Cholesterol (cont.)
Medical Author:
Benjamin Wedro, MD, FACEP, FAAEM
Benjamin Wedro, MD, FACEP, FAAEMDr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center. Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACRDr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. In this Article
 What are triglycerides and VLDL?Triglyceride is a fatty substance that is composed of three fatty acids. Like cholesterol, triglyceride in the blood either comes from the diet or the liver. Also, like cholesterol, triglyceride cannot dissolve and circulate in the blood without combining with a lipoprotein. The liver removes triglyceride from the blood, and it synthesizes and packages triglyceride into VLDL (very low-density lipoprotein) particles and releases them back into the blood circulation. Do high triglyceride levels cause atherosclerosis? Whether elevated triglyceride levels in the blood lead to atherosclerosis and heart attacks is controversial. While abnormally high triglyceride levels may be a risk factor for atherosclerosis, it is difficult to conclusively prove that elevated triglyceride by itself can cause atherosclerosis. Elevated triglyceride levels are often associated with other conditions that increase the risk of atherosclerosis, including obesity, low levels of HDL- cholesterol, insulin resistance and poorly controlled diabetes mellitus, and small, dense LDL cholesterol particles. What are the causes of elevated triglyceride levels? High triglyceride levels may be genetic or they may be acquired. Examples of inherited hypertriglyceridemia (hyper=high + triglyceride + emia= in blood) disorders include mixed hypertriglyceridemia, familial hypertriglyceridemia, and familial dysbetalipoproteinemia. Hypertriglyceridemia can often be caused by non-genetic factors such as obesity, excessive alcohol intake, diabetes mellitus, kidney disease, and estrogen- containing medications such as birth control pills. How can elevated blood triglyceride levels be treated? Diet is the first step in treating hypertriglyceridemia. A low fat diet, regular aerobic exercise, loss of excess weight, reduction of alcohol consumption, and stopping cigarette smoking may be enough to control triglyceride levels in the blood. In patients with diabetes mellitus, meticulous control of elevated blood glucose is also important. When medications are necessary, fibrates (such as Lopid), nicotinic acid, and statin medications can be used. Lopid not only decreases triglyceride levels but also increases HDL cholesterol levels and LDL cholesterol particle size. Nicotinic acid lowers triglyceride levels, increases HDL cholesterol levels and the size of LDL cholesterol particles. The statin drugs have been found effective in decreasing triglyceride as well as LDL cholesterol levels and, to a lesser extent, in elevating HDL cholesterol levels. What medications are available to lower cholesterol, lipids, and triglycerides?Lipid altering medications are used in lowering blood levels of undesirable lipids such as LDL cholesterol and triglycerides and increasing blood levels of desirable lipids such as HDL cholesterol. Several classes of medications are available in the United States, including HMG CoA reductase inhibitors (statins), nicotinic acid, fibric acid derivatives, and medications that decrease intestinal cholesterol absorption (bile acid sequestrants and cholesterol absorption inhibitors). Some of these medications are primarily useful in lowering LDL cholesterol, others in lowering triglycerides, and some in elevating HDL cholesterol. Medications also can be combined to more aggressively lower LDL, as well as in lowering LDL and increasing HDL at the same time. Note: Dosing guidelines change. The US Food and Drug Administration (FDA) issued a guideline concerning the potential dangers of taking the 80mg dose of simvastatin (Zocor). Lipid altering medications commonly used in the United States
Historically, niacin has been a one of the medications used to lower cholesterol and decrease the risk of heart attack and stroke. Its usefulness has been called into question by studies conducted in 2011 by the National Institutes of Health. Patients who are taking niacin should not stop using it without discussing treatment options for cholesterol control with their health care provider. Patient CommentsViewers share their comments
Cholesterol - Effective Treatments
Question: What kinds of treatments have been effective for your cholesterol?
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Suggested Reading on Cholesterol by Our Doctors
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Related Diseases & Conditions
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Liver Disease
- Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
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Blood Clots
- Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
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Hypothyroidism
- Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the rate of thyroid hormone production is controlled by the brain at the pituitary. Hypothyroidism is a very common condition and the symptoms of hypothyroidism are often subtle.
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Liver Cancer
- Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
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Diabetes (Type 1 and Type 2)
- Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
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Dementia
- Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
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Angina
- Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle. Angina can be caused by coronary artery disease or spasm of the coronary arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac catheterization are important tests used in the diagnosis of angina.
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Abdominal Aortic Aneurysm
- Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is "hardening of the arteries" called arteriosclerosis.
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Heart Attack
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Erectile Dysfunction (Impotence)
- Impotence, also known as erectile dysfunction, is a common problem among men characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation, or both. Impotence can have emotional causes but most often it is due to a physical problem.
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Rhabdomyolysis
- Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
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Insulin Resistance
- Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
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Cushing's Syndrome
- Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
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Obesity
- Obesity is the state of being well above one's normal weight. A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.
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Heart Disease
- Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
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Metabolic Syndrome
- The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
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Iron Deficiency
- Iron is a mineral our bodies need. Iron deficiency is a condition resulting from not enough iron in the body. It is the most common nutritional deficiency and the leading cause in the US. Iron deficiency is caused due to increased iron deficiency from diseases, nutritional deficiency, or blood loss and the body's inability to intake or absorb iron. Children, teen girls, pregnant women, and babies are at most risk for developing iron deficiency. Symptoms of iron deficiency include feeling weak and tired, decreased work or school performance, slow social development, difficulty maintaining body temperature, decreased immune function, and an inflamed tongue. Blood tests can confirm an iron deficiency in an individual. Treatment depends on the cause of the deficiency. Proper diet that includes recommended daily allowances of iron may prevent some cases of iron deficiency.
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Transient Ischemic Attack (TIA, Mini-Stroke)
- When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
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Renal Artery Stenosis
- Renal artery stenosis is a narrowing of the diameter of the renal arteries. When the renal arteries narrow, the result is restricted blood flow to the kidneys, which may lead to impaired kidney function and high blood pressure (referred to as renovascular hypertension (RVHT). Renal artery stenosis can occur in one or both kidneys. The primary cause of renal artery stenosis is atherosclerosis. Risk factors for renal artery stenosis include high blood pressure, high cholesterol levels, age, cigarette smoking, and diabetes. Symptoms of renal artery stenosis include high blood pressure that does not respond to treatment, severe high blood pressure in individuals younger than 30 or greater than 50 years of age. Renal artery stenosis is diagnosed with imaging and functional tests. Treatment for renal artery stenosis include medication or surgery.
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Binge Eating Disorder
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Heart Attacks in Women
- Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
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Your Cholesterol Profile - In Depth
- Cholesterol is the most common type of steroid in the body. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications. By understanding your cholesterol profile you can better manage your cholesterol levels.
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Childhood Obesity
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Heart Attack Pathology: Photo Essay
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Heart Attack Prevention Overview
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Coats' Disease
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Vitamins & Exercise: Heart Attack Prevention Series
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Disease Prevention in Women
- Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests are commonly available through your general doctor. Some specialized tests may be available elsewhere.
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Disease Prevention in Men
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