Too much of a good thing. That’s what you have if you have High cholesterol - one of the major risk factors for Heart disease.

Cholesterol is needed by every cell of your body. But your risk of Heart disease goes up considerably if you have too much of this waxy, fatty substance in your blood. If your cholesterol stays high, it can build up in your arteries and block the flow of blood to your heart, which can lead to a Heart Attack.

High cholesterol causes as many as half of all deaths each year from Heart disease, the nation’s No. 1 killer of both men and women. To control it, you may need to take a cholesterol-lowering drug.

Do you need medication?

Whether you need a cholesterol-lowering drug depends on a number of factors including the levels of cholesterol and other fats in your blood and your risk of Heart disease.

Measuring your cholesterol
Cholesterol and triglycerides - another form of fat, or lipid - are carried through your bloodstream by proteins called apoproteins. The combination of a lipid and an apoprotein is called a lipoprotein. A typical blood-screening test measures the level of two such substances, which increase your Heart disease risk: low-density lipoprotein (LDL), the “bad” cholesterol” and triglycerides. It also measures the level of high-density lipoprotein (HDL), the “good” cholesterol, which protects against Heart disease. In the United States, each measurement is expressed in terms of milligrams per deciliter, or mg/dL.

Your LDL cholesterol level is especially important because LDL forms fatty plaques in the walls of arteries. As plaques form in your blood vessels, they restrict blood flow to your heart, which can cause chest pain (angina) and lead to a Heart Attack. A blood clot also may form on a buildup of plaques and block an artery, causing a Heart Attack.

If you’re age 20 or older, have your cholesterol measured at your doctor’s office at least once every five years.

Evaluating your risk of Heart disease
The following factors increase your risk of Heart disease and help your doctor decide whether to recommend a cholesterol-lowering drug.

• Age. If you’re a woman, it’s either age 55 or older or any age at which you may have experienced premature menopause. If you’re a man, it’s age 45 or older.
• Family history. You’re at increased risk if you have a father, brother or son who developed Heart disease before age 55, or a mother, sister or daughter who developed it before age 65.
• Smoking. This applies not only if you smoke, but also if you live or work every day with people who smoke.
• Low HDL cholesterol. A measurement 40 mg/dL or lower. (A measurement of 65 mg/dL or higher protects against Heart disease.)
• High blood pressure (hypertension). Blood pressure is measured when your heart beats and rests, resulting in two numbers. If your top number (systolic pressure) is 120 to 139, or your bottom number (diastolic pressure) is 80 to 89, you have prehypertension and are at risk of developing full-fledged hypertension. If your systolic or diastolic number is higher than that, you have high blood pressure.
• Diabetes. The sugar in your bloodstream is measured the same way as cholesterol. A fasting blood sugar level of 126 mg/dL or higher is considered diabetes.

Making the decision
To determine whether you need medication, your doctor looks at your cholesterol and other blood fat levels and considers these alongside your Heart disease risk factors. Treatment decisions depend on which risk factors you have. All of these risk factors work together to increase your risk of a Heart Attack.

According to revised guidelines issued July 2004 by the National Cholesterol Education Program, you may need medication if:

• You have an LDL level of 190 mg/dL or higher and none or one of the Heart disease risk factors
• You have an LDL level of 160 mg/dL or higher, two or more risk factors, and less than a 10 percent risk of having a Heart Attack in the next 10 years
• You have an LDL level of 130 mg/dL or higher, two or more risk factors, and a 10 percent to 20 percent risk of having a Heart Attack in the next 10 years

The National Cholesterol Education Program’s revised guidelines recommend especially aggressive treatment for people described as “high risk” and “very high risk.”

You’re considered high risk and may need medication if:

• You have an LDL level of 100 mg/dL or higher, have Heart disease or diabetes, or have two or more risk factors that give you greater than a 20 percent risk of having a Heart Attack in the next 10 years

You’re considered very high risk and may need medication if:

• You have an LDL level of 70 mg/dL or higher, have Heart disease with multiple risk factors (especially diabetes), with poorly controlled risk factors (especially continued smoking) or metabolic syndrome (a cluster of risk factors associated with obesity, including low HDL and high triglycerides), and have greater than a 20 percent risk of having a Heart Attack in the next 10 years

How drugs can help
At first your doctor may recommend lifestyle changes. You can significantly lower your cholesterol by switching from high-fat foods to those low in saturated fat and cholesterol, maintaining a healthy weight, and gradually working up to 30 to 60 minutes a day of vigorous exercise.

Sometimes, however, lifestyle changes aren’t enough. If so, cholesterol-lowering drugs can help. These drugs not only prevent new plaques from forming, but also may help repair damaged blood vessels and reduce the risk of life-threatening blood clots.

If you have elevated LDL-cholesterol, the most effective treatment is with statin drugs. But which lipid-lowering drug your doctor recommends depends on many factors. These include how much good and bad cholesterol you have and whether triglycerides in your blood are high. Your age also may be a factor. No single drug works well for everyone. Nor is it necessary to take the newest drug if your current medication is effective.

A weighty decision
The decision to take any kind of lipid-lowering drug is a serious matter. Your doctor generally starts you out with a single drug. But if that fails to lower your LDL levels, he or she may either increase the dosage or prescribe a combination of drugs. After you achieve the goal set by you and your doctor, you must stay on drug therapy indefinitely to maintain results. Also have your cholesterol checked every four to six months.

You might also need to have your liver checked regularly. All types of cholesterol-lowering drugs - with the possible exception of cholesterol absorption inhibitors - can cause liver function abnormalities. So you may need to have periodic liver function tests. Grapefruit juice interacts with some statins, causing blood levels of the medication to rise, which increases the risk of side effects.

If you have High cholesterol, the bottom line is that even a modest lowering of your cholesterol levels can reduce your risk of Heart disease. If lifestyle changes haven’t helped, talk with your doctor about whether you need cholesterol-lowering medications.

By Mayo Clinic staff