Cholesterol plays a major role in a person’s heart health. High blood cholesterol is a major risk factor for coronary heart disease and stroke. That is why it is important for all individuals to know their cholesterol levels. They should also learn about their other risk factors for heart disease and stroke.
UK Albert B. Chandler Hospital - Pavilion GGill Heart & Vascular Institute800 Rose St.
Lexington KY 40536Fax 859-257-8699
People over the age of 20 should have a blood test to determine their cholesterol and triglyceride (another type of blood fat) levels. Young children whose parents have heart disease or who are identified to be at risk for developing heart disease should also be screened, but they must be at least 5 years old to tolerate blood sampling.
If you are a healthy person who has a high cholesterol level, you can reduce the risk of a first-time heart attack by changing your lifestyle and lowering your cholesterol. If you already have heart disease, lowering your cholesterol and making changes in your lifestyle can slow the progress of atherosclerosis and reduce the risk of future heart attacks.
Preparing for the test
Although a physician referral is not needed by our program, your health insurance plan may require it. Please check with your health care plan before your visit.
Please do not eat or drink anything except water for 12 hours (except that you should take your regularly scheduled medications) before your first appointment since we may request that you have a blood test. Depending on the outcome of your evaluation and the desire of your referring physician, you may be seen either only for an initial consultation or for continuing treatment.
What the results mean
In a cholesterol screening, a small sample of blood will be drawn from your arm. Your blood sample is then analyzed by a laboratory. The test will reveal the level of HDL and LDL. HDL is the generally "good" cholesterol that helps keep the LDL, or “bad,” cholesterol from getting lodged into your artery walls. A healthy level of HDL may also protect against heart attack and stroke, while low levels of HDL (less than 40 mg for men and less than 50 mg for women) have been shown to increase the risk of heart disease. These general concepts with HDL hold for most current patient situations. However, we have now learned that not all HDL is good and the future may bring more specific tests.
If you need to increase your HDL to your reach your goals, studies show that regular physical activity and quitting tobacco use can help your body produce more HDL. Reducing trans fats (found in hydrogenated fats), and eating a balanced, nutritious diet is another way to increase HDL. If these measures are not enough to increase your HDL, your doctor may prescribe a medication designed to increase your HDL.
Although LDL has a role to play in the body, too much of it in the blood can clog arteries, increasing your risk of heart attack and stroke.
LDL cholesterol is produced naturally by the body, but many people inherit genes from their mother, father or even grandparents that cause them to make too much. Eating saturated fat, trans fats and dietary cholesterol also increases how much you have. If high blood cholesterol runs in your family, lifestyle modifications may not be enough to help lower your LDL blood cholesterol. Everyone is different, so work with your doctor to find a treatment plan that’s best for you.
Abnormal levels of total cholesterol – HDL cholesterol, LDL cholesterol and triglycerides – are called lipid disorders. One of the most common lipid disorders is hypercholesterolemia, or high cholesterol, which can lead to atherosclerosis.
Atherosclerosis, also known as arteriosclerosis or hardening of the arteries, is a buildup of cholesterol on the inner walls of arteries. This buildup causes the artery to narrow and eventually can lead to heart attacks. Cholesterol is a fatty substance that the body both produces and obtains from certain foods you eat.
The major risk factors for coronary atherosclerosis have been known for some time. These risk factors include:
- Elevated cholesterol
- Cigarette smoking
- Diabetes mellitus
- A sedentary lifestyle
- Family history of coronary or other atherosclerotic disease in parents or siblings before age 55.
The aim of lipid therapy is to decrease the risk of heart disease by lowering harmful cholesterol levels. Our physicians often recommend patients make lifestyle changes, such as quitting tobacco products, eating a diet lower in fat, exercising and losing weight.
If lipid levels do not improve after three months of lifestyle changes, or if a person has coronary heart disease or blood lipid levels that are thought to be genetically determined, physicians may consider adding medical therapy to lifestyle changes.
Some of the medications include:
- Statins, which lower levels of LDL and triglycerides by blocking the liver from manufacturing cholesterol.
- Bile acid sequestrants block intestinal resorption of bile acids, resulting in lower LDL levels.
- Fibrates, which have been shown to lower cholesterol and triglycerides in the blood.
- Niacin or Vitamin B5, which appear to reduce the breakdown of triglycerides in the liver, in turn preventing fat storage and decreasing LDL.
- Omega fatty acids (fish oils) can reduce high triglyceride levels and thereby reduce LDL in association.
There are several classic clinical outcomes studies, especially utilizing statins, but also other therapies, that that have shown a significant targeted LDL reduction. The result has been the demonstration of a decrease in the risk for coronary atherosclerosis. However, statins have the advantage at this point due to their greater effectiveness in reducing LDL as well as their other beneficial effects. Current clinical trials include:
A Phase 2a, Multi-center, Randomized, Double-blind, Placebo-controlled, Single Ascending Dose Study to Investigate the Safety, Tolerability and Pharmacokinetics of a Single Intravenous Infusion of CSL112 in Patients With Stable Atherothrombotic Disease
Reconstituted high-density lipoprotein used in patients with acute coronary syndrome (ACS) may reduce atherosclerotic plaque burden, thereby reducing the risk of recurrent cardiovascular events. This study is a multi-center, randomized, placebo-controlled, single ascending dose study in patients with stable atherothrombotic disease in whom the safety and pharmacokinetic profile of CSL112 will be assessed.
Principal investigator: Alison L. Bailey, MD
A Multicenter, Double-Blind, Randomized Study to Establish Clinical Benefit and Safety of Vytorin (Ezetimibe/Simvastatin Tablet) vs. Simvastatin Monotherapy in High-Risk Subjects Presenting with Acute Coronary Syndrome (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial – IMPROVE-IT)
This is a randomized, active-control, double-blind study of subjects with stabilized high-risk acute coronary syndrome (ACS). The primary objective is to evaluate the clinical benefit of Ezetimibe/Simvastatin Combination 10/40 (single tablet, under the brand VYTORIN in the United States) compared with Simvastatin 40 mg. As per the original protocol, if low-density lipoprotein cholesterol (LDL-C) response was inadequate, the dose of simvastatin in the VYTORIN arm or simvastatin arm, could be increased to 80 mg (Note: per June 2011 protocol amendment, criteria for continued use of 80 mg simvastatin were modified and new increases of simvastatin dose to 80 mg were stopped). Clinical benefit will be defined as the reduction in the risk of the occurrence of the composite endpoint of CV death, major coronary events, and stroke.
Principal investigator: John Gurley, MD
Study coordinators and research nurses cannot give medical advice over the phone. Telephone numbers are provided for obtaining additional information on specific clinical research trials only. If you have specific questions which require clinical expertise, please call your primary care physician. If you do not have a primary care physician, we can help you find a UK doctor or clinic location to meet your health care needs.
Although the studies described on this website may have potential benefits as described, the University of Kentucky and its physicians and affiliated hospitals cannot and do not guarantee or promise that you will receive any benefits from participating in a study.
The information posted on this site is consistent with the research reviewed and approved by the University of Kentucky Institutional Review Board (IRB). However, the IRB has not reviewed all material posted on this site. Contact the IRB if you have questions regarding your rights as a research participant. Also contact the IRB if you have questions, complaint, or concerns which you do not feel you can discuss with the investigator. The UK IRB may be reached by phone at 859-257-9428 or toll free at 1-866-400-9428.