecules and vitamins from food. Cholesterol comes from two sources: your own body and the food you consume. Your liver produces all the cholesterol you need and circulates it through the blood. Cholesterol is also found in foods from animal sources — for example, meat, poultry and high-fat dairy products.

What is the difference between good and bad cholesterol?

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An easy way to remember the different types of cholesterol is LDL (lousy) and HDL (healthy). Low-density lipoproteins (LDL) make up the majority of your body's cholesterol. Although some LDL cholesterol is necessary for normal body functions, high levels can contribute to atherosclerosis, or plaque buildup in the arteries, and damage to the inside of your blood vessels. High-density lipoproteins (HDL) absorb cholesterol and bring it back into your liver to help cleanse excess cholesterol from your body. HDL also protects against clots and helps to keep the inside of the blood vessels healthy. High levels of HDL can help lower a person's risk for heart disease and stroke.

How can people lower their levels of bad cholesterol?

For most people with high cholesterol, the first step is to try lowering LDL cholesterol through various lifestyle changes such as exercise and a healthy diet. Patients are encouraged to eat a lot of fruits, vegetables and foods low in saturated fat. Losing weight, quitting smoking, engaging in regular exercise and dietary changes can all help to raise your HDL levels and lower LDL.

What role do genetics play in cholesterol?

Studies have shown that people who are related tend to have similar levels of cholesterol in their blood. There are certain genetic conditions that you can inherit from your parents, which can give you extremely high and difficult to treat cholesterol, such as familial hypercholesterolemia, which affects one in 300 to 500 people. In general, though, your cholesterol is determined by both your genetics and lifestyle.

What are the newest treatments for cholesterol?

Aside from diet and exercise, the standard treatment for high cholesterol is a type of medication called a statin. Statins help to lower your risk of a heart attack or stroke by preventing the liver from producing cholesterol internally. All patients who have heart disease, as well as many patients with certain risk factors such as a stroke or diabetes, should be prescribed a statin. Your primary care physician can calculate your risk and help to determine if medication is appropriate for your health plan. It is important to note that the FDA has recently approved two new medications for familial hypercholesterolemia, but current guidelines recommend statin medications for most people with high cholesterol.

Do a person's cholesterol levels increase with age?

Yes, cholesterol levels do often increase with age. Women's cholesterol tends to rise after menopause. Your primary care physician will continue to monitor your cholesterol throughout your life. There are guidelines for when to test and treat even children for high cholesterol. Don't forget that age is just a number — there are so many more important factors for your health than age.

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