Diagnostics: Cholesterol
Overview
Cholesterol is a lipid, which is a waxy fat-like substance that the body needs to produce bile, some hormones, vitamin D, and cell membranes. However, elevated levels of cholesterol in your blood can accumulate on the walls of your arteries. According to the American Heart Association (AHA), elevated cholesterol levels, also known as hypercholesterolemia, is a major risk factor in the development of cardiovascular disease and stroke, which are 2 of the leading causes of death in the United States. According to the AHA, more than 98 million individuals in the United States have an elevated cholesterol level of 200 mg/dL or higher, and of those individuals, more than 34 million have cholesterol levels higher than 240 mg/dL.

Signs and Symptoms
Many people are unaware that they have elevated cholesterol levels because there are typically no signs or symptoms. It is important to have routine blood work to monitor your cholesterol levels, especially if you are at high risk for heart disease and have a family history of heart disease or other risk factors, such as hypertension, diabetes, and a history of smoking.

Common Causes
  • Sedentary lifestyle
  • Obesity
  • Unhealthy diet
  • Family history
  • Smoking
  • Uncontrolled diabetes
  • Hypertension
Testing and Diagnosis
To determine your cholesterol levels and cardiovascular disease risk, your doctor will order a blood test known as a lipid panel, which provides the values of total cholesterol, lowdensity lipoprotein (LDL) cholesterol (“bad” cholesterol), high-density lipoprotein (HDL) cholesterol (“good” cholesterol), and triglycerides. To get accurate test results, you will be required to fast for at least 12 hours before the blood test. Your doctor will also review your medical and family history to determine your cardiovascular disease risk and may order other tests as well. 

Prevention and Management
The most effective way to maintain healthy cholesterol levels is to maintain a healthy and balanced diet. Other preventive/management measures include:
  • Establishing a routine exercise regimen (at least 30 minutes of exercise several times a week)
  • Avoiding foods with trans fats or that have a high saturated fat content
  • Decreasing or eliminating refined carbohydrate intake
  • Using relaxation and stress-management techniques
  • Maintaining a healthy weight
  • Maintaining a waist circumference less than 35 inches for women and less than 40 inches for men
  • Drinking alcohol in moderation
  • Quitting smoking
  • Adhering to medication regimens if prescribed
  • Getting a sufficient amount of sleep
  • Maintaining routine visits with a doctor
Treatment and Care
Lifestyle modifications, such as beginning to exercise, losing weight if needed, and eating a healthy diet, are key for decreasing elevated cholesterol levels. Sometimes medications are necessary if your cholesterol remains elevated despite lifestyle modifications. The drug class known as statins is one of the most popular types prescribed. Your doctor will decide which medication is best for your individual needs. Your pharmacist can counsel you on the proper use of your prescribed medication and can tell you about its potential adverse effects.

Homeopathic and Alternative Remedies
Several natural products are marketed for the promotion of cardiovascular health. According to the National Institutes of Health, common alternative therapies include:
  • Plant sterols
  • Garlic supplements
  • Omega-3 supplements
  • Green tea
  • Artichoke extract
  • Flaxseed
  • Red clover
Prior to using any of these supplements, it is important to check with your doctor or pharmacist to ascertain their appropriateness and to avoid potential drug interactions or contraindications.

Self-Care
A host of multivitamins are formulated to promote cardiovascular health. Individuals at risk for, or with, cardiovascular disease who seek to use OTC cardiovascular supplements or OTC drugs for treating other conditions must first consult a pharmacist before using any medication or nutritional supplement in order to prevent drug interactions or contraindications. Pharmacists should also be informed of all the medications that you are currently taking.

Resources for Patients
Centers for Disease Control and Prevention
Medline Plus

Resources for Pharmacists
National Heart, Lung, and Blood Institute
Centers for Disease Control and Prevention
National Center for Complementary and Alternative Medicine
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